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Chronic hepatitis C in patients with persistently normal alanine transaminase levels

Mitchell L Shiffman1, Moisés Diago, Albert Tran

  • 1Virginia Commonwealth University Medical Center, Richmond, Virginia 23298, USA, and Hospital General de Valencia, Spain. mshiffma@vcu.edu

Clinical Gastroenterology and Hepatology : the Official Clinical Practice Journal of the American Gastroenterological Association
|April 25, 2006
PubMed

Insights

Patients with chronic hepatitis C (HCV) and normal alanine transaminase (ALT) levels still show liver disease and should be evaluated similarly to those with elevated ALT. Treatment decisions for HCV should consider multiple factors beyond just ALT levels.

Area of Science:

  • Hepatology
  • Virology
  • Clinical Trials

Background:

  • Many chronic hepatitis C virus (HCV) patients exhibit persistently normal serum alanine transaminase (ALT) levels.
  • The clinical significance and characteristics of these patients are not fully understood.

Purpose of the Study:

  • To compare the characteristics of chronic hepatitis C patients with normal ALT levels versus those with elevated ALT levels.
  • To assess the liver disease progression and histological findings in patients with normal ALT.

Main Methods:

  • Analysis of data from 480 chronic hepatitis C patients with normal ALT and 1993 patients with elevated ALT from 3 randomized phase III trials.
  • Comparison of demographic, virologic, and histologic features.
  • Monitoring of 68 untreated normal ALT patients for 72 weeks.

Main Results:

  • Patients with normal ALT were more likely to be women (59% vs 32%) and had lower HCV RNA titers.
  • Despite normal ALT, significant inflammation and fibrosis were observed, with nearly two-thirds having portal fibrosis and 10% bridging fibrosis.
  • In untreated normal ALT patients, 53% developed elevated ALT during follow-up, but none cleared HCV RNA.

Conclusions:

  • Chronic hepatitis C patients with normal ALT levels are at risk for significant liver disease and require similar evaluation as those with elevated ALT.
  • Treatment decisions for peginterferon alfa and ribavirin should incorporate multiple factors beyond ALT levels.
Abstract

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