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Chronic hepatitis C with normal aminotransferase levels: a clinical histologic study

C F Gholson1, K Morgan, G Catinis

  • 1Department of Medicine & Pathology, Louisiana State University School of Medicine, Shreveport, USA.

The American Journal of Gastroenterology
|October 23, 1997
PubMed

Insights

Chronic hepatitis C virus (HCV) infection can present with normal liver enzymes, particularly in women who do not drink alcohol. Some patients with HCV and normal aminotransferase levels show signs of liver inflammation and fibrosis.

Area of Science:

  • Hepatology
  • Virology
  • Immunology

Background:

  • Chronic hepatitis C virus (HCV) infection is typically associated with elevated aminotransferase levels.
  • Defining HCV infection in patients with persistently normal aminotransferase levels (PNAL) is crucial for understanding disease spectrum.

Purpose of the Study:

  • To characterize chronic hepatitis C virus (HCV) infection in patients exhibiting persistently normal aminotransferase levels (PNAL).

Main Methods:

  • Retrospective chart review of 50 HCV-positive patients with PNAL from two academic hepatology clinics.
  • Analysis of epidemiologic profiles, seroscreening, and confirmatory assays.
  • Blinded review of liver histology, including grading of inflammatory activity and fibrosis stage.

Main Results:

  • Among 50 patients with PNAL, 70% were female, 68% had parenteral HCV acquisition, and 88% abstained from ethanol.
  • HCV infection was confirmed in all patients, with detectable HCV-RNA levels.
  • Liver histology revealed chronic hepatitis (70%), cirrhosis (14%), and normal histology (6%).

Conclusions:

  • Active inflammation, fibrosis, and variable HCV-RNA levels can coexist with PNAL in chronic HCV infection, especially in female non-drinkers.
  • Asymptomatic carriers with normal histology represent 6-8% of chronic hepatitis C patients with PNAL.
  • Development of specific management guidelines for this patient group is warranted.
Abstract

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