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The relationship of serum alanine aminotransferase (ALT) level and viral replication to liver damage in chronic hepatitis C virus (HCV) patients remains unclear.The aim of the present study was to determine whether the stage of fibrosis correlates with HCV-RNA titer and/or serum ALT level in patients with chronic hepatitis C (genotype 4) infection.Clinical and biochemical characteristics were collected from 138 patients with chronic HCV genotype 4 infection. Quantitative HCV-RNA level measurement, HCV genotyping, and abdominal ultrasonography were investigated in all patients.Liver biopsy was done for 80 patients and the remaining 58 patients were examined using Fibroscan.Highly significant higher percentage of cases with high level of HCV viremia was found among patients with fibrosis stage 3 as compared to other stages of fibrosis. In contrast, grades of activity were independent of serum HCV-RNA titer.Patients with stages 1 and 4 hepatic fibrosis had significantly higher levels of ALT than patients with other stages of fibrosis. In contrast, an insignificant correlation was found between ALT level and grade of necroinflammation.In conclusion neither ALT level nor HCV viremia can reflect the histological liver change accurately. As a result, liver biopsy or other noninvasive procedures that measure liver stiffness (i.e., Fibroscan) remain essential for accurate staging of liver fibrosis in patients with genotype 4 chronic HCV infection

Correlation between alanine aminotransferase level, HCV-RNA titer and fibrosis stage in chronic HCV genotype 4 infection