Should patients with chronic hepatitis c who have normal alt levels be treated?

Abstract

Up to 25% of patients with chronic hepatitis C have persistently normal serum alanine aminotransferase (ALT) levels. Reports from some studies indicate that patients with normal ALT levels are more likely to be female and nondrinkers. Patients with persistently normal aminotransferase levels often have mild disease on liver biopsy with little or no fibrosis, but a small number of patients may have substantial fibrosis or cirrhosis. Treatment with interferon monotherapy has been disappointing. Combination therapy with interferon and ribavirin is controversial, but early clinical results have shown good response rates. Currently, therapy for chronic HCV patients with normal ALT levels should be based upon results from liver biopsy and preferably be done in the context of a clinical trial.

The clinical significance of persistently normal ALT in chronic hepatitis B infection

“…We know that in hepatitis C infection, there are up to 25% of patients with persistently normal transaminase levels who have been found to have significant fibrosis [15]. In prior small preliminary studies, there have also been reports of histological injury in patients with normal ALT similar to the findings in this study [16,17].…”

Review article: management of patients with chronic hepatitis C virus infection and ‘normal’ alanine aminotransferase activity

“…Although considerable debate continues on the merits of treating HCV in patients with normal ALT, 5, 113–118 perceptions and practice are changing as new data become available. Arguments for treatment include the eradication of a transmissible virus, interruption of disease progression, efficacy of new treatments at an early stage, reduction of symptoms, improved quality of life and patient motivation for treatment.…”

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

“…It is suggested that the HCV infected patients with persistent normal ALT levels shows less activated cellular immune response favoring the histological profile progression. 23 Calabrese and colleagues demonstrated that patients with normal ALT presented with the progressive nature of hepatic inflammation and loss of hepatocytes by apoptosis. 24 Similarly, patients with persistently normal serum ALT may present with progressive hepatic fibrosis, cirrhosis, extra-hepatic manifestations and hepatocellular carcinoma.…”