Subjects positive for hepatitis C virus RNA with normal aminotransferase levels, a "trompe l'oeil" clinical picture?

Background. Quite often subjects affected by chronic hepatitis C virus infe ction have no clinical signs of liver disease and serum aminotransferase va lues never go beyond the upper limit of normal. Yet these subjects, defined "asymptomatic HCV carriers", often have active viral replication and vario us degrees of histological damage. Aims. To verify: in a population of antibody to hepatitis C virus carriers, if normal serum aminotransferase values in hepatitis C virus-RNA positive differed considerably from those in hepatitis C virus-RNA negative subjects . Subjects/Methods. We followed 24 anti-hepatitis C virus-positive subjects ( 15 hepatitis C virus-RNA positive and 9 negative) by measuring alanine and aspartate aminotransferase levels at 3-month intervals for a median of 40 m onths (range 6-77). Results. Determinations resulted repeatedly and rigorously within the norma l range in all participants. Alanine aminotransferase values were higher in hepatitis C virus-RNA positives than in negatives (mean +/- SD: 0.609+/-0. 172 vs 0.434+/-0.153 times the upper limit of normal; p<0.001). Aspartate a minotransferase values in both groups reflected the same consistent differe nce (mean +/- SD: 0.652+/-0.170 vs 0.528+/-0.151 times the upper limit of n ormal; p<0.001). Conclusions. Our findings demonstrate that biochemical activity exists in a symptomatic hepatitis C virus-RNA-positive carriers, but it is so slight th at serum aminotransferase levels do not go beyond the upper limit of normal . With the prevailing range of normality, serum aminotransferase determinat ion is a helpful but not reliable marker of disease activity in chronic hep atitis C virus infection. The normal range for aminotransferases needs to b e redefined in order to set up a more accurate diagnostic profile of subjec ts with chronic hepatitis C virus infection.