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

Area of Science:

• Hepatology
• Virology
• Immunology

Background:

• Some Hepatitis C Virus (HCV) patients exhibit normal aminotransferase (ALT) levels despite cirrhosis.
• This study focuses on the disease progression in anti-HCV-positive individuals with persistently normal ALT.

Purpose of the Study:

• To prospectively evaluate the disease progression in anti-HCV-positive patients with persistently normal ALT levels.
• To assess changes in liver histology and viral load over time.

Main Methods:

• 37 anti-HCV-positive subjects with normal ALT underwent liver biopsy at baseline and after 5 years.
• Serum samples were analyzed for HCV genotypes and RNA load.
• ALT and HCV RNA levels were monitored regularly; patients with elevated ALT received Interferon (IFN) therapy.

Main Results:

• Baseline liver biopsies revealed chronic hepatitis in 34 patients and normal histology in 3.
• HCV genotypes included 2a (56%), 1b (41%), and 1a (3%).
• After 7 years, 73% maintained normal ALT, and liver histology remained comparable to baseline, indicating slow or absent disease progression.

Conclusions:

• Persistently normal ALT levels in most anti-HCV-positive patients indicate very mild chronic hepatitis.
• A subset of healthy anti-HCV-positive subjects exists.
• HCV-related chronic hepatitis with normal ALT shows minimal disease activity increase and slow progression to cirrhosis.