Histological and virological features and follow-up of hepatitis C virus carriers with normal aminotransferase levels: the Italian prospective study of the asymptomatic C carriers (ISACC)

Puoti, Claudio; Castellacci, Roberto; Montagnese, Fabrizio; Zaltron, S.; Stornaiuolo, Gianfranca; Bergami, Nicoletta; Bellis, Lia; Precone, Davide F; Corvisieri, Paolo; Puoti, Massimo; Minola, E.; Gaeta, Giovanni Battista

doi:10.1016/s0168-8278(02)00101-0

Cited by 117 publications

(118 citation statements)

References 37 publications

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“…It is true that patients coinfected with HIV/HCV with normal ALT might suffer from more progressive fibrosis and more severe liver damage than carriers who are HIVnegative 2 ; however, several studies have shown that the majority of HCV carriers with normal ALT have some degree of histological liver damage despite persistent biochemical normality, 3 and that fewer than 20% of these people show normal liver (the true "healthy" HCV carriers). 4 Although liver disease is usually minimal/mild and fibrosis is generally absent or minimal, the association of normal ALT with cirrhosis or with hepatocellular carcinoma has been reported, 5,6 even in the absence of HIV positivity.…”

Section: Liver Biopsy In Hepatitis C Virus Carriers With Normal Alanimentioning

confidence: 99%

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et al. 2009

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surface antigen (HBsAg) but also in patients with "resolved" HBV infection. 5,6 In a retrospective analysis of lymphoma patients who were HBsAg-negative and anti-HBV core antigen (anti-HBc) positive, 5 of the 21 patients who received chemotherapy plus rituximab, an anti-CD20 antibody, developed hepatitis; all of them were attributed to HBV reactivation. The actual incidence of HBV reactivation may be even higher. Prospective studies to clarify the actual incidence and risk factors of HBV reactivation after immunotherapy in this patient population are necessary to define the optimal preventive strategy.

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Section: Liver Biopsy In Hepatitis C Virus Carriers With Normal Alanimentioning

confidence: 99%

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et al. 2009

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“…3 Indeed, several studies have shown that many subjects called HCV carriers with PNALT on the basis of a 6-month observation period did suffer from ALT flares during the follow-up, showing histological worsening and fibrosis progression after these flares. 4,5 In light of these data, the Italian Association for the Study of the Liver 6 suggested that the definition of HCV carriers with PNALT should be made on the basis of at least nine normal ALT values 2 months apart over an 18-month period. We have to be very cautious before we define these persons as subjects with PNALT, given the risks of sudden exacerbation of the disease and a less benign natural history in many of these apparently healthy carriers.…”

Section: Diagnosis Management and Treatment Of Hepatitis Cmentioning

confidence: 99%

Diagnosis, management, and treatment of hepatitis C

Puoti¹,

Guarisco²,

Bellis³

et al. 2009

Hepatology

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“…28 So, male gender, advanced age, severe fibrotic stage and ALT flare are the factors responsible for disease progression. Careful evaluation of such patient is mandatory to assess the disease progression and need for antiviral therapy.…”

Section: Discussionmentioning

confidence: 99%

Clinical and histological spectrum of hepatitis C disease associated with persistently normal alanine aminotransferase levels

et al. 2017

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Background: Around 20% of patients with chronic hepatitis C infection (HCV) have persistently normal alanine aminotransferase (PNALT) levels. These patients are considered to have mild degree of histological hepatic damage. This study was conducted to compare the histological degree of necro-inflammation and stage of fibrosis among HCV patients with PNALT and patients with persistently or intermittently elevated serum ALT (PIEALT) levels..Methods: This study includes 154 untreated patients with serological and histological diagnosis of chronic HCV infection. A total of 70 patients with PNALT (group A) and 84 patients with PIEALT (group B) were identified and treated with 6 months interferon therapy. Histological grade of necro-inflammatory activity and the stage of fibrosis was evaluated by Ishak scoring system. HCV-RNA quantification was done by real-time polymerase chain reaction (PCR). Further univariate and multivariate analysis was done to evaluate correlation between patients characteristics and significant hepatic fibrosis..Results: Out of one hundred and fifty four patients, mean ALT was 30.59 ± 5.59 U/L in group A as compare to 68.65 ± 23.17 U/L in group B (p = 0.001). Patients with PNALT were younger (p = 0.005) with milder grade of necrosis (p = 0.037), lower serum HCV viral load (p = 0.044) and significant achievement of sustained virological response (p = 0.012) as compare to patients with abnormal ALT. Different variable were also analysed by univariate and mutivaraite analysis among patients with significant and insignificant fibrosis. High serum HCV-RNA level was found to be the independent variable predictive of advanced fibrosis among HCV infected patients (OR = 0.89; 95% CI = 1.65-1.94; p < 0.001) with r2 = 80%.Conclusions: Our study suggests that normal serum ALT does not mean healthy liver. So, histological evaluation is still an essential tool to assess liver damage precisely.

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Histological and virological features and follow-up of hepatitis C virus carriers with normal aminotransferase levels: the Italian prospective study of the asymptomatic C carriers (ISACC)

Cited by 117 publications

References 37 publications

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Diagnosis, management, and treatment of hepatitis C

Clinical and histological spectrum of hepatitis C disease associated with persistently normal alanine aminotransferase levels

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