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Significance of normal liver enzymes in patients with hepatitis C virus
1Department of Medicine, King Abdulaziz University Hospital, Jeddah, Saudi Arabia.
Insights
Persistently normal liver enzymes in Hepatitis C Virus (HCV) positive patients do not indicate good health. Liver biopsy is recommended for these individuals to assess liver histology and potential damage.
Area of Science:
- Hepatology
- Virology
- Immunology
Background:
- Hepatitis C Virus (HCV) infection presents a significant global health challenge, particularly prevalent in the Arab World.
- The prognostic value of normal liver enzymes in anti-HCV positive individuals remains unclear.
Purpose of the Study:
- To evaluate the significance of persistently normal liver enzymes in anti-HCV positive patients.
- To determine the appropriate diagnostic approach for this patient cohort.
Main Methods:
- A cohort of 56 anti-HCV positive patients with normal liver enzymes for over a year underwent liver biopsy.
- Liver histology was assessed using the METAVIR scoring system to determine fibrosis stage (F0-F4).
- Other causes of chronic liver disease were excluded prior to biopsy.
Main Results:
- Out of 52 biopsies, 44 (84.6%) revealed abnormal liver histology.
- Mild histology (F1-F2) was observed in 23 (44.2%) patients, severe histology (F3) in 15 (28.8%), and cirrhosis (F4) in 2 (3.8%).
- Non-specific changes (Al/FO) were noted in 4 (7.7%) patients.
Conclusions:
- Normal liver enzymes in anti-HCV positive patients lack prognostic value.
- Liver biopsy is crucial for assessing liver histology in these patients.
- Over 50% of patients with normal enzymes show mild histology with minimal inflammation, underscoring the need for biopsy.
Background:
Hepatitis C Virus (HCV) infection is a common universal problem especially in the Arab World.
Objective:
To assess the significance of persistently normal liver enzymes in patients who were anti HCV positive and suggest the proper approach for this group of patients.
Method:
56 patients who were anti HCV positive with persistently normal liver enzymes for more than one year underwent liver biopsy to assess their liver histology after excluding other possible causes of chronic liver disease. METAVIR scoring system was used and the degree of fibrosis (F0-F4) was considered as reflection of severity.
Results:
Out of 56 patients, only 52 patients had liver biopsies; 44 (84.6%) patients had abnormal liver histology and eight (15.4%) patients had normal liver biopsy. Out of the 44 patients with abnormal liver biopsy, 23 (44.2%) patients had mild histology (F1-F2); 15 (28.8%) patients had severe histology (F3); two (3.8%) patients had cirrhosis (F4); four (7.7%) patients had non-specific changes (Al/FO).
Conclusion:
Normal liver enzymes in patients who were anti HCV positive does not carry prognostic implication and patients should have a liver biopsy to assess their liver histology, though the chance of having mild histology with minimal inflammation is more than 50%.
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