826 Antiviral Treatment of HCV Carriers With Normal Alt

Puoti, Claudio; Pellicelli, A.; Romano, Marcello; Guarisco, Riccardo; Mecenate, F.; Barbarini, Giorgio; Mazzoni, Ettore; Barlattani, A.; Picardi, Antonio; Paffetti, Amerigo; Nosotti, L.; Bonaventura, M.E.; Villani, R.; Bellis, Lia; Nicodemo, Sabino; Spilabotti, L.; Soccorsi, F

doi:10.1016/s0168-8278(08)60828-4

Cited by 5 publications

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“…It is known that HCV carriers with persistently normal ALT levels overall show demographic and virological features (prevalence of women and non‐1 HCV genotypes, younger age, often lean, mild liver damage or even absence of fibrosis) traditionally associated with higher response rates to combined treatment with PEG‐IFN plus RBV [2,22–24], and thus, they might achieve SVR even with shorter than usually recommended treatment periods [25]. Despite several studies have evaluated the ability of RVR to predict SVR in HCV patients with elevated ALT levels [15–18], no data exist on this topic in subjects with PNALT.…”

Section: Discussionmentioning

confidence: 99%

Rapid virological response as a predictor of sustained response in HCV-infected patients with persistently normal alanine aminotransferase levels: A multicenter study

Puoti¹,

Barbarini

Picardi

et al. 2011

Journal of Viral Hepatitis

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Rapid virological response (RVR) is now considered the strongest predictor of sustained virological response (SVR) in patients with HCV undergoing antiviral treatment, and thus, shorter antiviral treatment for these patients has been suggested. However, no data exist on the predictive value of RVR in HCV carriers with normal ALT values. A total of 137 patients with persistently normal ALT treated with peginterferon alfa 2a and ribavirin were studied. Fifteen patients dropped out early because of side effects, and in 10 patients with HCV-1 treatment was discontinued because of lack of early virological response (EVR). RVR was observed in 68% of the patients (42% patients with HCV-1, 90% HCV-2 and 64% HCV-3). An end-of-treatment response was observed in 86% of the patients (68% HCV-1, 100% HCV-2 and 91% HCV-3). SVR was maintained in 91 patients (46% HCV-1, 97% HCV-2 and 82% HCV-3). Overall, 92% patients with rapid response did obtain HCV eradication vs only 38% of those without rapid response. HCV-1 patients with baseline HCV RNA <400×10(3) IU/mL were more likely to achieve RVR and SVR than those with higher HCV RNA levels. We conclude that patients with genotype 1 and normal ALT who achieve HCV RNA negativity at week 4 may have a higher probability of eradicating their infection. Because of the concomitant favourable demographic and virological features often found in this particular subset of patients, the duration of therapy in these people might be shortened in the case of RVR. Persistently normal alanine aminotransferase levels patients with genotype 2 or 3 have a high chance of achieving SVR, so retesting of HCV RNA during treatment may have no additional practical value in these subjects.

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Section: Discussionmentioning

confidence: 99%

Rapid virological response as a predictor of sustained response in HCV-infected patients with persistently normal alanine aminotransferase levels: A multicenter study

Puoti¹,

Barbarini

Picardi

et al. 2011

Journal of Viral Hepatitis

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“…In conclusion, the combination of PEG‐IFN α‐2a and RBV produces SVR rates in patients with normal ALT activity comparable or even higher than those obtained in patients with elevated ALT levels, suggesting that the treatment algorithm for patients with elevated ALT activity can be extended to patients with persistently normal ALT activity (37–39). Thus, we suggest that in selected cases, immediate therapy might be preferred to a ‘wait and see’ policy (40).…”

Section: Discussionmentioning

confidence: 99%

Treatment of hepatitis C virus carriers with persistently normal alanine aminotransferase levels with peginterferon α‐2a and ribavirin: a multicentric study

Puoti¹,

Pellicelli

Romano

et al. 2009

Liver International

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“…Despite early supposition that HCV carriers with PNALT should be considered as healthy people with invariably normal liver, it is now widely accepted that ‘ normal ALT’ does not always mean ‘ healthy liver’ [4]. It has been clearly shown that the majority of these carriers have some degree of liver damage on biopsy [6–10,29–31].…”

Section: Why Should We Treat Hcv Carriers With Normal Alt?mentioning

confidence: 99%

Should we treat HCV carriers with normal ALT levels? The ‘5Ws’ dilemma

Puoti

Guarisco

Spilabotti

et al. 2011

Journal of Viral Hepatitis

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Approximately 30% of patients with chronic HCV infection have persistently normal ALT levels. Although formerly referred to as 'healthy' or 'asymptomatic' HCV carriers, and thus historically excluded from antiviral treatment, it has now become clear that the majority of these patients have some degree of histological liver damage that may be significant in up to 20% of cases and might progress towards a more severe degree of liver fibrosis. A significant proportion of patients experience periods of increased serum ALT associated with enhanced disease progression. However, controversies still exist in clinical practice regarding the definition of 'persistent' ALT normality, the virological and histological features of these subjects, the need for liver biopsy, the role of noninvasive tools for the assessment of liver fibrosis, the natural history and the usefulness of antiviral treatment. The advent of new therapeutic options (pegylated interferon plus ribavirin) has shifted treatment targets towards the eradication of underlying infection, with therapy decision based on age, severity of disease and likelihood of response rather than on aminotransferase levels. This review is aimed at approaching the main unresolved issues on this topic, trying to give evidence-based answers to the more frequently asked questions from patients and their physicians.

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826 Antiviral Treatment of HCV Carriers With Normal Alt

Cited by 5 publications

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Rapid virological response as a predictor of sustained response in HCV-infected patients with persistently normal alanine aminotransferase levels: A multicenter study

Rapid virological response as a predictor of sustained response in HCV-infected patients with persistently normal alanine aminotransferase levels: A multicenter study

Treatment of hepatitis C virus carriers with persistently normal alanine aminotransferase levels with peginterferon α‐2a and ribavirin: a multicentric study

Should we treat HCV carriers with normal ALT levels? The ‘5Ws’ dilemma

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