title: Prediction of a favorable clinical course in hepatitis C virus carriers with persistently normal serum alanine aminotransferase levels: A long-term follow-up study.
abstract: OBJECTIVE
  This study examined serum alanine aminotransferase (ALT) levels at first visit and their relationship with long-term normal serum ALT levels in hepatitis C virus (HCV) carriers with persistently normal ALT (PNALT).
  
  
  METHODS
  HCV carriers with PNALT were identified as those patients with positivity of serum HCV RNA, ALT levels of 30 IU/L or less over a 12-month period on at least three different occasions, platelet count of more than 15 × 10(4)  μl/mL and body mass index of 30 kg/m(2) or less. Outcome was retrospectively studied in 49 HCV carriers with PNALT, who were followed up for more than 10 years.
  
  
  RESULTS
  During the mean follow-up period of 14.7 ± 2.5 years, ALT levels of 30 IU/L or less were preserved in only eight patients (8/49; 16.3%). Among the 17 patients with initial ALT levels of 19 IU/L or less, nine patients remained with ALT levels of 30 IU/L or less after 10 years (9/17; 52.9%). The probability of ALT levels in PNALT being maintained at 30 IU/L or less was significantly higher (P = 0.001) in these patients than in those with initial ALT levels of 20 IU/L or more (n = 32). Abnormal ALT levels were more common in female PNALT patients aged 45-55 years, which is usually the time of menopause onset.
  
  
  CONCLUSIONS
  Because antiviral therapy in the treatment of chronic hepatitis C is rapidly advancing, waiting for more effective and safer treatments may be an option. The results of this study provide an important insight into this issue.
authors.affiliation: Molecular Gastroenterology and Hepatology, Kyoto Prefectural University of Medicine, Graduate School of Medical Science, Kyoto.
authors.forename: Takeshi
authors.initials: T
authors.lastname: Nishimura
authors.forename: Kanji
authors.initials: K
authors.lastname: Yamaguchi
authors.forename: Hideki
authors.initials: H
authors.lastname: Fujii
authors.forename: Yorihisa
authors.initials: Y
authors.lastname: Okada
authors.forename: Chihiro
authors.initials: C
authors.lastname: Yokomizo
authors.forename: Toshihisa
authors.initials: T
authors.lastname: Niimi
authors.forename: Yoshio
authors.initials: Y
authors.lastname: Sumida
authors.forename: Kohichiroh
authors.initials: K
authors.lastname: Yasui
authors.forename: Hironori
authors.initials: H
authors.lastname: Mitsuyoshi
authors.forename: Masahito
authors.initials: M
authors.lastname: Minami
authors.forename: Atsushi
authors.initials: A
authors.lastname: Umemura
authors.forename: Toshihide
authors.initials: T
authors.lastname: Shima
authors.forename: Takeshi
authors.initials: T
authors.lastname: Okanoue
authors.forename: Yoshito
authors.initials: Y
authors.lastname: Itoh