Virological characterization and liver histology in HCV positive subjects with normal and elevated ALT levels

Abstract

LNER ISSN 0106-9543Virological characterization and liver histology in HCV positive subjects with elevated ALT levels normal and Rossini A, Ravaggi A, Agostinelli E, Bercich L, Gazzola GB, Radaeli E, Callea F, Cariani E. Virological characterization and liver histology in HCV positive subjects with normal and elevated ALT levels.Abstract: We analyzed HCV genotype and RNA titer in 36 chronically infected subjects, 20 with persistently normal or near-normal alanine aminotransferase (ALT) activity and 16 with raised ALT activity. All subjects underwent liver biopsy and evaluation of the histological activity index (HAI) by both Knodell's and Ishak's scoring systems. Genotype 2 was detected in most subjects with normal ALT activity, whereas genotype 1 was more frequent among subjects with raised ALT activity. HCV-RNA titer was higher in subjects with increased ALT. Histological evidence of chronic hepatitis was documented in all cases, but higher scores for grading and for staging were associated with increased ALT activity. HCV genotype had no statistical relationship with RNA titer or with liver histology. In logistic regression analysis, viral genotype, RNA titer and histological scores for grading and staging were correlated independently with the ALT profile. The evidence of chronic hepatitis in all subjects with persistently normal ALT activity suggests that healthy HCV carriage is a rare event.

Significance of Serum Alpha-Glutathione S-Transferase Assessment in Hepatitis C Patients with Different Alanine Aminotransferase Patterns

“…Comparing the sensitivity and specificity of α-GST with viremia of these patients, we found higher sensitivity and specificity of α-GST (91.67% and 93.33% respectively) than viremia (79.17% and 88.89% respectively). This may be attributed to the intermittent pattern of viremia [30-32]. However, the sensitivity of α-GST in this group (91.67%) was lower than the sensitivity of ALT and AST which showed 100% sensitivity and higher than the sensitivity of ALP, GGT, TP, and Alb.…”

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

“…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 . 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 .…”

“…Cirrhosis has been reported with varying incidence (1.5–14%), and case reports of hepatocellular carcinoma have also been published 40, 56, 58, 78, 81–83 . The extent of necroinflammation and fibrosis is generally lower in patients with normal ALT compared to those with elevated ALT (histological activity index range approximately 3–6 vs. 5–10 in patients with elevated ALT; fibrosis scores 0.5–1.4 vs. 1.5–2) 5, 10, 29, 39, 40, 46, 47, 55, 58, 61, 78, 84 . Other studies have reported equivalent liver damage in the two patient populations 38, 41, 85, 86 …”