Long-term observation of HCV-positive patients with normal ALT values: persistence of a clinically healthy state.

Res Virol 1998 Sep-Oct;149(5):277-82
Morisco F, Del Vecchio Blanco G, Tuccillo C, Galli C, Cirino S, Caporaso N Department of Internal Medicine F. Magrassi, Second University of Naples, Italy.

The purpose of our investigation was to ascertain the presence of viral replication in subjects positive for antibodies to hepatitis C virus (anti-HCV) with persistently normal values of liver tests, to define their natural history, and to determine whether the immunoglobulin M (IgM) response could be a useful parameter to distinguish viraemic from non-viraemic patients.

Twenty-seven subjects were selected based on their anti-HCV positivity and sustained normality (for at least 18 months) of alanine-aminotransferase (ALT) values. They were enrolled into the study and observed for another 1-4 years (mean 2.6).

Fifteen out of 27 subjects were positive for hepatitis C virus ribonucleic acid (HCV RNA) and 12/15 were also positive for IgM. The remaining 12/27 patients were negative for both assessments. ALT levels remained in the norm throughout the investigation for all 27 subjects studied; the 15 viraemic patients showed persistent positivity for HCV RNA and the 12 positive for IgM anti-core also maintained their positivity. Patients shown to be negative for HCV RNA and IgM sustained their negativity throughout the study.

Our results indicates that some patients remain viraemic while not having and/or developing clinical and biochemical signs of liver damage. IgM anti-HCV seems to be a specific index of viraemia in HCV-positives and could be useful for monitoring these patients.