Hepatitis C virus with normal transaminase levels

Approximately 30% of patients with chronic HCV infection show persistently normal alanine aminotransferase (PNALT) levels. The majority of these patients have some degree of histological liver damage. Controversies still exist regarding the definition of 'persistent' alanine aminotransferase (ALT) normality, and the natural history and optimal management of chronic hepatitis C with normal ALT. Although patients with HCV infection and normal ALT have been historically excluded from antiviral treatment, with the advent of the new treatment with PEG-interferon plus ribavirin, it has been suggested that the issue of whether or not to treat subjects with PNALT should be re-evaluated, and that antiviral treatment should be useful at least in selected subsets of patients.