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Hepatitis C virus‐infected patients with a persistently normal alanine aminotransferase: do they exist and is this really a group with mild disease?
Author(s) -
Lawson A.
Publication year - 2010
Publication title -
journal of viral hepatitis
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 1.329
H-Index - 100
eISSN - 1365-2893
pISSN - 1352-0504
DOI - 10.1111/j.1365-2893.2009.01148.x
Subject(s) - medicine , gastroenterology , fibrosis , alanine transaminase , alanine aminotransferase , hepatitis c virus , cohort , liver disease , virus , immunology
Summary. Opinion varies on whether or not hepatitis C virus (HCV) infected patients with persistently normal aminotransferase (PNALT) levels represent a group with mild disease. To evaluate the risk of ALT flare and fibrosis progression in patients with PNALT followed up as part of the Trent HCV cohort. Treatment‐naïve patients with an elevated ALT ( n = 1140) or PNALT, the latter defined as either an ALT ≤ 30 IU/L ( n = 43) or an ALT ≤ 40 IU/L ( n = 87) on ≥2 occasions in the 6 months following diagnosis, and no ALT > 40 U/L were included. The likelihood of maintaining a PNALT ≤ 30 IU/L was 42.2% and PNALT ≤ 40 IU/L 41.7% at 3 years. The Ishak fibrosis score was ≥3 in 3.7%, 8.3% and 29.6% of patients with PNALT ≤ 30 IU/L, PNALT ≤ 40 IU/L and elevated ALT, respectively. Fibrosis progression between paired biopsies was similar for patients with PNALT ≤ 30 IU/L (0.33 ± 0.94 Ishak fibrosis points/year), PNALT ≤ 40 IU/L (0.35 ± 0.82) and elevated ALT (0.19 ± 0.48). The majority of those defined as PNALT subsequently have an abnormal ALT. They have a similar risk of disease progression to other HCV infected patients and, therefore, warrant the same consideration with regard to treatment.