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2013, Number 1

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Ann Hepatol 2013; 12 (1)

Long-term follow-up of hepatitis C virus-positive patients with persistently normal serum transaminases

La Spada E, Soresi M, Giannitrapani L, La Spada M, Campagna E, Terranova A, Cartabellotta F, Montalto G

Language: English
References: 40
Page: 36-43
PDF size: 111.46 Kb.


ABSTRACT

Material and methods. This study prospectively evaluated the progression of liver disease in a group of anti-HCV-positive patients with persistently normal ALT levels (PNALT) who were HCV-RNA positive. Patients selected for this study were those who presented with PNALT according to the Italian Association for the Study of the Liver (AISF) criteria in the year 1995/96 and underwent liver biopsy. They were divided into two groups according to their ALT evolution. Forty-five patients were included in this study. Results. After a median follow-up time of 180 months twenty-five of them maintained PNALT, but two of these developed liver cirrhosis (LC) in a mean time of 174 and 202 months, respectively. Twenty patients had flares of ALT and three of them developed LC in a mean time of 162-178 months. Twelve of these patients underwent current antiviral treatment; six patients were SVR. At baseline, the 5 patients who progressed to LC had age and BMI significantly higher than patients without LC (P ‹ 0.005 and P ‹ 0.01, respectively). Grading (P ‹ 0.006) and staging (P ‹ 0.003) were also more severe at histology, while serum HDL-C levels were statistically lower (P ‹ 0.002). Comparing patients with flares of transaminases with and without LC, we found a significant difference at baseline for age, BMI, HDL-C, grading and staging (P ‹ 0.05; P ‹ 0.01 and P ‹ 0.003, respectively). Conclusion. In HCV-RNA positive patients associated with PNALT the grade of disease activity increased over the years in only half of patients and a higher degree of liver fibrosis at baseline was the major relevant factor for progression.


REFERENCES

  1. Puoti C, Bellis L, Galossi A, Guarisco R, Nicodemo S, Spilabotti L, Unto OD. Antiviral treatment of HCV carriers with persistently normal ALT levels. Mini Rev Med Chem 2008; 8: 150-2.

  2. Puoti C. HCV carriers with persistently normal aminotransferase levels: normal does not always mean healthy. J Hepatol 2003; 38: 529-32.

  3. Alberti A, Morsica G, Chemello L, Cavalletto D, Noventa F, Pontisso P, Ruol A. Hepatitis C viraemia and liver disease in symptom-free individuals with anti-HCV. Lancet 1992; 340: 697-8.

  4. Puoti C, Magrini A, Stati T, Rigato P, Montagnese F, Rossi P, Aldegheri L, et al Clinical, histological, and virological features of hepatitis C virus carriers with persistently normal or abnormal alanine transaminase level. Hepatology 1997; 26: 1393-8.

  5. Gholson CF, Morgan K, Catinis G, Favrot D, Taylor B, Gonzalez E, Balart L. Chronic hepatitis C with normal aminotransferase levels: a clinical histologic study. Am J Gastroenterol 1997; 92: 1788-92.

  6. Puoti C, Castellacci R, Montagnese F, Zaltron S, Stornaiuolo G, Bergami N, Bellis L. Histological and virological features and follow up of hepatitis C virus carriers with normal amínotransferase levels: the Italian prospective study of the asymptomatic C carriers (ISACC). J Hepatol 2002; 37: 117-23.

  7. Pradat P, Alberti A, Poynard T, Esteban Jl, Welland O, Marcellin P, Badalamenti S, et al. Predictive value of ALT levels for histologic findings in chronic Hepatitis C: a European Collaborative Study. Hepatology 2002; 36: 973-7.

  8. Montalto G, Zignego L, Ruggeri MI, Giannini C, Soresi M, Monti M, Carroccio A, et al. Serum HCV-RNA and liver histologic findings in patients with long-term normal transaminases. Dig Dis Sci 1997; 42: 1703-7.

  9. Puoti C, Guido M, Mangia A, Persico M, Prati D. Clinical management of HCV carriers with normal aminotransferase levels. Dig Liver Dis 2003; 35: 362-9.

  10. Bacon BR. Treatment of patients with Hepatitis C and normal serum aminotransferase levels Proc. of the NIH Consensus Conference Management of Hepatitis C. Hepatology 2002; 36(Suppl. 1). 5179-84.

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

  12. Huí 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: 511-7.

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

  14. Ghany MG, Kleiner DE, Alter H, Doo E, Khokar F, Promrat K, Herion D, et al. Progression of fibrosis in chronic hepatitis C. Gastroenterology 2003; 124: 97-104.

  15. Cividini A, Rebucci C, Silini E, Mondelli MU. Is the natural history of HCV carriers with normal aminotransferase levels really benign? Gastroenterology 2001; 121: 1526-7.

  16. Persico M, Palmentieri B, Coppola L, Di Giacomo Russo G, De Marino F, De Sio I, Torella L. Occurrence of HCC in asymptomatic HCV related chronic hepatitis. Dig Dis Sci 2002; 11: 2407-10.

  17. Puoti C, Bellis L, Martellino F, Durola L, Spilabotti L, Dell’Unto O, Galossi A, et al. Occurrence of HCC in an apparently healthy HCV carrier. Eur J Gastroenterol Hepatol 2005; 17: 1263-4.

  18. Persico M, Perrotta S, Persico E, Terraciano L, Folgori A, Ruggeri L, Nicosia A, et al. Hepatitis C virus carriers with persistently normal ALT levels: biological peculiarities and update of the natural history of liver disease at 10 years. J Viral Hep 2006; 13: 290-6.

  19. Dienstag JL, McHutchison JG. American Gastroenterological Association [AGA] Medical position statement on the management of hepatitis C. Gastroenterology 2006; 130: 225-64.

  20. Mangia A, Spinzi G, Vuturo O, Pazienza V, Iacobellis A, Piattelli M, Giacobbe A, et al. 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.

  21. Lee SS, Sherman M. Pilot Study of interferon-alpha and ribavirin treatment in patients with chronic hepatitis C and normal transaminase values. J Viral Hepat 2001; 8: 202-5.

  22. Hui CK, Monto A, Belaye T, Lau E, Wirght TL. Outcomes of interferon and ribavirin treatment for chronic hepatitis C in patients with normal serum aminotransferase. Gut 2003; 52: 1644-8.

  23. Jacobson IM, Ahmed F, Russo MW, Lebovics E, Dieterich DT, Esposito SP, Bach N, et al. Interferon alpha-2b and ribavirin for patients with chronic hepatitis C and normal ALT. Am J Gastroenterol 2004; 99: 1700-5.

  24. Alberti A, Bonino F, Bortolotti F, per la Commissione Terapia antivirale della Associazione Italiana per lo Studio del fegato (AISF). Trattamento della epatite da HCV. Available from: www.webaisf.org

  25. Puoti C, Pellicelli AM, Romano M, Mecenate F, Guarisco R, Barbarini G, Mazzoni E, et al. Treatment of hepatitis C virus carriers with persistently normal alanine aminotransferase levels with peginterferon alpha-2a and ribavirn: a multicentric study. Liver Int 2009; 29: 1479-84.

  26. EASL International Consensus Conference on Hepatitis C: Consensus Statement. J Hepatol 1999; 30: 956-61.

  27. National Institutes of Health Consensus Development Conference Panel Statement: Management of Hepatitis C. Hepatology 1997; 26 (Suppl.): 1335-65.

  28. Montalto G, Mazzola A, Soresi M, Consiglio P, Ruggeri M I, Ingrassia G, Cartabellotta A, et al. Antibodies to hepatitis C virus and histological pattern in Sicilian blood donors. Eur J Int Med 1994; 5: 299-304.

  29. Soresi M, Carroccio A, Bonfissuto G, Agate V, Magliarisi C, Aragona F, Levrero M, et al. Ultrasound detection of abdominal lymphadenomegaly in subjects with hepatitis C virus infection and persistently normal transaminases: a predictive index of liver histology severity. J Hepatol 1998; 28: 544-9.

  30. Gaiani S, Gramantieri L, Venturoli N, Piscaglia F, Siringo S, D’Errico A, Zironi G, et al. What is the criterion for differentiating chronic hepatitis from compensated cirrhosis? A prospective study comparing ultrasonography and percutaneous liver biopsy. J Hepatol 1997; 27: 679-85.

  31. Piscaglia F, Donati G, Serra C, Muratori R, Solmi L, Gaiani S, Gramantieri L, et al. Value of splanchnic Doppler ultrasound in the diagnosis of portal hypertension. Ultrasound Med Biol 2001; 27: 893-9.

  32. Li Vecchi V, Soresi M, Colomba C, Mazzola G, Colletti P, Mineo M, Di Carlo P, et al. Transient elastography: a non-invasive tool for assessing liver fibrosis in HIV/HCV patients. World J Gastroenterol 2010; 16: 5225-32.

  33. Coco B, Oliveri F, Maina AM, Ciccorossi P, Sacco R, Colombatto P, Bonino F, et al. Transient elastography: a new surrogate marker of liver fibrosis influenced by major changes of transaminases. J Viral Hepat 2007; 14: 360-9.

  34. Wai CT, Greenson JK, Fontana RJ, Kalbfleisch JD, Marrero JA, Conjeevaram HS, Conjeevaram HS, et al. A Simple Noninvasive Index can predict both significant fibrosis and cirrhosis in patients with chronic hepatitis C. Hepatology 2003; 38: 518-26.

  35. Knodell RG, Ishak KG, Black WC, Chen TS, Craig R, Kaplowitz N, Kiernan TW, et al. Formulation and application of a numerical scoring system for assessing histological activity in asymptomatic chronic active hepatitis. Hepatology 1991; 1: 431-5.

  36. Guidelines Sub-Committee. 1999 World Health Organization- International Society of Hypertension guidelines for the management of hypertension. J Hypert 1999; 17: 151-83.

  37. Alberti KG, Zimmet PZ. Definition, diagnosis and classification of diabetes mellitus and its complications. Part 1:diagnosis and classification of diabetes mellitus. Provisional report of a WHO consultation. Diabet Med 1998; 15: 539-53.

  38. Persico M, Persico E, Suozzo R, Conte S, De Seta M, Coppola L, et al. Natural history of Hepatitis C virus carriers with persistently normal aminotransferase levels. Gastroenterology 2000; 118: 760-4.

  39. Deuffic-Burban S, Babany G, Lonjon-Domanec I, Deltenre P, Canva-Delcambre V, Dharancy S, Louvet A, et al. Impact of pegylated interferon and ribavirirn on morbidity and mortality in patients with chronic hepatitis C and normal aminotransferases in France. Hepatology 2009; 50: 1351-599.

  40. Puoti C, Guarisco R, Spilabotti L, Bellis L. Sustained virological response following extremely short antiviral treatment in selected HCV carriers with persistently normal ALT. Dig Liver Dis 2010; 42: 745.




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