SERUM ALANINE AMINOTRANSFERASE MEASUREMENT AS A GUIDE TO SELECTIVE TESTING FOR HEPATITIS-C DURING MEDICAL CHECKUP

The efficiency of elevated serum alanine aminotransferase values for s electing subjects to be tested for hepatitis B or C infections in a la rge French population undergoing a medical checkup was investigated. F or 5 consecutive weeks, serum alanine aminotransferase values were con trolled in 9044 subjects; 308 subjects (202 males) were selected with alanine aminotransferase levels 1.2-fold above the normal value (58 iu /l for men, 34 iu/l for women). For each selected case, an age- and se x-cross-matched control was included. Of the 308 subjects with elevate d alanine aminotransferase values, one was HBsAg positive and 15 (seve n males) were anti-HCV positive. All anti-HCV sera tested by enzyme im munoassay were also positive by three immunoblots and 11/15 (73%) were HCV-RNA positive by reverse transcription-polymerase chain reaction. Of the 308 control subjects, two were HBsAg positive and four (two mal es) were weakly anti-HCV positive by enzyme immunoassay. Only one weak ly anti-HCV positive serum was reactive by one immunoblot and all were HCV-RNA negative. This study shows the usefulness of alanine aminotra nsferase screening to detect hepatitis C virus infection in the genera l French population. Many of the anti-HCV positive subjects detected i n this study were not aware of their hepatitis C virus seropositivity (12/15) or that they were viremic (11/15). Use of this low-cost assay will considerably reduce the number of subjects to be tested for hepat itis C virus serological status and therefore the cost. It may make po ssible the investigation of large populations by setting up public hea lth programs to detect and treat hepatitis C virus. Hepatitis C virus infected subjects detected in these programs could benefit from medica l follow up, including antiviral therapy. (C) Journal of Hepatology.