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

Alberti, Alfredo

doi:10.1016/j.jhep.2004.12.004

Cited by 46 publications

(37 citation statements)

References 64 publications

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“…In agreement with the most recent guidelines and recommendations for the management of hepatitis C [21] , it could be suggested that in clinical practice young patients infected with 'easy-to-treat' HCV genotypes (HCV-2 or HCV-3), highly motivated and without contraindication may be treated without histological assessment considering the very high rate of SVR that can be achieved with 24 weeks of PEG-IFN plus ribavirin and the excellent safety profile. On the other hand, initiation of antiviral therapy might still be decided mainly on the basis of histological findings by taking a diagnostic liver biopsy in HCV patients with PNALT older than 50 years or infected with 'difficult-to-treat' genotypes, with long-lasting infection or with some relative contraindication.…”

Section: Puotimentioning

confidence: 68%

Hepatitis C Virus with Normal Transaminase Levels

Puoti¹

2007

Dig Dis

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Approximately 30% of patients with chronic HCV infection show persistently normal alanine aminotransferase (PNALT) levels. The majority of these patients have some degree of histological liver damage. Controversies still exist regarding the definition of ‘persistent’ alanine aminotransferase (ALT) normality, and the natural history and optimal management of chronic hepatitis C with normal ALT. Although patients with HCV infection and normal ALT have been historically excluded from antiviral treatment, with the advent of the new treatment with PEG-interferon plus ribavirin, it has been suggested that the issue of whether or not to treat subjects with PNALT should be re-evaluated, and that antiviral treatment should be useful at least in selected subsets of patients.

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Section: Puotimentioning

confidence: 68%

Hepatitis C Virus with Normal Transaminase Levels

Puoti¹

2007

Dig Dis

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“…These results, in agreement with studies of Negro et al [1998Negro et al [ , 1999, suggest that HCV by itself might not be fully responsible for the liver injury. Indeed, HCV can be present at high titer without inducing significant morphological changes as seen in most carriers with normal transaminases [Kronenberger et al, 2004;Alberti, 2005] or in pregnant patients infected with HCV [Gervais et al, 2000], suggesting that the ensuing immune response plays a crucial role in the pathogenesis of the liver disorder. In contrast, Pal et al [2006] found that the amount of liver cells harboring HCV-NS correlated with the degree of liver inflammation and fibrosis in patients with chronic hepatitis C of genotype-1; however 48% of their patients were co-infected with HIV presumably altering their immunological response.…”

Section: Discussionmentioning

confidence: 99%

Quantitation of replication of the HCV genome in human livers with end‐stage cirrhosis by strand‐specific real‐time RT‐PCR assays: Methods and clinical relevance

Lin

Libbrecht

Verbeeck

et al. 2009

Journal of Medical Virology

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HCV replicates in liver via an intermediate negative strand RNA. To study the relevance of HCV genome replication, quantitative strandspecific HCV real-time RT-PCR assays were developed and applied to livers explanted because of end-stage cirrhosis. The assays have broad ranges of determination and a high reproducibility and accuracy. Analysis of five different samples showed an even distribution of HCV genomes in four livers. Hepatic concentrations of positive (PS)-and negative (NS)-strand RNA did correlate with each other, with PS/NS ratios ranging between 3 and 340. Hepatic concentrations of HCV-PS or -NS RNA did not correlate with serum HCV-RNA levels or with genotypes. A high HCV envelope-2 protein expression correlated with a low NS concentration. HCV-PS and -NS levels, E2 protein expression and genotype did not correlate with biochemical tests or with histological changes in the explanted liver, but the ratio NS/PS, a marker of viral replication, correlated with the severity of the recurrent post-transplant hepatitis caused by HCV. This suggests the existence of an extra-hepatic location of HCV with comparable viral replication rate being responsible for the infection of the newly transplanted liver.

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“…Chronic infection develops in 74% to 86% of exposed patients over time, during which patients usually remain asymptomatic. Most patients with chronic HCV infection present with abnormal liver tests, although many may have normal alanine aminotransferase levels and up to 20% of those with normal levels may have significant fibrosis on liver biopsy (20).…”

Section: Diagnosismentioning

confidence: 99%

Hepatitis C

Jou¹,

Muir²

2008

Ann Intern Med

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Chronic hepatitis C virus (HCV) infection is the most common blood-borne infection in the United States, with an estimated overall prevalence of 3.2 million persons (1.3%) and prevalence peaks between age 40 to 49 years (1). The worldwide prevalence of HCV infection is even higher at 2.0%, corresponding to 140 million persons (2).In terms of complications, cirrhosis due to HCV disease is the most frequent indication for liver transplantation in the United States (3), and the overall incidence of hepatocellular carcinoma, a complication of HCV cirrhosis, continues to increase at alarming rates. In an evaluation of population-based registries of the Surveillance, Epidemiology, and End Results (SEER) program in the United States, the overall age-adjusted incidence rates of hepatocellular carcinoma increased from 1.4 per 100 000 in 1975 to 1977 to 3.0 per 100 000 in 1996 to 1998 (4). Prevention What factors increase the risk for hepatitis C virus (HCV) infection?The predominant risk factor for the transmission of HCV is percutaneous exposure to infected blood, which most commonly takes place through remote or chronic injection drug use. Transmission of HCV historically occurred with transfusion of blood products before screening of the blood supply in the United States before 1992. There seems to be no increased risk for HCV transmission through cosmetic procedures, such as tattooing and piercings, unless infection control measures are not followed (5).Transmission of HCV in health care workers after a needle-stick exposure occurs in up to 10% of cases (6). Additionally, the prevalence of HCV infection in hemodialysis patients isThe content of In the Clinic is drawn from the clinical information and education resources of the American College of Physicians (ACP), including PIER (Physicians' Information and Education Resource) and MKSAP (Medical Knowledge and Self-Assessment Program). Annals of Internal Medicine editors develop In the Clinic from these primary sources in collaboration with the ACP's Medical Education and Publishing Division and with the assistance of science writers and physician writers. Editorial consultants from PIER and MKSAP provide expert review of the content. Readers who are interested in these primary resources for more detail can consult http://pier.acponline.org and other resources referenced in each issue of In the Clinic. The information contained herein should never be used as a substitute for clinical judgment. For More Information Centers for Disease Control and Prevention (CDC)Hepatitis C Prevention www.cdc.gov/ncidod/diseases/hepatitis/c/hepcprev.htm Viral Hepatitis C www.cdc.gov/ncidod/diseases/hepatitis/c/index.htm National Institute of Diabetes and Digestive and Kidney Diseases (NIDDK) Chronic Hepatitis C: Current Disease Management digestive.niddk.nih.gov/ddiseases/pubs/chronichepc/index.htm What I Need to Know about Hepatitis C digestive.niddk.nih.gov/ddiseases/pubs/hepc_ez/index.htm (English) digestive.niddk.nih.gov/ spanish/pubs/hepc_ez/index.htm (Spanish)

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

Cited by 46 publications

References 64 publications

Hepatitis C Virus with Normal Transaminase Levels

Hepatitis C Virus with Normal Transaminase Levels

Quantitation of replication of the HCV genome in human livers with end‐stage cirrhosis by strand‐specific real‐time RT‐PCR assays: Methods and clinical relevance

Hepatitis C

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