Chronic hepatitis C with normal or abnormal aminotransferase levels: is itthe same entity?

Objective The features of hepatitis C virus (HCV) infection with persistent ly normal serum alanine aminotransferase (ALT) activity levels are not well defined. This study evaluated the characteristics of HCV infection accordi ng to the presence or absence of elevated ALT. Methods Demographic data, liver histology and HCV genotype were studied in a group of 80 HCV-RNA-positive subjects with persistently normal ALT (PNALT ) (group 1), and compared with a second group of 455 HCV-RNA-positive patie nts with elevated ALT (group 2). The annual progression of liver fibrosis w as also calculated. Results A higher proportion of women was found in group 1: 64% vs 42% in gr oup 2 (P < 0.0002). The HCV genotype 1 was less frequent in group 1:49% vs 60% in group 2 and genotype 2 was more frequent: 16% in group 1 vs 4% in gr oup 2 (P < 0.002). Cirrhosis was less frequent in group 1 (4% vs 13% in gro up 2 (P < 0.0001)). Normal liver was more frequent in group 1: 9% vs 1% in group 2 (P < 0.0001). The Knodell score was significantly different between the two groups: 3.2 +/- 0.27 vs 7.15 +/- 0.22 (P < 0.0001). The progressio n of liver fibrosis was lower in group 1:0.053 +/- 0.14 units/year vs 0.13 +/- 0.24 in group 2 (P < 0.007). Conclusion HCV infection with PNALT is associated with less severe histolog ical liver disease and a lower fibrosis progression rate. This suggests tha t the natural history of HCV infection in these patients is different from that in patients with abnormal ALT. Eur J Gastroenterol Hepatol 13:495-500 (C) 2001 Lippincott Williams & Wilkins.