Is the natural history of hepatitis C virus carriers with normal aminotransferase really benign?

Towards more individualised management of hepatitis C virus patients with initially or persistently normal alanineaminotransferase levels

“…In a longitudinal study aimed to assess the histological outcomes in patients with mild chronic hepatitis C and in HCV patients with PNALT, a second liver biopsy was taken after a mean interval of 7.3 years and showed progression of fibrosis from F0 to F1 in 15% of the cases, from F1 to F2 in 8% and from F2 to F3 in 20% and from F2 to F4 (cirrhosis) in 9%, despite ALT levels being confirmed 'normal' at annual testing. Progression of liver fibrosis in HCV patients with PNALT has also been reported by Ryder et al [42] and by Cividini et al [43].…”

The history of the “natural history” of hepatitis C (1968–2009)

“…Metabolic factors with inter‐relationships among steatosis (83, 84), diabetes (85, 86) and obesity (87, 88) have all been reported as affecting disease progression. As noted earlier, normal values of alanine aminotransferase and its associated lesser degree of histological inflammation appear to predict a lower level and rate of fibrosis progression (61, 69). Finally, the rate of progression is increased in the face of co‐infection with HIV (53–57), hepatitis B (89, 90) and schistosomiasis (91, 92), as well as with the comorbidity of haemochromatosis (93).…”

“…There has been some controversy as to whether persons with persistently normal enzymes do have potentially progressive liver disease. Studies of paired biopsies spaced 1.5–5 years apart have reported no fibrosis progression (62–66), while other studies of paired biopsies spaced 2.8–7 years apart have reported fibrosis progression in 17–28% (67–69).…”

Clinical aspects and outcomes of volunteer blood donors testing positive for hepatitis‐C virus infection in Taiwan: a prospective study

“…The outcome is generally benign in two follow‐up studies on this population (13, 14). In spite of this fact, a few cases developed LC at screening or during short‐term follow‐up (1, 2, 15–17). Some showed that histologic evidence of LC could actually be found at screening in about 7% of the seropositive donors (1, 2, 16, 17).…”