Slow progression rate of fibrosis in hepatitis C virus patients with persistently normal alanine transaminase activity

Abstract

In hepatitis C virus (HCV) patients with persistently normal alanine transaminase (ALT), the progression rate of fibrosis is unknown. The aims of this study were: 1) to compare HCV patients with normal ALT (group I) with HCV patients with elevated ALT (group II) matched on independent factors associated with fibrosis; and 2) to assess the progression rate of fibrosis. One hundred two HCV patients were included in each group. Histological lesions were staged using the METAVIR score. We defined fibrosis progression per year as the ratio of the fibrosis stage in METAVIR units to the duration of infection. In group I, ALT values were normal, and lower than in group II (25 vs. 127 IU/L; P < .0001). HCV RNA was present less frequently in group I (66% vs. 97%; P < .0001). There were no significant differences for viremia and genotypes. Histological activities were lower in group I (0.6 vs. 1.38; P < .0001). The stage of fibrosis was lower in group I (0.95 vs. 1.8; P < .001). The median progression rate of fibrosis was lower in group I (0.05 vs. 0.13; P < .001). In group I, after exclusion of negative HCV‐RNA patients, the median progression rate of positives remained lower (0.05 vs. 0.13; P < .001). In group I, all cirrhotic patients (n = 3) were heavy drinkers. HCV patients with normal ALT showed weaker histological activity and lower fibrosis scores, and the progression rate of fibrosis was twice as slow as in HCV patients with elevated ALT. In these patients, severe fibrosis was associated with high alcohol consumption.

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

“…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 .…”

“…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 .…”

There is no difference in hepatic fibrosis rates of patients infected with hepatitis C virus and those co-infected with HIV

“…It is recognized that an AST/ALT ratio above 1 suggests a diagnosis of cirrhosis in patients with chronic HCV infection (35), and some investigators (11,33) have observed a relationship between aminotransferase levels and fibrosis grade. In the present study, patients with more advanced fibrosis presented high AST and ALT levels, but only AST level proved to be correlated with FPR.…”

“…Some factors identified in individual studies are associated with a greater progression of liver fibrosis: length of infection, age at the time of infection, male gender, abuse of alcohol (3,7), co-infection with hepatitis B virus (8) and with human immunodeficiency virus (HIV) (9), and the presence of elevated alanine aminotransferase (ALT) (10,11). The natural history of liver fibrosis progression in patients with HCV/HIV co-infection has been studied during the last decade.…”

Viral Kinetics During Antiviral Therapy in Patients With Chronic Hepatitis C and Persistently Normal Alt Levels

“…[1][2][3][4] Patients with persistently normal ALT levels generally have mild degrees of liver inflammation and fibrosis and exhibit a lower disease progression rate compared with patients with elevated ALT levels. 5 Nevertheless, some patients with persistently normal ALT levels have marked fibrosis, and in rare cases these patients may develop cirrhosis. 6 The current standard therapy for patients with chronic hepatitis C and elevated ALT levels is the combination of pegylated interferon ␣ (PEG IFN-␣) with ribavirin.…”