DIFFERENTIAL DISTRIBUTION OF HEPATITIS-C VIRUS GENOTYPES IN PATIENTS WITH AND WITHOUT LIVER-FUNCTION ABNORMALITIES

Hepatitis C virus (HCV) infection persists for an indefinite length of time in a major proportion of patients, inducing chronic liver lesion s that evolve to cirrhosis and hepatocellular carcinoma (HCC) in appro ximately 20% of cases. We studied HCV viremia and genotypes by reverse transcription-polymerase chain reaction (RT-PCR) in 341 consecutive a nti-HCV-positive patients. Of these, 167 patients had persistently nor mal or near normal alanine aminotransferase (ALT) levels (fluctuations less than or equal to 5 IU above the upper limit of normal); the rema ining 174 patients presented with elevated ALT and histological eviden ce of chronic liver disease, Seventy percent of patients with normal A LT values had circulating HCV RNA despite the absence of biochemical i ndicators of Liver damage and mild histological forms of chronic hepat itis were detected in most patients who underwent liver biopsy, Isolat ed genotype III infection was significantly more prevalent in this pat ient group with respect to control patients with abnormal ALT values ( 70% vs, 39%; P < .001). Conversely, isolated genotype II was more freq uently found in patients with elevated ALT values and evidence of chro nic liver disease (45% vs, 23%; P < .01) and it was progressively more represented in advanced liver disease, such as cirrhosis and HCC. Vir ological features of HCV infection might be associated with different clinical manifestations, suggesting a potential prognostic significanc e on disease outcome.