European Journal of Internal Medicine
Volume 21, Issue 2 , Pages 57-61 , April 2010

HCV carriers with normal alanine aminotransferase levels: Healthy persons or severely ill patients? Dealing with an everyday clinical problem

  • Claudio Puoti

      Affiliations

    • Dept. of Internal Medicine and Liver Unit, Marino Hospital, Rome, Italy
    • Corresponding Author InformationCorresponding author. Dept. of Internal Medicine, Marino General Hospital, Via XXIV Maggio 5, 00047 Marino, Rome, Italy. Tel.: +39 06 9327 7681; fax: +39 06 9327 3093.
    • ,
  • Lia Bellis

      Affiliations

    • Hepatic Haemodynamic Unit, Marino Hospital, Rome, Italy
    • ,
  • Riccardo Guarisco

      Affiliations

    • Dept. of Internal Medicine and Liver Unit, Marino Hospital, Rome, Italy
    • ,
  • Orlando Dell' Unto

      Affiliations

    • Dept. of Internal Medicine and Liver Unit, Marino Hospital, Rome, Italy
    • ,
  • Lucia Spilabotti

      Affiliations

    • Dept. of Internal Medicine and Liver Unit, Marino Hospital, Rome, Italy
    • ,
  • Olga Mitidieri Costanza

      Affiliations

    • Molecular Biology Lab, Marino Hospital, Rome, Italy

Received 8 November 2009 ,Revised 24 November 2009 ,Accepted 7 December 2009.

References 

  1. Dore GJ, Haber PS. Tell me it ain't so. Patient-to-patient transmission of hepatitis C in an endoscopy clinic. Hepatology. 2008;48:1333–1335
  2. Bisset L, Cossart YE, Selby W, West R, Catterson D, O'hara K, et al. A prospective study of the efficacy of routine decontamination for gastrointestinal endoscopes and the risk factors for failure. Am J Infect Control. 2006;34:274–280
  3. Ciancio A, Manzini P, Castagno F, et al. Digestive endoscopy is not a major risk factor for transmitting hepatitis C virus. Ann Intern Med. 2005;142:903–909
  4. The Writing Committee on behalf of the Consensus Panel. Expert Consensus Conference. The screening for hepatitis C virus infection in adults in Italy. Digest Liver Dis. 2006;38:445–451
  5. Ghany MG, Strader DB, Thomas DL, Seef LB. Diagnosis, management, and treatment of hepatitis C: an update. Hepatology. 2009;49:1335–1373
  6. Puoti C, Magrini A, Filippi T, Aldegheri L. Do symptomless HCV carriers spread infection to their relatives?. Lancet. 1995;346:893
  7. Puoti C. Hepatitis C with normal aminotransferase levels. Dig Dis. 2007;25:277–278
  8. Puoti C, Stati A, Magrini A. Serum HCV RNA titer does not predict the severity of liver damage in HCV carriers with normal ALT levels. Liver. 1999;19:104–109
  9. Puoti C. HCV carriers with persistently normal aminotransferase levels: normal does not always mean healthy. J Hepatol. 2003;38:529–532
  10. Strader DB, Wright T, Thomas DL, Seef LB. Diagnosis, management and treatment of hepatitis C. AASLD practice guideline. Hepatology. 2004;39:1147–1171
  11. Puoti C, Guido M, Mangia A, Persico M, Prati D. Committee on HCV carriers with normal alanine aminotransferase levels of the Italian Association for the Study of the Liver. Clinical management of HCV carriers with normal ALT levels. Digest Liver Dis. 2003;35:362–369
  12. Dienstag JL, McHutchison JG. American Gastroenterological Association [AGA] medical position statement on the management of hepatitis C. Gastroenterology. 2006;130:225–264
  13. Marcellin P, Levy S, Erlinger S. Therapy of hepatitis C: patients with normal aminotransferase levels. Hepatology. 1997;26(Suppl 1):133S–136S
  14. Tassopoulos NC. Treatment in patients with normal ALT levels. J Hepatol. 1999;31(Suppl 1):193–196
  15. Bacon BR. Treatment of patients with Hepatitis C and normal serum aminotransferase levels. Hepatology. 2002;36(Suppl 1):S179–S184
  16. Puoti C, Castellacci R, Montagnese F. Hepatitis C virus carriers with normal aminotransferase levels: healthy people or true patients?. Dig Liver Dis. 2000;32:634–643
  17. Martinot-Peignoux M, Boyer N, Cazals-Hatem D, et al. Perspective study of anti-hepatitis C virus-positive patients with persistently normal serum ALT with or without detectable serum HCV RNA. Hepatology. 2001;34:1000–1005
  18. Puoti C, Magrini A, Stati T, et al. Clinical, histological and virological features of Hepatitis C Virus carriers with persistently normal aminotransferase levels. Hepatology. 1997;26:1393–1398
  19. Puoti C, Castellacci R, Montagnese F, et al. Histological and virological features and follow up of hepatitis C virus carriers with normal aminotransferase levels: the Italian Prospective Study of The Asymptomatic C Carriers (ISACC). J Hepatol. 2002;37:117–123
  20. Piton A, Poynard T, Imbert-Bismut F, Khalil L, Delattre J, Pelissiere E, et al. Factors associated with serum alanine transaminase activity in healthy subjects: consequences for the definition of normal values, for selection of blood donors, and for patients with chronic hepatitis C. Hepatology. 1998;27:1213–1219
  21. Prati D, Taioli E, Zanella A, Della Torre E, Butelli S, Del Vecchio E, et al. Updated definitions of healthy ranges for serum alanine aminotransferase. Ann Intern Med. 2002;137:1–10
  22. Gordon SC, Fang JWS, Silverman A, McHutchinson JG, Albrecht JK. The significance of baseline serum alanine aminotransferase on pretreatment disease characteristics and response to antiviral therapy in chronic hepatitis C. Hepatology. 2000;32:400–404
  23. Jamal MM, Sony A, Quinn PG, Wheeler DE, Arora S, Johnston DE. Clinical features of hepatitis C-infected patients with persistently normal alanine transaminase levels in the Southwestern United States. Hepatology. 1999;30:1307–1311
  24. Mathurin P, Moussali J, Cadranel JF, Thibault V, Charlotte F, Dumouchel P, et al. Slow progression rate of fibrosis in hepatitis C virus patients with persistently normal alanine transaminase activity. Hepatology. 1998;27:868–872
  25. Renou C, Halfon P, Pol S, Cacoub P, Jouve E, Bronowicki JP, et al. Histological features and HLA class II alleles in HCV chronically infected patients with persistently normal alanine aminotransferase levels. Gut. 2002;51:585–590
  26. Hui C-K, Belaye T, Montegrande K, Wright TL. A comparison in the progression of liver fibrosis in chronic hepatitis C between persistently normal and elevated transaminase. J Hepatol. 2003;38:511–517
  27. Puoti C, Bellis L, Martellino F, Durola L, Spilabotti L, Dell'Unto O, et al. Occurrence of hepatocellular carcinoma in an apparently healthy HCV patient. Eur J Gastroenterol Hepatol. 2005;17:1263–1264
  28. Persico M, Palmentieri B, Coppola L, Di Giacomo Russo G, Di Marino F, De Sio I, et al. Occurrence of HCC in asymptomatic HCV-related chronic hepatitis. Dig Dis Sci. 2002;47:2407–2410
  29. Pradat P, Alberti A, Poynard T, Esteban JI, Weiland O, Marcellin P, et al. Predictive value of ALT levels for histologic findings in chronic hepatitis C: a European Collaborative Study. Hepatology. 2002;36:973–977
  30. Rockey DC, Caldwell SH, Goodman ZD, Nelson RC, Smith AD. Liver biopsy. Hepatology. 2009;49:1017–1044
  31. Castera L, Foucher J, Bertet J, Couzigou P, de Ledinghen V. FibroScan and FibroTest to assess liver fibrosis in HCV with normal aminotransferases. Hepatology. 2006;43:373–374
  32. Puoti C, Bellis L, Galossi A, Guarisco R, Nicodemo S, Spilabotti L, et al. Antiviral treatment of HCV carriers with normal ALT. Mini Rev Med Chem. 2008;8:150–152
  33. Rumi MG, De Filippi F, Donato MF, Del Ninno E, Colombo M. Progressive hepatic fibrosis in healthy carriers of hepatitis C virus with a transaminase breakthrough. J Viral Hepat. 2002;9:71–74
  34. Serfaty L, Chazouilleres O, Pawlotski JM, Andreani T, Pellet C, Poupon R. Interferon alpha therapy in patients with chronic hepatitis C and persistently normal aminotransferase activity. Gastroenterology. 1996;110:291–295
  35. Sangiovanni A, Morales R, Spinzi GC, Rumi MG, Casiraghi A, Ceriani R, et al. Interferon alpha treatment of HCV RNA carriers with persistently normal transaminase levels: a pilot randomized controlled study. Hepatology. 1998;27:853–856
  36. Rossini A, Ravaggi A, Biasi L, Agostinelli E, Bercich L, Gazzola GB, et al. Virological response to interferon treatment in hepatitis C virus carriers with normal aminotransferase levels and chronic hepatitis. Hepatology. 1997;26:1012–1017
  37. Zeuzem S, Diago M, Gane E, Reddy KR, Pockros P, Prati D, et al. PEGASYS Study NR16071 Investigator Group. Peginterferon alfa-2a [40KD] and ribavirin in patients with chronic hepatitis C and normal aminotransferase levels. Gastroenterology. 2004;127:1724–1732
  38. Snoeck E, Hadziyannis SJ, Puoti C, et al. Predicting efficacy and safety outcomes in patients with hepatitis C virus genotype 1 and persistently ‘normal’ alanine aminotransferase levels treated with peginterferon alfa-2a (40KD) plus ribavirin. Liver Int. 2008;28:61–71
  39. Puoti C, Pellicelli A, Romano M, et al. Treatment of hepatitis C virus carriers with persistently normal alanine aminotransferase levels with peginterferon a-2a and ribavirin: a multicentric study. Liver Int. 2009;29:1479–1484
  40. Zeuzem S, Alberti A, Rosenberg W, Marcellin P, Diago M, Negro F, et al. Management of patients with chronic hepatitis C virus infection and ‘normal’ aminotransferase activity. Aliment Pharmacol Ther. 2006;24:1133–1149
  41. Alberti A. Towards a more individualised management of HCV patients with initially or persistently normal alanine aminotransferase levels. J Hepatol. 2005;42:266–274
  42. Okanoue T, Itoh Y, Minami M, et al. Guidelines for the antiviral therapy of hepatitis C virus carriers with normal serum aminotransferase based on platelet counts. Hepatol Res. 2008;38:27–36
  43. Puoti C, Guarisco R, Bellis L, Spilabotti L. Diagnosis, management, and treatment of hepatitis C. Hepatology. 2009;50:322
  44. Puoti C, Bellis L, Guarisco R. Liver biopsy in Hepatitis C carriers with persistently normal ALT levels. Hepatology. 2009;50:655–656

PII: S0953-6205(09)00249-0

doi: 10.1016/j.ejim.2009.12.006

European Journal of Internal Medicine
Volume 21, Issue 2 , Pages 57-61 , April 2010

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