Persistently normal alanine aminotransferase levels in HIV/HCV-coinfected patients: the role of steatosis.
OBJECTIVE
The frequency and significance of, and liver biopsy findings associated with, a persistently normal alanine aminotransferase (ALT) level in HIV/hepatitis C virus (HCV)-coinfected patients are poorly characterized. We analysed factors associated with persistently normal ALT levels, defined as at least three consecutive normal ALT values over a 6-month period, in a group of 381 HIV/HCV-coinfected patients.


METHODS
Patients were categorized into two groups according to ALT values: group 1, patients with persistently normal ALT levels; and group 2, patients with elevated ALT values. Possible interactions with host factors, HIV and HCV viral factors, antiretroviral treatment and histological features were examined.


RESULTS
Thirty-six patients (9.4%) had persistently normal ALT levels. None of the 36 patients had cirrhosis. Seven patients (19.4%) had a METAVIR fibrosis score of F3. In multivariate analysis, a lower mean METAVIR inflammation score [odds ratio (OR) 0.50, 95% confidence interval (CI) 0.28-0.89; P=0.017], the absence of steatosis (OR 0.43, 95% CI 0.20-0.90; P=0.026) and HCV genotype 4 infection (OR 2.81, 95% CI 1.15-6.68; P=0.023) were associated with persistently normal ALT levels.


CONCLUSIONS
The slower progression of chronic hepatitis in patients with persistently normal ALT levels could be related, in part, to a lower frequency of steatosis.
Bani-Sadr
F
F
Groupe Hospitalier Universitaire Est, INSERM U 707, Université Pierre et Marie Curie, Paris, France.
Barange
K
K
Daoud
F
F
Jacomet
C
C
Bicart-See
A
A
Rosenthal
E
E
Cacoub
P
P
Pol
S
S
Perronne
C
C
Carrat
F
F
D000328:Adult; D000410:Alanine Transaminase / Q000097:blood*; D001706:Biopsy; D018791:CD4 Lymphocyte Count; D018450:Disease Progression; D005234:Fatty Liver / Q000150:complications / Q000201:enzymology* / Q000473:pathology; D005260:Female; D005355:Fibrosis; D005838:Genotype; D015658:HIV Infections / Q000150:complications / Q000201:enzymology*; D016174:Hepacivirus / Q000235:genetics; D006526:Hepatitis C / Q000150:complications / Q000201:enzymology* / Q000473:pathology; D006801:Humans; D008099:Liver / Q000473:pathology; D008297:Male; D008875:Middle Aged; D015999:Multivariate Analysis; D012016:Reference Values; D012720:Severity of Illness Index; D019562:Viral Load; D055815:Young Adult
D000410:Alanine Transaminase