title: Long-term follow-up of hepatitis C virus-positive patients with persistently normal serum transaminases.
abstract: METHODS
  This study prospectively evaluated the progression of liver disease in a group of anti-HCV-positive patients with persistently normal ALT levels (PNALT) who were HCV-RNA positive. Patients selected for this study were those who presented with PNALT according to the Italian Association for the Study of the Liver (AISF) criteria in the year 1995/96 and underwent liver biopsy. They were divided into two groups according to their ALT evolution. Forty-five patients were included in this study.
  
  
  RESULTS
  After a median follow-up time of 180 months twenty-five of them maintained PNALT, but two of these developed liver cirrhosis (LC) in a mean time of 174 and 202 months, respectively. Twenty patients had flares of ALT and three of them developed LC in a mean time of 162-178 months. Twelve of these patients underwent current antiviral treatment; six patients were SVR. At baseline, the 5 patients who progressed to LC had age and BMI significantly higher than patients without LC (P < 0.005 and P < 0.01, respectively). Grading (P < 0.006) and staging (P < 0.003) were also more severe at histology, while serum HDL-C levels were statistically lower (P < 0.002). Comparing patients with flares of transaminases with and without LC, we found a significant difference at baseline for age, BMI, HDL-C, grading and staging (P < 0.05; P < 0.01 and P < 0.003, respectively).
  
  
  CONCLUSIONS
  In HCV-RNA positive patients associated with PNALT the grade of disease activity increased over the years in only half of patients and a higher degree of liver fibrosis at baseline was the major relevant factor for progression.
authors.affiliation: Cattedra di Medicina Interna ed Epatologia, Department of Internal Medicine and Specialties, University of Palermo, Palermo, Italy.
authors.forename: Emanuele
authors.initials: E
authors.lastname: La Spada
authors.forename: Maurizio
authors.initials: M
authors.lastname: Soresi
authors.forename: Lydia
authors.initials: L
authors.lastname: Giannitrapani
authors.forename: Monica
authors.initials: M
authors.lastname: La Spada
authors.forename: Elisa
authors.initials: E
authors.lastname: Campagna
authors.forename: Antonino
authors.initials: A
authors.lastname: Terranova
authors.forename: Fabio
authors.initials: F
authors.lastname: Cartabellotta
authors.forename: Giuseppe
authors.initials: G
authors.lastname: Montalto
mesh_terms: D000328:Adult; D000410:Alanine Transaminase / Q000097:blood*; D000998:Antiviral Agents / Q000627:therapeutic use; D062005:Biopsy, Large-Core Needle; D015992:Body Mass Index; D018450:Disease Progression; D054459:Elasticity Imaging Techniques; D005260:Female; D018937:Hepatitis C Antibodies / Q000097:blood; D019698:Hepatitis C, Chronic / Q000097:blood* / Q000188:drug therapy / Q000473:pathology; D006801:Humans; D008099:Liver / Q000000981:diagnostic imaging / Q000201:enzymology / Q000473:pathology; D008103:Liver Cirrhosis / Q000097:blood* / Q000000981:diagnostic imaging / Q000473:pathology; D008137:Longitudinal Studies; D008297:Male; D008875:Middle Aged; D016016:Proportional Hazards Models; D011446:Prospective Studies; D012367:RNA, Viral / Q000097:blood; D018615:Ultrasonography, Doppler, Color
chemical_list: D000998:Antiviral Agents; D018937:Hepatitis C Antibodies; D012367:RNA, Viral; D000410:Alanine Transaminase