Long-term observation of HCV-positive patients with normal ALT values: persistence of a clinically healthy state

Morisco, Filomena; Blanco, Giovanna Del Vecchio; Tuccillo, Concetta; Galli, Claudio; Cirino, Sílvia Letícia Merceo Bacchi; Caporaso, N.

doi:10.1016/s0923-2516(99)89006-2

Cited by 9 publications

(5 citation statements)

References 16 publications

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“…However, some studies have reported that a significant number have relatively marked liver lesions of chronic hepatitis with cirrhosis in rare cases. [4][5][6][7]9,11,[14][15][16][17][18][19][20][21][22] A recent cross-sectional study has suggested a slow but significant progression of liver fibrosis in this group of patients. 23 Finally, the long-term outcome of serum ALT levels and liver lesions is still unclear, and the management of anti-HCV-positive patients with normal ALT levels remains controversial.…”

mentioning

confidence: 83%

Prospective study on anti-hepatitis C virus-positive patients with persistently normal serum alanine transaminase with or without detectable serum hepatitis C virus RNA

Martinot‐Peignoux

2001

Hepatology

145

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A significant proportion of patients with detectable antibodies to hepatitis C virus have normal serum alanine transaminase levels. Our aim was to study the outcome of this group. Between 1992 and 1999, 135 consecutive anti-HCV-positive patients with persistently normal ALT were followed for 3.6 ؎ 2.3 years (0.5 to 8.5 years), 108 had a liver biopsy at inclusion, and 24 had a second liver biopsy 3.5 ؎ 1.0 years later. Serum HCV RNA was detectable with PCR in 94 patients (69%) and not detectable in 41 patients (31%). Patients with and without detectable serum HCV RNA had similar epidemiological characteristics. Serum ALT levels and anti-HCV ratio were lower (P ‫؍‬ .

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mentioning

confidence: 83%

Prospective study on anti-hepatitis C virus-positive patients with persistently normal serum alanine transaminase with or without detectable serum hepatitis C virus RNA

Martinot‐Peignoux

2001

Hepatology

145

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“…A recent study suggests a greater risk of ALT flares (and rapid progression to fibrosis) in patients infected with genotype 2 compared with genotype 1, 70 although an influence of additional factors cannot be ruled out. For example, a high proportion of female normal ALT patients infected with genotype 2 frequently experience an increase in ALT during middle age, possibly due to hormones, obesity or a number of other cofactors 71 . However, patients may experience long periods of biochemical remission 52, 71 …”

Section: Natural History Of Chronic Hepatitis C In Patients With ‘Normentioning

confidence: 99%

“…For example, a high proportion of female normal ALT patients infected with genotype 2 frequently experience an increase in ALT during middle age, possibly due to hormones, obesity or a number of other cofactors 71 . However, patients may experience long periods of biochemical remission 52, 71 …”

Section: Natural History Of Chronic Hepatitis C In Patients With ‘Normentioning

confidence: 99%

Review article: management of patients with chronic hepatitis C virus infection and ‘normal’ alanine aminotransferase activity

Zeuzem

Alberti

Rosenberg

et al. 2006

Aliment Pharmacol Ther

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“…Brillanti et al 4 reported the presence of ASC, however, the biological nature and prognosis of such patients was not fully elucidated. Although some studies contradicted the presence of ASC, 23,24 the evidence of only minimal or mild hepatitis was recognized in patients with normal ALT value in 2 community-based studies, 5,25 and a follow-up study of single source of infection. 26 There are no reports directly focused on the long-term prognosis of ASC so far.…”

Section: Discussionmentioning

confidence: 99%

Characteristics of hepatitis C viral genome associated with disease progression

et al. 2000

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The clinical presentations of chronic hepatitis C are not uniform. Some patients show persistently high serum alanine transaminase (ALT) values and develop liver cirrhosis and hepatocellular carcinoma (HCC), whereas serum ALT values stay normal in other patients. The mechanism causing this diversity remains to be elucidated. The aim of this study was to identify genomic characteristics of hepatitis C virus (HCV) genotype 1b associated with disease progression. Full length sequences of HCV were determined in 14 patients who showed persistently normal serum ALT values (normal ALT group) and 13 cirrhotics with HCC (HCC group). Residues in which amino acid usage was different between these 2 groups were extracted, and Progression score was defined as the total number of residues with 7 amino acids, more frequently present in the HCC group than in the normal ALT group. In the validation of this Progression score in 9 patients with normal ALT and 25 with HCC, the score was significantly higher in the HCC group (3.1 ؎ 1.1 vs. 2.0 ؎ 0.9, P ‫؍‬ .019). Finally, the correlation between the score and clinical markers related to disease progression was analyzed. In a total of 107 patients with chronic HCV infection, the Progression score was correlated significantly with platelet counts (r ‫؍‬ ؊0.31, P ‫؍‬ .0024) by multivariate analysis. In conclusion, high Progression scores were associated with the presence of HCC and low platelet counts. Sequences of the HCV-1b genome may be related to the progression of chronic hepatitis C. (HEPATOLOGY 2000;31:745-750.) Hepatitis C virus (HCV) is a single-strand RNA virus that consists of approximately 9,500 nucleotides and causes chronic hepatitis. 1,2 Chronic HCV infection can result in liver cirrhosis (LC) and hepatocellular carcinoma (HCC) over the course of 20 to 30 years. 3 Conversely, the existence of healthy HCV carriers showing persistently normal serum alanine transaminase (ALT) values and minimal changes in liver histology has been reported. 4 Because these patients are thought to have better long-term prognosis, 4,5 the ability to discriminate which patients take an indolent course or eventually develop HCC is an important clinical issue. Although a few studies suggest that patients infected with HCV genotype 1b (HCV-1b) show more aggressive clinical courses than those with HCV genotype 2, 6 such attempts have not been made among patients infected with HCV-1b, and it is unknown whether virulent or less-virulent HCV-1b may exist. Our primary objective was to define virological characteristics of HCV-1b and the clinico-pathological status of the patient. For this purpose, we compared the full-length sequence of dominant HCV-1b clones for the discrimination of an aggressive or indolent clinical course. PATIENTS AND METHODS Patients.A total of 107 patients with chronic HCV-1b infection were studied. All patients showed positive serum anti-HCV antibodies (third generation assay) and serum HCV-RNA of genotype-1b. 7,8

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Long-term observation of HCV-positive patients with normal ALT values: persistence of a clinically healthy state

Cited by 9 publications

References 16 publications

Prospective study on anti-hepatitis C virus-positive patients with persistently normal serum alanine transaminase with or without detectable serum hepatitis C virus RNA

Prospective study on anti-hepatitis C virus-positive patients with persistently normal serum alanine transaminase with or without detectable serum hepatitis C virus RNA

Review article: management of patients with chronic hepatitis C virus infection and ‘normal’ alanine aminotransferase activity

Characteristics of hepatitis C viral genome associated with disease progression

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