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

Renou, Christophe

doi:10.1136/gut.51.4.585

Cited by 60 publications

(58 citation statements)

References 40 publications

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“…The host immune response might play an important role in such different outcomes. Many studies assessed an association between HLA Class II and severity of liver injury or favourable outcomes of chronic HCV infection [37][38][39][40]. On the other hand, studies about Class I association with HCV disease patterns is relatively poor.…”

Section: Discussionmentioning

confidence: 99%

Association of Human Leucocyte Antigen Class I (HLA-A and HLA-B) With Chronic Hepatitis C Virus Infection in Egyptian Patients

Mosaad

Farag

Arafa

et al. 2010

Scandinavian Journal of Immunology

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Egypt has the highest prevalence of hepatitis C virus (HCV) in the world, ranging from 6% to 28% with an average of approximately 13.8% in the general population. It has been reported that human leucocyte antigen (HLA) alleles are associated with the outcome of HCV infection, but this associations showed ethnic and geographical differences. The objective of this study is to investigate the association between the frequencies of HLA Class I and chronic HCV infection in Egyptian patients and to find out whether there is a relation between certain HLA Class I antigens and HCV viral load, degree of fibrosis, activity and alanine aminotransferase (ALT) level. A case control study was conducted on 100 patients with chronic HCV infection and 150 healthy controls. HLA‐A and HLA‐B typing by complement‐dependent micro‐lympho‐cytotoxicity assay was performed for both groups. HLA‐A11 antigen was significantly increased in patients with chronic HCV infection versus controls (OR 3.98; 95% CI = 1.85–8.89; P = 0.001; and Pc = 0.021). HLA‐B12, HLA‐B13, HLA‐B17 and HLA‐B40 were higher in patients, and HLA‐A32 and HLA‐B14 were higher in controls, although the significance was lost after correction for multiple testing. HLA‐A9 was significantly associated with low viral load (P = 0.008, Pc = 0.048). The results of this work implicate that HLA‐A11 antigen may influence chronic HCV infection and may play a role in viral persistence. Different HLA Class I antigens are not associated with degree of liver fibrosis, grades of activity or level of ALT. However, HLA‐A9 is associated with low HCV viral load in chronic HCV Egyptian patients.

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Section: Discussionmentioning

confidence: 99%

Association of Human Leucocyte Antigen Class I (HLA-A and HLA-B) With Chronic Hepatitis C Virus Infection in Egyptian Patients

Mosaad

Farag

Arafa

et al. 2010

Scandinavian Journal of Immunology

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“…On the ot her hand, nu me ro us stu di es con duc ted showed that its ac cu racy was higly va ri ab le. 3,4,[7][8][9][10][11][12][13][14][15][16][17][18] In our study, the only sig ni fi cant cor re la ti on was found bet we en se rum AST le vels and HAI in he pa ti tis C. On the ot her hand, in he pa ti tis B, serum AST le vels sho wed cor re la ti on both with fibro sis and HAI. Furt her mo re, a po si ti ve cor re la ti on was al so se en bet we en se rum ALT le vels and HAI in he pa ti tis B ca ses.…”

Section: Discussionmentioning

confidence: 62%

“…A sta tis ti cally sig ni fi - cant cor re la ti on was fo und bet we en bi oc he mi cal tests and his to lo gi cal fin dings in so me of the se studi es, tho ugh not in ot hers. [7][8][9][10][11][12][13][14][15][16][17][18] ALT is con si de red as a li ver-spe ci fic enz yme and nor mally fo und lar gely only in the li ver. Eleva ti ons in se rum ALT le vels are as so ci a ted with rever sib le or ir re ver sib le da ma ge to the he pa tocy te plas ma mem bra ne.…”

Section: Discussionmentioning

confidence: 99%

The Correlation of Serum Transaminase Values with Fibrosis Staging and Necroinflammatory Activity Scores in Chronic Hepatitis

Özkara¹,

Tosun²,

Sari³

et al. 2011

Turkiye Klinikleri J Med Sci

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A AB BS S T TR RA AC CT T O Ob bj je ec ct ti iv ve e: : The aim of this study is to compare the necroinflammatory activity score / histological activity index (HAI) and fibrosis score detected in liver biopsies with serum transaminase levels of chronic hepatitis B, C and steatohepatitis. M Ma at te er ri ia al l a an nd d M Me et th ho od ds s: : This retrospective study included total of 398 cases whose liver biopsies were performed because increased liver enzyme levels and had the diagnoses of chronic hepatitis B, hepatitis C or steatohepatitis ofter liver biopsy between [2003][2004][2005][2006][2007]. The HAI and fibrosis scores of all cases were evaluated according to ISHAK classification criteria and then the results were compared with the serum alanine aminotransferase (ALT) and aspartate aminotransferase (AST) levels at the time of biopsy. R Re es su ul lt ts s: : When all cases were considered, serum AST values emerged as the most statistically significant variable for hepatic fibrosis (r:0.311; p<0.01). Additionally, there was a correlation between AST values and HAI (r:0.295; p<0.01). On the other hand, serum ALT values did not correlate with (r:0.094; p>0.05) the extent of hepatic fibrosis but correlated weakly with HAI (r:0.242; p<0.01). C Co on nc cl lu us si io on n: : Serum AST level is found to be a significant indicator of histological activity index and fibrosis as well as hepatic damage. These findings suggested that, among other factors, serum AST values should be considered in decisions regarding the need for liver biopsy and treatment in patients with chronic hepatitis.K Ke ey y W Wo or rd ds s: : Aspartate aminotransferases; hepatitis, chronic; fibrosis Ö ÖZ ZE ET T A Am ma aç ç: : Bu çalışmanın amacı kronik hepatit B, hepatit C ve steatohepatitteki serum transaminaz düzeyleri ile karaciğer biyopsisinde tespit edilen nekroinflamatuvar aktivite derecesi / histolojik aktivite indeksi (HAİ) ve fibrozis skorunu karşılaştırmaktır. G Ge er re eç ç v ve e Y Yö ön nt te em ml le er r: : Bu retrospektif çalışmaya 2003-2007 yılları arasında kronik hepatit B, hepatit C veya yüksek karaciğer enzim seviyeleri nedeniyle karaciğer biyopsisi yapılıp steatohepatit tanısı alan toplam 398 olgu dahil edildi. Tüm olguların HAİ ve fibrozis skorları ISHAK sınıflama kriterlerine göre değerlendirildi ve ardından sonuçlar biyopsi anındaki serum alanin aminotransferaz (ALT) ve aspartat aminotransferaz (AST) düzeyleri ile karşılaştırıldı. B Bu ul lg gu ul la ar r: : Tüm olgular göz önüne alındığında, serum AST değerleri hepatik fibrozis için en anlamlı değişken olarak ortaya çıktı (r: 0.311; p <0.01). Ayrıca, AST değerleri ve HAI arasında da bir ilişki vardı (r: 0.295; p <0.01). Diğer taraftan, serum ALT değerleri ile hepatik fibrozisin derecesi arasında korelasyon olmamakla birlikte (r: 0.094; p> 0.05) HAI ile zayıf korelasyon saptandı (r: 0.242; p <0.01). S So on nu uç ç: : Serum AST düzeyinin histolojik aktivite indeksi, fibrozis ve aynı zamanda karaciğer hasarının önemli bir göstergesi olduğu saptamıştır. Bu bul...

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“…In our series, severity of fibrosis has significant correlation with severity of inflammation, level of AST and presence of steatosis. Above factors have already been validated in literature 4,5,11,18 . We also found that age, weight, sex, AST/ALT ratio and genotype has no impact on fibrosis, where increasing age (> 35 years) and AST / ALT ratio > 1 has correlation with severity of fibrosis (21).…”

Section: Discussionmentioning

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 ...

show abstract

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

Cited by 60 publications

References 40 publications

Association of Human Leucocyte Antigen Class I (HLA-A and HLA-B) With Chronic Hepatitis C Virus Infection in Egyptian Patients

Association of Human Leucocyte Antigen Class I (HLA-A and HLA-B) With Chronic Hepatitis C Virus Infection in Egyptian Patients

The Correlation of Serum Transaminase Values with Fibrosis Staging and Necroinflammatory Activity Scores in Chronic Hepatitis

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

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