Prevalence of liver disease in a population of asymptomatic persons with hepatitis C virus infection

Ann Intern Med. 2002 Dec 17;137(12):961-4. doi: 10.7326/0003-4819-137-12-200212170-00009.


Background: The prevalence of significant liver disease in persons with asymptomatic hepatitis C virus (HCV) infection is unclear.

Objective: To determine the prevalence and severity of HCV infection in asymptomatic persons.

Design: Population-based cross-sectional study.

Setting: Northeastern Italy.

Patients: 4820 apparently healthy Telecom Italy employees or their relatives who underwent screening for cardiovascular risk factors.

Measurements: Initial screening for anti-HCV by enzyme-linked immunosorbent assay followed by HCV RNA testing by polymerase chain reaction and monitoring of alanine aminotransferase levels in viremic persons (92% of viremic persons also had liver biopsies to assess their METAVIR scores).

Results: 116 persons (2.4% [95% CI, 1.97% to 2.84%]) were positive for anti-HCV and 85 (1.76% [CI, 1.39% to 2.14%]) were also viremic. The ALT level was persistently normal in 39 (46%) of viremic patients and elevated in 46 (54%). Significant hepatic histologic abnormalities were detected in 19% (CI, 7.21% to 36.4%) of persons with persistently normal ALT levels and in 61% (CI, 45.4% to 74.9%) of viremic persons who had elevated ALT levels (P < 0.001). The prevalence of HCV infection and number of persons with chronic liver fibrosis increased with age (P = 0.003).

Conclusions: Hepatitis C is histologically active and progressive in up to 40% of asymptomatic persons with HCV infection. The severity of liver disease correlates with abnormal ALT levels and increases with age.

Publication types

  • Research Support, Non-U.S. Gov't

MeSH terms

  • Age Factors
  • Alanine Transaminase / blood
  • Biopsy
  • Cross-Sectional Studies
  • Enzyme-Linked Immunosorbent Assay
  • Genotype
  • Hepacivirus / classification
  • Hepacivirus / genetics
  • Hepatitis Antibodies / blood
  • Hepatitis C / complications*
  • Hepatitis C / pathology
  • Humans
  • Italy / epidemiology
  • Liver Cirrhosis / pathology
  • Liver Diseases / complications*
  • Liver Diseases / epidemiology*
  • Prevalence
  • RNA, Viral / blood
  • Viremia / complications*
  • Viremia / pathology


  • Hepatitis Antibodies
  • RNA, Viral
  • Alanine Transaminase