Does normal ALT mean healthy liver in HCV infection?

Abstract We studied 102 consecutive subjects after their completion of acute lymphoblastic leukemia (ALL)-directed chemotherapy, for evidence of hepatitis C virus (HCV) infection by enzyme immunoassay 2 and 3, second generation recombinant immunoblot assay and reverse transcription- polymerase chain reaction (PCR) for detection of circulating HCV-RNA. Forty-four patients (43%) had evidence of exposure to HCV; 30 of these were anti-HCV+. Of the 23 patients who were positive for both anti-HCV and HCV-RNA, 16 (69%) had a moderate increase in serum alanine aminotransferase (ALT) activity without clinical signs of liver disease. Fourteen patients were seronegative despite the presence of HCV-RNA in the serum. The proportion of different HCV genotypes was not significantly different from other anti-HCV+ patient groups. Although half of the patients with genotype III had normal ALT value, patients with normal ALT levels were represented in all genotype groups. Our study documents the prevalence of HCV infection in childhood ALL survivors, which is responsible for the majority of cases of non-B chronic liver disease in these patients. Whereas serologic screening identifies over 70% of patients with ongoing HCV infection, real HCV infection may be present even in the absence of a detectable humoral immune response to the virus. Based on this observation, determination of HCV-RNA by PCR should be recommended in patients in prolonged remission even if they test negative on serological assay. Normal ALT levels do not exclude the presence of HCV infection because the values were repeatedly normal in over half of our viremic patients.

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Hepatitis C virus infection in children treated for acute lymphoblastic leukemia

Blood ◽

10.1182/blood.v84.9.2919.bloodjournal8492919 ◽

1994 ◽

Vol 84 (9) ◽

pp. 2919-2922 ◽

Cited By ~ 4

Author(s):

M Arico ◽

G Maggiore ◽

E Silini ◽

F Bono ◽

C Vigano ◽

...

Keyword(s):

Hepatitis C Virus ◽

Liver Disease ◽

Hepatitis C ◽

Acute Lymphoblastic Leukemia ◽

Lymphoblastic Leukemia ◽

Hcv Infection ◽

Hcv Rna ◽

Moderate Increase ◽

Childhood All ◽

Normal Alt

We studied 102 consecutive subjects after their completion of acute lymphoblastic leukemia (ALL)-directed chemotherapy, for evidence of hepatitis C virus (HCV) infection by enzyme immunoassay 2 and 3, second generation recombinant immunoblot assay and reverse transcription- polymerase chain reaction (PCR) for detection of circulating HCV-RNA. Forty-four patients (43%) had evidence of exposure to HCV; 30 of these were anti-HCV+. Of the 23 patients who were positive for both anti-HCV and HCV-RNA, 16 (69%) had a moderate increase in serum alanine aminotransferase (ALT) activity without clinical signs of liver disease. Fourteen patients were seronegative despite the presence of HCV-RNA in the serum. The proportion of different HCV genotypes was not significantly different from other anti-HCV+ patient groups. Although half of the patients with genotype III had normal ALT value, patients with normal ALT levels were represented in all genotype groups. Our study documents the prevalence of HCV infection in childhood ALL survivors, which is responsible for the majority of cases of non-B chronic liver disease in these patients. Whereas serologic screening identifies over 70% of patients with ongoing HCV infection, real HCV infection may be present even in the absence of a detectable humoral immune response to the virus. Based on this observation, determination of HCV-RNA by PCR should be recommended in patients in prolonged remission even if they test negative on serological assay. Normal ALT levels do not exclude the presence of HCV infection because the values were repeatedly normal in over half of our viremic patients.

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A continuous13C methacetin breath test for noninvasive assessment of intrahepatic inflammation and fibrosis in patients with chronic HCV infection and normal ALT

Journal of Viral Hepatitis ◽

10.1111/j.1365-2893.2008.01007.x ◽

2008 ◽

Vol 15 (10) ◽

pp. 716-728 ◽

Cited By ~ 37

Author(s):

G. Lalazar ◽

O. Pappo ◽

T. Hershcovici ◽

T. Hadjaj ◽

M. Shubi ◽

...

Keyword(s):

Breath Test ◽

Hcv Infection ◽

Chronic Hcv Infection ◽

Noninvasive Assessment ◽

Normal Alt ◽

Chronic Hcv

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CHRONIC HEPATITIS C-INFECTED PATIENTS;

The Professional Medical Journal ◽

10.29309/tpmj/2013.20.01.478 ◽

2012 ◽

Vol 20 (01) ◽

pp. 068-071

Author(s):

JAVED AHMED PHULPOTO

Keyword(s):

Activity Index ◽

Elevated Serum ◽

Activity Grade ◽

Normal Serum ◽

Hcv Infection ◽

College Hospital ◽

Medical College ◽

Histological Activity ◽

Normal Alt ◽

Chronic Hcv

Background: In our region the sensitivity of serum alanine aminotransferase (ALT) levels in predicting the severity ofhepatitis C virus (HCV) infection is unclear. Objective: To compare histologic scoring of liver pathology in patients with chronic HCVinfection with normal or elevated serum ALT. Study Design: Prospective observational study. Place & Duration of Study: Liver clinic,Ghulam Mohammad Mahar Medical College Hospital, Sukkur, between January 2010 and December 2010. Methods: Liver biopsies wereperformed in patients with HCV infection and either normal (n=40) or elevated (n=76) serum ALT levels, and scored for activity andfibrosis using the modified histological activity index. Results: Patients with normal ALT and elevated ALT had similar demographicfeatures. Median (range) histological activity grade was higher in patients with elevated ALT than in those with normal ALT (6 [1-15] vs. 5[0-11], respectively; p=0.001), as was the fibrosis stage (2 [0-6] vs. 1 [0-6]; p=0.02). Two patients with normal ALT and 4 with elevatedALT had liver cirrhosis. Conclusions: Among patients with chronic HCV infection, liver lesions are milder in those with normal serum ALTlevels than those with abnormal ALT levels. However, some patients with normal ALT too may have advanced liver disease.

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