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Prospective study on anti‐hepatitis C virus–positive patients with persistently normal serum alanine transaminase with or without detectable serum hepatitis C virus RNA
Author(s) -
MartinotPeignoux Michelle,
Boyer Nathalie,
CazalsHatem Dominique,
Pham BachNga,
Gervais Anne,
Breton Véronique Le,
Levy Stéphane,
Degott Claude,
Valla DominiqueCharles,
Marcellin Patrick
Publication year - 2001
Publication title -
hepatology
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 5.488
H-Index - 361
eISSN - 1527-3350
pISSN - 0270-9139
DOI - 10.1053/jhep.2001.28458
Subject(s) - hepatitis c virus , alanine transaminase , liver biopsy , medicine , rna , aspartate transaminase , gastroenterology , hepatitis c , biopsy , hepatology , transaminase , virus , pathology , immunology , biology , enzyme , alkaline phosphatase , gene , biochemistry
A significant proportion of patients with detectable antibodies to hepatitis C virus have normal serum alanine transaminase levels. Our aim was to study the outcome of this group. Between 1992 and 1999, 135 consecutive anti‐HCV‐positive patients with persistently normal ALT were followed for 3.6 ± 2.3 years (0.5 to 8.5 years), 108 had a liver biopsy at inclusion, and 24 had a second liver biopsy 3.5 ± 1.0 years later. Serum HCV RNA was detectable with PCR in 94 patients (69%) and not detectable in 41 patients (31%). Patients with and without detectable serum HCV RNA had similar epidemiological characteristics. Serum ALT levels and anti‐HCV ratio were lower ( P = .001), and histological lesions had lower grade and stage in patients without detectable serum HCV RNA ( P = .001). Liver HCV RNA was not detectable with PCR in the 12‐serum HCV RNA‐negative patients tested. During follow‐up, all patients without detectable serum HCV RNA remained HCV RNA‐negative and kept normal serum ALT; all patients with detectable serum HCV RNA remained HCV RNA‐positive, 20 (21%) had a slight fluctuation of serum ALT above the upper limit of normal. No significant changes were observed in the liver lesions of the 24 patients who underwent a second liver biopsy. In anti‐HCV‐positive patients with persistently normal serum ALT, histological lesions are significantly lower in HCV RNA‐negative than in HCV RNA‐positive patients. During follow‐up, the HCV RNA status of patients remained unchanged; 21% of the patients with detectable serum HCV RNA had slight increase in serum ALT levels, but histological lesions remained stable.