Treatment of patients with chronic hepatitis C and normal ALT levels

A certain group of patients with chronic hepatitis C have normal serum alan ine aminotransferase (ALT) levels, despite the replication of hepatitis C v irus (HCV) in infected liver cells and detection of HCV RNA in serum. These patients are usually asymptomatic and are discovered fortuitously, general ly after a volunteer blood donation. A standard definition for this group o f patients is obviously needed, which should include the presence of anti-H CV detectable serum HCV RNA by polymerase chain reaction and persistently n ormal ALT levels. These patients have minimal or mild necroinflammatory lesions in liver tiss ue specimens and cirrhosis is rare. The natural course of the disease in th is epidemiologic setting is unknown, but the progression is probably good. Alpha-interferon has been administered in small pilot studies and three con trolled studies, Overall, the end of treatment response was 35% and the sus tained virologic response 15%, These response rates are similar to those re ported in patients with elevated ALT levels. More important, serum ALT leve ls became abnormal during therapy in 47% of the patients and levels remaine d elevated in some patients after therapy, Prospective studies on the long-term natural history of HCV infection in th is setting are needed and well designed randomized controlled trials are ne cessary to determine whether these patients would benefit from IFN or a com bination treatment with ribavirin regimen, Currently, there is no rationale to treat these patients.