Slow progression rate of fibrosis in hepatitis C virus patients with persistently normal alanine transaminase activity

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

“…Differences in HCV genotype have been reported, for example a lower frequency of genotype 1 and a higher frequency of genotype 2 in patients with normal ALT 11, 34, 37, 52, 58, 61 . However, there are no consistent findings as other studies found no difference between genotype frequency, 33, 39, 40 suggesting that epidemiological differences exert an important influence.…”

“…Generally, comparisons between normal ALT or elevated ALT have not identified clear differences that could be used as predictive factors of ALT level 6, 52–55 . Women are more likely to present with normal ALT, 11, 13, 56–59 but there are no significant differences in the source of HCV infection and no consistent differences in viral titre 33, 38–40, 60, 61 . Differences in HCV genotype have been reported, for example a lower frequency of genotype 1 and a higher frequency of genotype 2 in patients with normal ALT 11, 34, 37, 52, 58, 61 .…”

Glycyrrhizin has a high likelihood to be a victim of drug–drug interactions mediated by hepatic organic anion‐transporting polypeptide 1B1/1B3

“…Long-term glycyrrhizin therapy was reported to suppress alanine aminotransferase (ALT) and to prevent progression towards liver cirrhosis and hepatocellular carcinoma in patients with chronic hepatitis (Arase et al, 1997;Zhang et al, 2000;van Rossum et al, 2001a;Orlent et al, 2006;Ikeda, 2007). Persistent normalization of ALT in patients with chronic hepatitis appears to be a key prognostic factor for a reduction in long-term complications, regardless of the presence of viral markers in the serum (Kasahara et al, 1998;Mathurin et al, 1998). In China, a series of clinical studies have established a major role for glycyrrhizin in anti-inflammation and hepatoprotection in patients with liver diseases, including chronic viral hepatitis, drug-induced liver injury, alcoholic and non-alcoholic steatohepatitis, autoimmune and biliary diseases, liver cirrhosis,and hepatocellular carcinoma (Expert Committee for Prevention and Management of Liver Inflammation, Chinese Society of Infectious Diseases, 2014; Expert Committee on Clinical Application of Glycyrrhizin Preparation in the Treatment of Liver Diseases, 2016).…”

Risk of alanine aminotransferase flare‐up among asymptomatic hepatitis C virus RNA carriers: A 10‐year follow‐up study

“…In the present study, we investigated the flare‐up of ALT levels in the so‐called ‘asymptomatic’ HCV carriers, and determined the demographic, clinical and virologic features of HCV‐RNA‐positive subjects with normal or elevated serum ALT levels. Several studies have examined the differences between patients with normal ALT levels and those with elevated ALT levels 2,5,6,11–14 . However, only one study described the use of a long‐term follow‐up protocol or evaluated the risk ratio of flare‐up rate among HCV‐RNA carriers, similar to the present study 15…”

“…Since the discovery of hepatitis C virus (HCV), the availability and widespread use of serologic HCV screening tests led to the identification of many individuals with normal serum alanine aminotransferase (ALT) levels who were positive for HCV‐RNA 1 . There is a growing body of evidence to show that many of these subjects have histological liver injury in spite of normal liver biochemistry 1–9 . However, the natural history of these carriers is still not very clear.…”