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

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

doi:10.1002/hep.510300526

Cited by 119 publications

(84 citation statements)

References 34 publications

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“…ALT is a cytosolic enzyme also present in the liver and increased serum levels are more specific for liver injury than AST, because a greater proportion is found in the liver compared to the heart and skeletal muscles 26 . Although histological findings on liver biopsy are fundamental to the detection of liver disease as well as their intensity, hepatic enzymes changes are also used as a biochemical marker for HCV infection and its utility on predicting liver damage is described on several studies 1,[5][6][7]16,27,37 . For example, there is evidence that patients with HCV and normal values of ALT have milder hepatic injury than those with elevated ALT values 5,7,16,27 .…”

Section: Discussionmentioning

confidence: 99%

“…Although histological findings on liver biopsy are fundamental to the detection of liver disease as well as their intensity, hepatic enzymes changes are also used as a biochemical marker for HCV infection and its utility on predicting liver damage is described on several studies 1,[5][6][7]16,27,37 . For example, there is evidence that patients with HCV and normal values of ALT have milder hepatic injury than those with elevated ALT values 5,7,16,27 . Some authors also correlated serum ALT and AST levels with histologic activity score, parameters of disease severity 27,37 and extent of fibrosis 1 .…”

Section: Discussionmentioning

confidence: 99%

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Influence of human t-cell lymphotropic virus type 1 (HTLV-1) Infection on laboratory parameters of patients with chronic hepatitis C virus

Cardoso¹,

Souza

Fonseca³

et al. 2009

Rev. Inst. Med. trop. S. Paulo

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SUMMARYHepatitis C virus (HCV) and human T-cell lymphotropic virus type 1 (HTLV-1) share routes of transmission and some individuals have dual infection. Although some studies point to a worse prognosis of hepatitis C virus in patients co-infected with HTLV-1, the interaction between these two infections is poorly understood. This study evaluated the influence of HTLV-1 infection on laboratory parameters in chronic HCV patients. Twelve HTLV-1/HCV-coinfected patients were compared to 23 patients infected only with HCV, in regard to demographic data, risk factors for viral acquisition, HCV genotype, presence of cirrhosis, T CD4 + and CD8 + cell counts and liver function tests. There was no difference in regard to age, gender, alcohol consumption, smoking habits, HCV genotype or presence of cirrhosis between the groups. Intravenous drug use was the most common risk factor among individuals co-infected with HTLV-1. These patients showed higher TCD8 + counts (p = 0.0159) and significantly lower median values of AST and ALT (p = 0.0437 and 0.0159, respectively). In conclusion, we have shown that HCV/HTLV-1 co-infected patients differs in laboratorial parameters involving both liver and immunological patterns. The meaning of these interactions in the natural history of these infections is a matter that deserves further studies.

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Influence of human t-cell lymphotropic virus type 1 (HTLV-1) Infection on laboratory parameters of patients with chronic hepatitis C virus

Cardoso¹,

Souza

Fonseca³

et al. 2009

Rev. Inst. Med. trop. S. Paulo

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“…6 7 Whether a specific mechanism of liver damage induced by HCV is responsible for this unusual disease profile is unclear. Viral factors such as viral load, 4 6 8 HCV genotype, [5][6][7][8] or quasispecies variability 8 9 do not seem to be associated with ALT levels. Alternatively, the host immune response directed to HCV infected cells may be involved in the pathogenesis of HCV infection with normal ALT.…”

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confidence: 99%

Histological features and HLA class II alleles in hepatitis C virus chronically infected patients with persistently normal alanine aminotransferase levels

Renou¹

2002

Gut

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Objective: A significant proportion of individuals with chronic hepatitis C virus (HCV) infection have persistently normal alanine aminotransferase (ALT) levels. Although data are controversial, such patients usually have weaker histological damage and a lower progression rate of fibrosis. The aims of this study were: (1) to compare demographic, virological, and histological parameters of HCV patients with normal ALT values with those of HCV patients with elevated ALT levels; and (2) to determine whether HLA class II alleles contribute to the persistence of normal ALT levels in HCV patients. Patients and methods: Eighty three patients with chronic HCV infection and persistently normal ALT values (group 1) and 233 patients with chronic HCV infection and elevated ALT levels (group 2) were studied. Histological features were expressed using Knodell and Metavir scores. HLA DRB1* and DQB1* genotyping was performed using hybridisation with sequence specific oligonucleotides after genomic amplification. The χ2 and Fisher's exact tests were used to compare discrete variables and phenotype frequencies between the two groups, and Wilcoxon's test was used for continuous variables. A multivariate logistic regression model was used to determine which variables predicted normal ALT values. Results: ALT levels were correlated with the severity of liver damage. In group 1, 93% of patients had an F0 or F1 Metavir index of fibrosis compared with 47% of patients in group 2 (p<0.001). A longer duration of infection (p<0.001) and increased DRB1*11 phenotype frequency (pc=0.03) were observed among patients with normal ALT. The two groups did not differ with regard to the mode of contamination or viral genotype. After logistic regression, young age (p=0.0008), female sex (p=0.01), long duration of infection (p=0.0001), and HLA DRB1*11 (p=0.050) were more strongly associated with persistence of normal ALT. Conclusions: Our study confirms that patients with chronic hepatitis C and normal ALT levels have less severe liver disease than those with elevated ALT levels. This particular biochemical outcome may be explained, at least in part, by host immunogenetic factors such as the presence of HLA-DRB1*11.

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“…Although majority of data seem to show that HCV carriers with PNALT have mild and stable disease with a favorable prognosis. Most published studies agree on the conclusion that around two thirds of HCV patients with PNALT have no or minimal activity and / or fibrosis in their liver biopsy 5,6,14,19 . On the other hand significant fibrosis (> F2) has been reported in 5 -30% of the cases, with large variation among studies, when inclusion criteria and length of base line follow up was different.…”

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confidence: 86%

Liver Biopsy in Patients Infected With Chronic Hepatitis C and Persistently Normal Serum Alt Levels

2008

j liaquat uni med health sci

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RESULTS: A total of 55 patients were recruited from outpatient clinic with normal ALT during a follow up of six months. Mean age of these patients was 36.7± 9.78 years; out of these 39 (70.9%) were male. All these patients were diagnosed to have hepatitis C by HCV RNA PCR method. There were 24 (43.6%) patients with stage (fibrosis) equal or greater than 2 and 33 (60%) had biopsy grade equal or greater than 2. Eighteen (32.7%) patients had steatosis on liver biopsy. Twelve patients with stage > 2 had steatosis while 6 patients with stage < 2 had steatosis (p< 0.01). CONCLUSION: There was no correlation found between the transaminase level and biopsy scores. Approximately 44 % of the patients have fibrosis equal to or greater than stage 2. The extent of steatosis is directly related to the biopsy score of the patients. INTRODUCTIONApproximately 30-40% of the patients with chronic hepatitis "C" have persistently normal alanine aminotransferase (ALT) levels 1 . Antiviral treatment for patients with CHC infection has generally been limited to those with significantly abnormal serum ALT activity (2). Previously patients with normal ALT which consists mostly of female population and have lesser degree of inflammation and fibrosis used to be excluded from clinical trials (3, 4, 5, and 6). In past normal ALT levels even have been used as a surrogate marker for treatment response (7). It is true that if ALT levels are persistently normal, the possibility of significant and progressive liver disease tends to be low, but a significant proportion of patients with persistently normal ALT levels show some histological signs of fibrosis, the degree of which is usually mild but sometimes more marked and in rare cases, cirrhosis may be present (2). In fact in some series up to 14 to 20% of patients with normal ALT have advanced cirrhosis and advanced fibrosis on liver biopsy. It is a recognized fact that all of them do not have mild liver disease and slower disease progression 1,3,8 . Around 90% of HCV carriers with persistently normal ALT (PNALT) have normal to mild inflammation and fibrosis on liver histology. Long term follow-up studies suggest that 30% of such carriers became candidates for antiviral therapy within 5 years 9 . Persistently normal ALT in most studies is defined as "at least three normal ALT levels over a six month period". The degree of liver injury in patients with PNALT may not differ from the matched controls with elevated ALT 10. The efficacy and safety of pegylated interferon alfa-2a and ribavirin combination therapy in patients with chronic hepatitis C and PNALT are similar to that in patients with elevated ALT. The indication for treatment of hepatitis C can be evaluated independently from baseline ALT activity 11 . In many studies it is shown that normal ALT levels do not preclude the abnormal liver histology so we decided to perform this study to evaluate correlation between PNALT levels in patients with CHC and histological features of liver at our tertiary care center of Hyderabad, Pakistan. Liver ...

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

Cited by 119 publications

References 34 publications

Influence of human t-cell lymphotropic virus type 1 (HTLV-1) Infection on laboratory parameters of patients with chronic hepatitis C virus

Influence of human t-cell lymphotropic virus type 1 (HTLV-1) Infection on laboratory parameters of patients with chronic hepatitis C virus

Histological features and HLA class II alleles in hepatitis C virus chronically infected patients with persistently normal alanine aminotransferase levels

Liver Biopsy in Patients Infected With Chronic Hepatitis C and Persistently Normal Serum Alt Levels

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