Hernández MN

Language: English
References: 22
Page: 34-35
PDF size: 34.56 Kb.

Text Extraction

Chronic infection with hepatitis C virus (HCV) is a dynamic disease from a biochemical perspective because transaminase levels fluctuate and may even fall within normal ranges at times. Although most patients with this disease have elevated alanine aminotransferase (ALT) levels, up to 46% of cases have persistently normal serum ALT levels despite the presence of HCV RNA. Until recently, HCV patients with normal ALT levels were not considered for treatment because it was believed that this indicated that hepatic lesions were absent. The 1997 consensus conference did not recommend HCV treatment for patients with normal transaminase levels. At the consensus conference of 2002, expert opinions regarding the site of the biopsy and the indications for treatment of patients with APN were divided. The following aspects of the management of APN patients are still the subject of debate.

REFERENCES

1. Alberti A, Noventa F, Benvegnu L, Boccato S, Gatta A. Prevalence of liver disease in a population of asymptomatic persons with hepatitis C virus infection. Ann Intern Med 2002; 137: 961-4.

2. National Institutes of Health Consensus Development Conference Panel statement: management of hepatitis C. Hepatology 1997; 26(3 Suppl.1): 2S-10S.

3. National Institutes of Health Consensus Development Conference Statement: Management of hepatitis C: 2002 June 10-12. Hepatology 2002; 36: S3-20.

4. EASL International Consensus Conference on Hepatitis C. Paris, 26–28 February 1999, Consensus Statement. European Association for the Study of the liver. J Hepatol 1999; 30: 956-61.

5. Puoti C, Castellacci R, Montagneses F, Zaltron S, Stornaluolo G, Bergami N, Bellis L, et al. Histological and virological features and follow up of HCV carriers with normal aminotransferase levels: the Italian Study of the Asymptomatic C Carriers (ISAAC). J Hepatol 2002; 37: 117-23.

6. Taraneh D, Ebrahimi D, Mohammad B, Ali-Asad H, Babak H, Ali-Reza S, Madjid S. Relationship between serum alanine aminotransferase levels and liver histology in chronic hepatitis Cinfected patients. Indian J Gastro 2005; 24: 49-51.

7. Nut AK, Hassan HA, Lindsay J, Lamps LW, Raufman JP. Liver biopsy in the evaluation of patients with chronic hepatitis C who have repeatedly normal or near-normal serum alanine aminotransferase levels. Am J Med 2000; 109: 62-4.

8. Herve S, Savoye G, Riachi G, Hellot MF, Gloria O, Lerebours E, Colin R, Ducrotte P. Chronic hepatitis C with normal or abnormal aminotransferase levels: is it the same entity? Eur J Gastroenterol Hepatol 2001; 13: 405-500.

9. Pradat P, Alberti A, Poynard T, Esteban J, Eiland O, Marcellin P, Badallamenti S, Trépo C. Predictive value of ALT levels for histologic findings in chronic hepatitis C: a European Collaborative Study. Hepatology 2002; 36: 973-77.

10. Pasquale G, Sagnelli E, Coppola N, Scarano F, Scolastico C, Bellomo P, Lettieri A, Piccinino F. Is liver biopsy necessary for hepatitis C virus carriers with persistently normal aminotransferase levels? Eur J Gastroenterol Hepatol 2003; 15: 831-3.

11. Hui CK, 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: 511-17.

12. Puoti C, Bellis L, Martellino F, Guarisco R, Dell’Unto O, Durola L, Galossi A. Chronic hepatitis C and «normal» ALT levels: treat the disease not the test. J Hepatol 2005; 43: 534-5.

13. Bain VG, Bonacini M, Govindarajan S, Ma M, Sherman M, Gibas A, Cotler SJ, Deschenes M, Kaita K, Jhangri GS A multicentre study of the usefulness of liver biopsy in hepatitis C. J Viral Hepat 2004; 11: 375-82.

14. Almasio PL, Niero M, Angioli D, Ascione A, Gullini S, Minoli G, Oprandi N, Battista G, Verme G, Andriulli A. Experts opinions on the role of liver biopsy in HCV infection: a Delphi survey by the Italian Association of Hospital Gastroenterologists (A.I.G.O.). J Hepatol 2005; 43: 381-7.

15. Strader DB, Wright T, Thomas DL, Seeff LB. Diagnosis, management and treatment of hepatitis C. Hepatology 2004; 39: 1147-71.

16. Jacobson IM, Ahmed F, Russo MW, Lebovics E, Dieterich D, Esposito S, Bach N, Klion F, Tobias H, Antignano L, Brown R, Gabbaizadeh D, Geders J, Levendoglu H. Interferon alpha 2b and ribavirin for patients with chronic hepatitis C and normal ALT. Am J Gastroenterol 2004; 99: 1700-5.

17. Gordon S, Fang J, Silverman A, McHutchinson J, Albrecht J. The significance of baseline serum alanine aminotransferase on pretreatment disease characteristics and response to antiviral therapy in chronic hepatitis C. Hepatology 2000; 32: 400-4.

18. Mangia A, Spinzi G, Vuturo O, Pazienza V, Iacobellis A, Piattelli M, Giacobbe A, Leandro G, Piermanni V, Minoli G, Montalto G, Andriulli A. Viral clearance in HCV viraemic patients with normal alanine aminotransferase after combination therapy: a controlled open labelled study. Aliment Pharmacol Ther 2004; 19: 331-7.

19. Lee S, Sherman M. Pilot study of interferon alfa and ribavirin treatment in patients with chronic hepatitis C and normal transaminase values. J Viral Hepat 2001; 8: 202-5.

20. Hui CK, Monto A, Belaye T, Lau E, Wright TL. Outcomes of interferon alfa and ribavirin treatment for chronic hepatitis C in patients with normal serum aminotransferases. Gut 2003; 52: 1644-48.

21. Zeuzem S, Diago M, Gane E, Reddy R, Pockros P, Prati D, for the PEGASYS study NR16071 Investigator Group, et al. Peginterferon alfa 2a (40 KD) and ribavirin in patients with chronic hepatitis C and normal aminotransferase levels. Gastroenterology 2004; 127: 1724-32.

22. Alberti A. Towards more individualised management of hepatitis C virus patients with initially or persistently normal alanine aminotransferase levels. J Hepatol 2005; 42: 266-74.