Clinical features of hepatitis C-infected patients with persistently normal alanine transaminase levels in the southwestern United States

Approximately one third of patients with chronic hepatitis C virus (HCV) in fection have normal alanine transaminase (ALT) levels. We studied the clini cal, biochemical, virological, and histological features in patients with p ersistently normal ALT. A case-control study was conducted on 275 patients with chronic HCV infection, including;TS; patients with persistently normal ALT and 200 patients with abnormal ALT. Persistently normal ALT was define d as 4 consecutive ALT values in each patient within a period of 12 months. The average age of the patients was 44 years (range 18 to 69 years). More non-Hispanic whites had persistently normal ALT. The mean serum ferritin le vel was significantly lower in patients with persistently normal ALT as com pared with abnormal ALT (128 +/- 92 ng/mL and 224 +/- 128 ng/mL), respectiv ely (P = .017). The mean HCV-RNA level was significantly lower in patients with persistently normal ALT as compared with abnormal ALT (12 x 10(5) +/- 2.8 x 10(6) copies/mL and 33 x 10(5) +/- 8.0 x 10(6)), respectively (P = .0 2). Histologically, patients with persistently normal ALT had less severe p ortal inflammation (P < .05), lobular inflammation (P = .003), piecemeal ne crosis (P = .002), fibrosis (P < .05), lower prevalence of cirrhosis (P = . 007), as well as a slower fibrosis progression rate (P < .001). Chronic hep atitis C patients with persistently normal ALT have low-activity grade and stage on liver biopsy. In these patients the hepatitis C RNA level was lowe r compared with abnormal ALT patients, which may explain the slower fibrosi s progression rate.