title: Liver fibrosis progression in HIV/hepatitis C virus coinfected patients with normal aminotransferases levels.
abstract: BACKGROUND
  Approximately 30% of hepatitis C virus (HCV) monoinfected patients present persistently normal alanine aminotransferase (ALT) levels. Most of these patients have a slow progression of liver fibrosis. Studies have demonstrated the rate of liver fibrosis progression in hepatitis C virus-human immunodeficiency virus (HCV-HIV) coinfected patients is faster than in patients infected only by HCV. Few studies have evaluated the histological features of chronic hepatitis C in HIV-infected patients with normal ALT levels.
  
  
  METHODS
  HCV-HIV coinfected patients (HCV-RNA and anti-HIV positive) with known time of HCV infection (intravenous drugs users) were selected. Patients with hepatitis B surface antigen (HBsAg) positive or hepatitis C treatment before liver biopsy were excluded. Patients were considered to have a normal ALT levels if they had at least 3 normal determinations in the previous 6 months prior to liver biopsy. All patients were submitted to liver biopsy and METAVIR scale was used.
  
  
  RESULTS
  Of 50 studied patients 40 (80%) were males. All patients were treated with antiretroviral therapy. The ALT levels were normal in 13 (26%) patients. HCV-HIV co-infected patients with normal ALT levels had presented means of the liver fibrosis stages (0.77±0.44 versus 1.86±1.38; p<0.001) periportal inflammatory activity (0.62±0.77 versus 2.24±1.35; p<0.001) and liver fibrosis progression rate (0.058±0.043 fibrosis unit/year versus 0.118±0.102 fibrosis unit/year) significantly lower as compared to those with elevated ALT.
  
  
  CONCLUSIONS
  HCV-HIV coinfected patients with persistently normal ALTs showed slower progression of liver fibrosis. In these patients the development of liver cirrhosis is improbable.
authors.affiliation: Departamento de Gastroenterologia, Centro de Referência em Hepatologia, Universidade Federal de Juiz de Fora, Juiz de Fora, MG, Brasil. fpace@oi.com.br
authors.forename: Fábio Heleno de Lima
authors.initials: FH
authors.lastname: Pace
authors.forename: Lincoln Eduardo Vieira de Castro
authors.initials: LE
authors.lastname: Ferreira
authors.forename: Antonio Eduardo Benedito
authors.initials: AE
authors.lastname: Silva
authors.forename: Maria Lucia Gomes
authors.initials: ML
authors.lastname: Ferraz
mesh_terms: D000328:Adult; D000410:Alanine Transaminase / Q000097:blood*; D001706:Biopsy; D018791:CD4 Lymphocyte Count; D060085:Coinfection / Q000201:enzymology / Q000473:pathology*; D018450:Disease Progression; D005260:Female; D005838:Genotype; D015658:HIV Infections / Q000150:complications / Q000201:enzymology / Q000473:pathology*; D019698:Hepatitis C, Chronic / Q000150:complications / Q000201:enzymology / Q000473:pathology*; D006801:Humans; D008103:Liver Cirrhosis / Q000201:enzymology / Q000473:pathology / Q000821:virology*; D008297:Male; D012016:Reference Values; D019562:Viral Load
chemical_list: D000410:Alanine Transaminase