A follow-up study to determine the value of liver biopsy and need for antiviral therapy for hepatitis C virus carriers with persistently normal serum aminotransferase

Okanoue, Takeshi; Makiyama, Akiko; Nakayama, Mika; Sumida, Yoshio; Mitsuyoshi, Hironori; Nakajima, Tomoki; Yasui, Kohichiroh; Minami, Masahito; Itoh, Yoshito

doi:10.1016/j.jhep.2005.04.008

Cited by 70 publications

(76 citation statements)

References 42 publications

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“…In the present study, the normal range of ALT was defined as <40 IU/ L. No subjects showed an ALT level with a range between 30 and 40 IU/L during pregnancy; therefore, the data described above would not have changed if the normal range of ALT was defined as ! 30 IU/L, as has been reported elsewhere (15).…”

Section: Resultssupporting

confidence: 85%

Clinical Features and Hepatitis B Virus (HBV) Genotypes in Pregnant Women Chronically Infected with HBV

et al. 2012

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Objective The purpose of this study was to clarify the clinical features and hepatitis B virus (HBV) genotypes in pregnant women chronically infected with HBV. Methods Among 1,489 pregnant women who visited our hospital in 2010, 26 were positive for hepatitis B surface antigens (HBsAg). Of these subjects, 21 from whom informed consent was obtained were included in this study. The clinical features and HBV markers, including genotypes, were investigated. Results No adverse events were observed in the subjects or the neonates during pregnancy or the perinatal period. The HBV genotypes were C in 14 cases, D in six cases, and undetermined in one case. Hepatitis B e antigens and a high viral load (>7.0 log copies/mL) were found in four and six subjects with genotype C, respectively, and in none of subjects with genotype D. The alanine aminotransferase (ALT) levels and platelet counts were within the normal ranges during pregnancy in all subjects except two and three subjects with genotype C, respectively. Three subjects with genotype C showed transient elevations of ALT after delivery. Conclusion The majority of subjects were anti-HBe-positive with normal ALT levels; however, some subjects with genotype C showed a high viral load, elevated ALT levels and/or low platelet counts. The pregnancies and deliveries were safe; however, transient elevations of ALT after delivery were observed in some subjects with genotype C.

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Section: Resultssupporting

confidence: 85%

Clinical Features and Hepatitis B Virus (HBV) Genotypes in Pregnant Women Chronically Infected with HBV

et al. 2012

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“…This technique is associated with a small but finite morbidity and mortality, mainly due to infection and the risk of internal bleeding (1). Serial biopsy is often difficult to justify, even though such measurements may be useful to track disease progression and/or response to treatment as current serum based markers correlate poorly with hepatic fibrosis (2). There are ongoing intensive research efforts into non-invasive assessment of fibrosis, including novel serum markers (3), and assessment of structural and physical markers of fibrosis by various techniques including MRS (4) and ultrasound-based elastography (5).…”

Section: Introductionmentioning

confidence: 99%

Influence of perfusion on hepatic MR diffusion measurement

Hollingsworth

Lomas

2006

NMR in Biomedicine

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Percutaneous liver biopsy is the current gold standard for the diagnosis and assessment of hepatic fibrosis: it is an uncomfortable procedure with associated risks of infection and internal bleeding. Diffusion-weighted MRI may be important as a non-invasive measure of the grade of hepatic fibrosis, owing to the morphological and physiological changes in hepatic tissues as fibrosis develops. The factors that influence hepatic diffusion measurements are complex and are thought to include hepatic perfusion. This study assesses whether hepatic diffusion measurements are influenced by hepatic perfusion changes as this could be an important variable when investigating the relationship between diffusion measurements and grade of hepatic fibrosis. Hepatic apparent diffusion coefficients (ADCs) were measured in 10 healthy volunteers after an 8-h fast and 1-h after a standard meal (which increases portal vein flow and hepatic sinusoidal perfusion) using a breath-hold technique at b-values of 750, 500 and 200 s/mm(2). ADC measurements using b = 750 and 500 s/mm(2) in the posterior right lobe were unaffected by the perfusion changes (P = 0.15 and 0.14, respectively) whereas the results from the anterior right lobe significantly increased post-prandially (P = 0.03 and 0.008, respectively): inter-subject variability was low ( approximately 5%) for these b-values. Portal perfusion had a significant effect in both the posterior and anterior segments of the right lobe when using a b-value of 200 s/mm(2) (P = 0.01 and 0.00001 respectively): inter-subject variability was found to be high ( approximately 25%). The most reproducible measurements of the ADC can be made in the posterior right lobe and the effect of perfusion is minimised at the higher b-values (b = 500 and 750 s/mm(2)).

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“…Similarly steatosis was labeled absent if no fat accumulation and present if fat accumulation seen whatever was the severity. All the patients who had PNALT but sonological evidence of cirrhosis, platelets count less than 150x10 9 /L and prothrombin time more than 3 seconds higher than the control were excluded. Aspartate aminotransferase (AST) was also checked in all patients.…”

Section: Methodsmentioning

confidence: 99%

“…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".…”

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confidence: 99%

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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A follow-up study to determine the value of liver biopsy and need for antiviral therapy for hepatitis C virus carriers with persistently normal serum aminotransferase

Cited by 70 publications

References 42 publications

Clinical Features and Hepatitis B Virus (HBV) Genotypes in Pregnant Women Chronically Infected with HBV

Clinical Features and Hepatitis B Virus (HBV) Genotypes in Pregnant Women Chronically Infected with HBV

Influence of perfusion on hepatic MR diffusion measurement

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

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