Clinical features of hepatitis C–infected patients with persistently normal alanine transaminase levels in the southwestern United States

✍ Scribed by M. Mazen Jamal; Anurag Soni; Patrick G. Quinn; Donald E. Wheeler; Sanjeev Arora; David E. Johnston

• Publisher: John Wiley and Sons
• Year: 1999
• Tongue: English
• Weight: 108 KB
• Volume: 30
• Category: Article
• ISSN: 0270-9139
• DOI: 10.1002/hep.510300526

✦ Synopsis

Approximately one third of patients with chronic hepatitis C virus (HCV) infection have normal alanine transaminase (ALT) levels. We studied the clinical, biochemical, virological, and histological features in patients with persistently normal ALT. A case-control study was conducted on 275 patients with chronic HCV infection, including 75 patients with persistently normal ALT and 200 patients with abnormal ALT. Persistently normal ALT was defined as 4 consecutive ALT values in each patient within a period of 12 months. The average age of the patients was 44 years (range 18 to 69 years). More non-Hispanic whites had persistently normal ALT. The mean serum ferritin level was significantly lower in patients with persistently normal ALT as compared with abnormal ALT (128 ؎ 92 ng/mL and 224 ؎ 128 ng/mL), respectively (P ‫؍‬ .017). The mean HCV-RNA level was significantly lower in patients with persistently normal ALT as compared with abnormal ALT (12 ؋ 10 5 ؎ 2.8 ؋ 10 6 copies/mL and 33 ؋ 10 5 ؎ 8.0 ؋ 10 6 ), respectively (P ‫؍‬ .02). Histologically, patients with persistently normal ALT had less severe portal inflammation (P F .05), lobular inflammation (P ‫؍‬ .003), piecemeal necrosis (P ‫؍‬ .002), fibrosis (P F .05), lower prevalence of cirrhosis (P ‫؍‬ .007), as well as a slower fibrosis progression rate (P F .001). Chronic hepatitis C patients with persistently normal ALT have low-activity grade and stage on liver biopsy. In these patients the hepatitis C RNA level was lower compared with abnormal ALT patients, which may explain the slower fibrosis progression rate.