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VIROLOGICAL AND HISTOLOGICAL FEATURES OF HCV IN PATIENTS WITH NORMAL ALT: RESULTS OF A TEN YEAR PROPSECTIVE FOLLOW-UP STUDY
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Reported by Jules Levin
http://www.natap.org
from AASLD
Nov 11, 2005, San Francisco
--liver histology worsened in 20.8% of anti HCV+ve pts
with persistently normal ALT
--Neither serum HCV-RNA nor ALT level can reliably predict activity or degree of fibrosis
Carmen Vandelli, Modena and Reggio Emilia University, Modena, Italy; Francesco Renzo, Modena and Reggio Emilia University, Modena, Italy; Alberto Bagni, Azienda Ospedaliera Policlinico, Modena, Italy; Maria Vandelli,
Modena and Reggio Emilia University, Modena, Italy; Maurizio Ponz de Leon, University of Modena and Reggio Emilia, Modena, Italy
The natural history of patients (pts) HCVAb+ve and normal ALT (nALT) is not well defined. The aims of our investigation were: to assess the presence of viral replication in subjects HCVAb+ve with nALT and the relationship between viremia, nALT, histologic liver damage; to characterize its natural history in ten years follow-up study.
207 subjects (mean age 49.7 ± 11.6 ys) were selected based on their anti HCV positivity and normality of ALT value. They were enrolled into the study and observed for 10 years. Normal ALT values were defined as <30 IU obtained at serial monthly evaluation during 6 months. These data were obtained at 0, 5 and 10 years. ALT value was also collected four times every year during the study. HCV RNA was detected by PCR yearly. Liver histology was examined in all pts at baseline and in 75% of the cases at the end of the study.
189 pts were HCV RNA+ve at baseline, 23 tested HCV RNA-ve at the end of follow-up. Mean viral load was 1,320,500 IU/ml. 101 (48.8%) pts had persistently
nALT values; in 106 (21.2%) sporadic ALT elevations of 2-3xUNL occurred. The majority of pts was infected by genotype 1. At baseline, liver histology showed no lesions in 1.4% of pts, minimal changes in 24.2%, chronic moderate hepatitis in 40.6%, severe hepatitis with or without cirrhosis in 33.8%. In 96.3% of pts with
nALT value a variable degree of grading and staging was observed.
Of 101 pts with nALT, 5 had ALT elevations after 5 years follow-up. 72/96 pts with persistently nALT underwent to a 2nd liver biopsy. A deterioration of liver histology was detected in 15 pts (20.83%). Most patients remained asymptomatic. The majority of anti HCV+ve pts with nALT are HCV-RNA+ve; persistently nALT is observed in 45.4%. Despite absence of biochemical abnormality, liver histology worsened in 20.8% of anti HCV+ve pts
with persistently nALT, with some showing significant fibrosis. Long lasting 5 years of follow-up seems to be the required period of time to define normal ALT value carrier. Neither serum HCV-RNA nor ALT level can reliably predict activity or degree of fibrosis, therefore, more sensitive tests for diagnosis of liver damage
in anti-HCV+ve pts are required.
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