Hepatitis C virus genotype 4 with normal transaminases: histological changes, schistosomiasis and response to treatment

Abstract

Introduction and aims-Among individuals with chronic HCV infection, approximately 30% of patients show persistently normal alanine aminotransferase (PNALT). Individuals with PNALT have been historically excluded from antiviral treatment. However, some studies have reported sudden worsening of disease in patients with PNALT, suggesting the need to treat individuals with PNALT. To evaluate this further, we compared fibrosis severity and response to treatment in patients with PNALT to patients with abnormal ALT. In addition, we investigated whether liver histology and schistosomiasis affect response to treatment differently in those with PNALT and abnormal ALT.

Hepatitis B, C, and D and HIV Infections among Immigrants from Equatorial Guinea Living in Spain

“…Transaminases were within normal values in many of these subjects; nevertheless, the extent of liver fibrosis may be significant in a substantial proportion of them. 21 Therefore, all African immigrants should be screened for viral hepatitis regardless of their transaminases levels, and liver fibrosis should be assessed in those immigrants with markers of viral hepatitis using either liver biopsy or noninvasive tools. 21,22 The prevalence of chronic HBV in our immigrant population from EG was 7.9% (Table 2).…”

“…21 Therefore, all African immigrants should be screened for viral hepatitis regardless of their transaminases levels, and liver fibrosis should be assessed in those immigrants with markers of viral hepatitis using either liver biopsy or noninvasive tools. 21,22 The prevalence of chronic HBV in our immigrant population from EG was 7.9% (Table 2). This prevalence is in agreement with rates reported by others in sub-Saharan immigrants coming to Spain 3,4,6 and estimates in EG.…”

Schistosomiasis Does Not Affect the Outcome of HCV Infection in Genotype 4-Infected Patients

“…In this regard, a study by Derbala and others 41 suggested a lack of association of ALT levels with schistosomiasis. Consistent with ALT results and similar to our ultrasound findings of comparable liver pathology and cirrhosis proportions among subjects with and without Schistosoma infection (whether viremic or aviremic), Derbala and others 41 also found that chronic HCV patients with or without schistosomiasis had similar fibrosis and response to treatment rates and that schistosomiasis coinfection is not a surrogate of poor response.…”

Factors Affecting the Response to Interferon Alpha Therapy in Egyptian HCV Patients

“…The relation between the presence of schistosoma antibodies and treatment response shows no significant relation as the responded patient represented a percentage of 87.1% from negative schistosoma antibodies patient and 87% from positive patients so schistosomal co-infection did not affect the response. Derbala et al (2011) also concluded that schistosomal co-infection did not enhance liver pathology and did not affect response rate. On the other hand, Abdel-Rahman et al (2013) found that Positive schistosomal serology has no effect on fibrosis staging but is significantly associated with failure of response to HCV treatment despite antischistosomal therapy, as that early virological response EVR, virological response at week 24 and SVR were significantly higher in patients with negative schistosomal serology.…”

“…Although formerly referred to as 'healthy' or 'asymptomatic' HCV carriers and thus historically excluded from antiviral treatment, it has now become clear that they are at risk for developing significant liver disease; up to 20% might progress toward a more severe degree of liver fibrosis. Also Derbala et al (2011) reported that there is no effect of age, gender and serum alanine aminotransferase and aspartate aminotransferase levels on response to therapy in their patients.…”