title: Hepatitis C genotype 4 with normal transaminases: correlation with fibrosis and response to treatment, a cohort Egyptian study of 4277 patients.
abstract: OBJECTIVE
  Chronic hepatitis C virus (HCV) patients with persistently normal transaminases represent a subgroup of patients with mild, slowly progressive disease, natural history, and optimal management of these patients needs to be investigated in Egypt. Our aim is to assess the severity of hepatic fibrosis and response to therapy in a cohort of Egyptian HCV patients with normal transaminases.
  
  
  METHODS
  Retrospective demographics, laboratory, histological features and treatment outcome of patients included in the national program for the control of viral hepatitis in Egypt since 2007 were collected. Combined pegylated IFN/ribavirin therapy was given for patients with fibrosis stage ≥ F1 and elevated transaminases while those with normal transaminase; therapy was initiated only in patients with fibrosis stage ≥ F2.
  
  
  RESULTS
  Normal ALT and AST were detected in 1308/4277 (30.6%) and 1662/4277 (38.9%) patients, respectively, while both enzymes were normal in 943 patients (22%). Multivariate regression analysis showed that lower AFP and higher platelets count (compared with elevated transaminases group) were significantly correlated with normal transaminases (P<0.01), however, HCV-RNA levels did not show such significance. The number of patients with HAI score ≥ A1 was significantly lower in normal than elevated transaminases (36.5% vs 40.9%, respectively, P<0.01) and patients with fibrosis ≥ F2 was significantly lower in normal than elevated transaminases (36.4%) and (43%), respectively (P<0.01). There was no significant correlation between baseline transaminases levels and response to treatment.
  
  
  CONCLUSIONS
  Normal transaminases are frequently encountered in chronic HCV Egyptian patients (22%). They show low AFP level, mild degree of activity and stage of fibrosis with no correlation with response to therapy.
authors.affiliation: Endemic Medicine and Hepatology Department, Faculty of Medicine, Cairo University, Cairo, Egypt.
authors.forename: Mahasen
authors.initials: M
authors.lastname: Abdel-Rahman
authors.forename: Yasmin
authors.initials: Y
authors.lastname: Saad
authors.forename: Maissa
authors.initials: M
authors.lastname: El-Raziky
authors.forename: Naglaa
authors.initials: N
authors.lastname: Zayed
authors.forename: Wafaa
authors.initials: W
authors.lastname: El-Akel
authors.forename: Mohamed
authors.initials: M
authors.lastname: Said
authors.forename: Mohamed
authors.initials: M
authors.lastname: El-Beshlawy
authors.forename: Gamal
authors.initials: G
authors.lastname: Esmat
mesh_terms: D000328:Adult; D000410:Alanine Transaminase / Q000097:blood*; D000998:Antiviral Agents / Q000627:therapeutic use; D001219:Aspartate Aminotransferases / Q000097:blood*; D015331:Cohort Studies; D003430:Cross-Sectional Studies; D004534:Egypt; D005260:Female; D005838:Genotype; D006526:Hepatitis C / Q000235:genetics; D019698:Hepatitis C, Chronic / Q000097:blood / Q000188:drug therapy*; D006801:Humans; D000077190:Interferon alpha-2; D016898:Interferon-alpha / Q000627:therapeutic use; D008103:Liver Cirrhosis / Q000145:classification* / Q000188:drug therapy*; D008297:Male; D015999:Multivariate Analysis; D010976:Platelet Count; D011092:Polyethylene Glycols / Q000627:therapeutic use; D012367:RNA, Viral / Q000032:analysis; D011994:Recombinant Proteins / Q000627:therapeutic use; D012189:Retrospective Studies; D012254:Ribavirin / Q000627:therapeutic use; D012720:Severity of Illness Index; D012737:Sex Factors; D019562:Viral Load; D000509:alpha-Fetoproteins / Q000032:analysis
chemical_list: D000998:Antiviral Agents; D000077190:Interferon alpha-2; D016898:Interferon-alpha; D012367:RNA, Viral; D011994:Recombinant Proteins; D000509:alpha-Fetoproteins; D011092:Polyethylene Glycols; D012254:Ribavirin; D001219:Aspartate Aminotransferases; D000410:Alanine Transaminase; C417083:peginterferon alfa-2b; C100416:peginterferon alfa-2a