Clinical Features of Hepatitis C Virus Carriers With Persistently Normal Alanine Aminotransferase Levels

Department of Human and Environmental Sciences, Graduate School of Medical and Dental Sciences, Kagoshima University, Kagoshima, Japan.
Hepatitis Monthly (Impact Factor: 1.93). 02/2012; 12(2):77-84. DOI: 10.5812/hepatmon.829
Source: PubMed

ABSTRACT Hepatitis C virus (HCV) infection causes chronic hepatitis, which frequently leads to hepatic fibrosis and hepatocellular carcinoma (HCC). Alanine aminotransferase (ALT) is a biomarker of hepatocyte injury and is associated with the progression of hepatic fibrosis. Advanced hepatic fibrosis also predisposes HCV carriers to a risk of HCC. In contrast, some cases with persistent HCV infection have normal ALT levels that persist for a long time, and these HCV carriers have no or mild hepatitis and hepatic fibrosis. These HCV carriers are defined as persistent normal ALT (PNALT) cases and their risk of HCC is low compared to HCV carriers with abnormal ALT. However, there are various definitions of normal ALT and PNALT, and advanced hepatic fibrosis may be missed without a liver biopsy. In addition, there is also a risk of ALT elevation in HCV carriers with PNALT, which increases the risk of progression to hepatic fibrosis and HCC. Most HCV carriers with PNALT have asymptomatic or nonspecific symptoms. HCV carriers with PNALT are also considered to be responsive to interferon-based treatment. Thus, assessment of hepatic fibrosis is important in HCV carriers, and the eradication of HCV infection is more likely in HCV carriers with evidence of hepatic fibrosis, regardless of their ALT levels.

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Available from: Hirofumi Uto, Sep 28, 2015
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    • "Besides the CB2-63 QQ variant, the multivariate analysis identified another three factors independently associated with the PNALT status: HCV genotype 2, an older age and a lower BMI. HCV genotype 2 and a lower BMI have been suggested as independent predictors of PNALT in previous studies [10], [30], [31], and confirmed in the present investigation. Instead, this is the first time the CB2-63 QQ variant and an older age have been cited as independent predictors of the PNALT status. "
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