Chronic hepatitis C with normal or abnormal aminotransferase levels: is it the same entity?

Area of Science:

• Hepatology
• Virology
• Immunology

Background:

• Hepatitis C virus (HCV) infection features with normal alanine aminotransferase (ALT) are not well understood.
• Elevated ALT is a common marker for liver inflammation in HCV patients.

Purpose of the Study:

• To characterize HCV infection in patients with persistently normal ALT (PNALT).
• To compare liver histology and fibrosis progression in HCV patients with and without elevated ALT.

Main Methods:

• Retrospective analysis of 80 HCV-RNA-positive subjects with PNALT (Group 1) and 455 with elevated ALT (Group 2).
• Evaluation of demographic data, liver histology (Knodell score), HCV genotype, and annual fibrosis progression rate.

Main Results:

• Group 1 (PNALT) had a higher proportion of women, less frequent HCV genotype 1, and more frequent genotype 2.
• Significantly lower rates of cirrhosis and more frequent normal liver histology were observed in Group 1.
• Group 1 exhibited a significantly lower Knodell score and a slower annual fibrosis progression rate compared to Group 2.

Conclusions:

• HCV infection with PNALT is associated with less severe liver histology.
• Patients with PNALT demonstrate a reduced rate of liver fibrosis progression.
• The natural history of HCV infection differs between patients with PNALT and those with elevated ALT.