Clinical features of hepatitis C-infected patients with persistently normal alanine transaminase levels in the Southwestern United States

Hepatology. 1999 Nov;30(5):1307-11. doi: 10.1002/hep.510300526.

Abstract

Approximately one third of patients with chronic hepatitis C virus (HCV) infection have normal alanine transaminase (ALT) levels. We studied the clinical, biochemical, virological, and histological features in patients with persistently normal ALT. A case-control study was conducted on 275 patients with chronic HCV infection, including 75 patients with persistently normal ALT and 200 patients with abnormal ALT. Persistently normal ALT was defined as 4 consecutive ALT values in each patient within a period of 12 months. The average age of the patients was 44 years (range 18 to 69 years). More non-Hispanic whites had persistently normal ALT. The mean serum ferritin level was significantly lower in patients with persistently normal ALT as compared with abnormal ALT (128 +/- 92 ng/mL and 224 +/- 128 ng/mL), respectively (P =.017). The mean HCV-RNA level was significantly lower in patients with persistently normal ALT as compared with abnormal ALT (12 x 10(5) +/- 2.8 x 10(6) copies/mL and 33 x 10(5) +/- 8.0 x 10(6)), respectively (P =.02). Histologically, patients with persistently normal ALT had less severe portal inflammation (P <.05), lobular inflammation (P =.003), piecemeal necrosis (P =.002), fibrosis (P <.05), lower prevalence of cirrhosis (P =.007), as well as a slower fibrosis progression rate (P <.001). Chronic hepatitis C patients with persistently normal ALT have low-activity grade and stage on liver biopsy. In these patients the hepatitis C RNA level was lower compared with abnormal ALT patients, which may explain the slower fibrosis progression rate.

Publication types

  • Comparative Study

MeSH terms

  • Adult
  • Alanine Transaminase / blood*
  • Bilirubin / blood
  • Case-Control Studies
  • Continental Population Groups
  • Female
  • Ferritins / blood
  • Hepatitis C, Chronic / blood*
  • Hepatitis C, Chronic / enzymology
  • Hepatitis C, Chronic / pathology*
  • Humans
  • Inflammation
  • Iron / blood
  • Liver / pathology
  • Male
  • RNA, Viral / blood
  • Reference Values
  • Serum Albumin / analysis
  • Sex Characteristics
  • Southwestern United States

Substances

  • RNA, Viral
  • Serum Albumin
  • Ferritins
  • Iron
  • Alanine Transaminase
  • Bilirubin