A prospective, community-based evaluation of liver enzymes in individuals with hepatitis C after drug use

Abstract

Serum alanine transaminase (ALT) levels are used to select hepatitis C virus (HCV)-infected patients for treatment and liver biopsy. However, the natural history of these measurements is poorly understood. To examine the hypothesis that ALT levels vary over time in HCV-infected patients, serial serum ALT levels were prospectively measured in a No test uniformly predicts which individuals will have persistent infection, develop cirrhosis, or respond to therapy, although viral load, HCV genotype, liver histology, and serum transaminases have been studied. [4][5][6][7] Long-term elevation in serum transaminases, especially alanine transaminase (ALT), was once the principal indication of persistent HCV infection, formerly called non-A, non-B hepatitis. However, up to 30% of HCV infections persist without detectable ALT elevation. 8-10 Serum ALT has also been correlated with the degree of histological inflammation in the liver. However, histologically mild disease has been recognized in individuals with elevated ALT values, and histologically advanced disease has been demonstrated in individuals with normal or minimally elevated ALT measurements. 11,12 In addition, ALT normalization 8 to 12 weeks after interferon therapy predicts the ultimate response in some, but not all, individuals. 13,14 These limitations notwithstanding, serum transaminase measurements are inexpensive, safely obtained, and readily available, and continue to be widely used in the management of HCV infection. For example, a recent NIH Consensus Panel recommended that individuals with normal ALT levels not receive interferon therapy for HCV infection. 15 In addition, in a recent survey of 1,249 gastroenterologists and hepatologists, the result of a single ALT determination dramatically affected the frequency with which liver biopsies were performed. 16 Different estimates of the value of liver enzyme testing may derive from limitations of existing studies. Almost all existing studies are based in liver disease clinics, though it is estimated that fewer than 10% of HCV-infected individuals are followed in this setting. In addition to the referral bias of liver disease clinic-based studies, cross-sectional studies cannot evaluate ALT trends, and most prospective studies include few participants. Moreover, many HCV-infected individuals followed in clinical centers have received treatment, making natural history studies impossible. In this investigation, the temporal trends and demographic correlates of liver enzymes were prospectively assessed among a large cohort of almost entirely untreated HCV-infected individuals in the community. PATIENTS AND METHODSPopulation and Study Design. Since 1989, a cohort of former and current injection drug users in the AIDS Linked to the Intravenous Experience (ALIVE) study has been followed semiannually at Johns Hopkins University (Baltimore, MD). 17 Using a historical prospective study design, HCV infection in this group was evaluated at enrollment and at subsequent visits using a second-generation enzyme immunoassa...

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

“…Accordingly, one could imagine that "normal ALT" is a snapshot of a dynamic process that includes abnormal ALT. 22 Factors influencing this particular disease presentation are unclear. Our data indicated that HCV carriers with normal ALT levels were more likely to be female (57%), as previously reported.…”

Progression of liver fibrosis among injection drug users with chronic hepatitis C

“…11,[15][16][17] FibroSURE testing was done on serum specimens stored at Ϫ70°C and not thawed until testing, which was done by Laboratory Corporation of America (Burlington, NC). FibroSURE is based on a patented algorithm that incorporates results of six individual serum biochemicals, including alpha-2 macroglobulin, haptoglobulin, apoplipoprotein A-1, total bilirubin, gamma glutamyl transferase, and ALT.…”

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

“…However, up to a third of patients infected with hepatitis C have normal ALT levels. 7,8 Therefore, ALT level may not always predict histological evidence of chronic hepatitis C. 9 The aim of this study is to evaluate the clinical, biochemical, virological, and histological features of chronic hepatitis C patients with persistently normal ALT and to compare the results in patients with abnormal ALT.…”