Background & Aims: Some patients with serum hepati- tis C virus (HCV) have persistently normal aminotrans- ferase (ALT) levels and are affected by cirrhosis. This study prospectively evaluated progression of the dis- ease in a group of anti-HCV–positive patients with persistently normal ALT levels. Methods: Thirty-seven subjects were studied. Each subject underwent liver biopsy at baseline and after 5 years of follow-up. At baseline, serum samples were tested for genotypes and HCV RNA load. ALT levels and serum HCV RNA were tested every other month and every 6 months, respec- tively. Patients with increased ALT were discharged from the study and treated with IFN. Five years after the end of IFN therapy, a liver biopsy was performed. Results: Liver biopsy at baseline showed chronic hepa- titis in 34 patients and normal histology in 3 patients, 2 of whom were negative for HCV RNA and 1 positive. HCV genotypes were distributed as follows: 2a, 56%; 1b, 41%; and 1a, 3%. At the end of 7-year follow-up, 73% of the patients still had normal ALT values. Liver histology after 5 years was comparable to that ob- served at entry to study. Conclusions: Most patients with persistently normal ALT serum levels have very mild chronic hepatitis. However, healthy anti-HCV– positive subjects exist. In patients with HCV-related chronic hepatitis associated with persistently normal ALT levels, the grade of disease activity does not increase over years and progression to cirrhosis is slow or absent.

Natural history of hepatitis C virus carriers with persistently normal aminotransferase levels

SASSO, Ferdinando Carlo;
2000

Abstract

Background & Aims: Some patients with serum hepati- tis C virus (HCV) have persistently normal aminotrans- ferase (ALT) levels and are affected by cirrhosis. This study prospectively evaluated progression of the dis- ease in a group of anti-HCV–positive patients with persistently normal ALT levels. Methods: Thirty-seven subjects were studied. Each subject underwent liver biopsy at baseline and after 5 years of follow-up. At baseline, serum samples were tested for genotypes and HCV RNA load. ALT levels and serum HCV RNA were tested every other month and every 6 months, respec- tively. Patients with increased ALT were discharged from the study and treated with IFN. Five years after the end of IFN therapy, a liver biopsy was performed. Results: Liver biopsy at baseline showed chronic hepa- titis in 34 patients and normal histology in 3 patients, 2 of whom were negative for HCV RNA and 1 positive. HCV genotypes were distributed as follows: 2a, 56%; 1b, 41%; and 1a, 3%. At the end of 7-year follow-up, 73% of the patients still had normal ALT values. Liver histology after 5 years was comparable to that ob- served at entry to study. Conclusions: Most patients with persistently normal ALT serum levels have very mild chronic hepatitis. However, healthy anti-HCV– positive subjects exist. In patients with HCV-related chronic hepatitis associated with persistently normal ALT levels, the grade of disease activity does not increase over years and progression to cirrhosis is slow or absent.
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Utilizza questo identificativo per citare o creare un link a questo documento: https://hdl.handle.net/11591/192602
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