VIROLOGICAL CHARACTERIZATION AND LIVER HISTOLOGY IN HCV POSITIVE SUBJECTS WITH NORMAL AND ELEVATED ALT LEVELS

We analyzed HCV genotype and RNA titer in 36 chronically infected subj ects, 20 with persistently normal or near-normal alanine aminotransfer ase (ALT) activity and 16 with raised ALT activity. All subjects under went liver biopsy and evaluation of the histological activity index (H AI) by both Knodell's and Ishak's scoring systems. Genotype 2 was dete cted in most subjects with normal ALT activity, whereas genotype 1 was more frequent among subjects with raised ALT activity. HCV-RNA titer was higher in subjects with increased ALT. Histological evidence of ch ronic hepatitis was documented in all cases, but higher scores for gra ding and for staging were associated with increased ALT activity. HCV genotype had no statistical relationship with RNA titer or with liver histology. In logistic regression analysis, viral genotype, RNA titer and histological scores for grading and staging were correlated indepe ndently with the ALT profile, The evidence of chronic hepatitis in all subjects with persistently normal ALT activity suggests that healthy HCV carriage is a rare event.