Digestive Diseases and Sciences

, Volume 42, Issue 8, pp 1703-1707

First online:

Serum HCV-RNA and Liver Histologic Findings in Patients with Long-Term Normal Transaminases

  • G. Montalto
  • , A. Linda Zignego
  • , M. Irene Ruggeri
  • , C. Giannini
  • , M. Soresi
  • , Monica Monti
  • , A. Carroccio
  • , Grazia Careccia
  • , Daniela Di Martino

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In this study we aimed to correlate liverhistology and the presence of hepatitis C virus (HCV)viremia, genotype, and quantity of HCV genome in 19positive and 11 RIBA II indeterminate patientspresenting persistently normal ALT values over 24 monthsbefore biopsy. In addition, after biopsy serum ALTvalues were monitored monthly for a mean follow-upperiod of 24.8 months, after which patients werereevaluated for RIBA II and the presence of viremia.Sixteen patients (53%) were serum HCV-RNA-positive; 13of them (68%) were confirmed positive and 3 (27%)indeterminate on RIBA II. Histology of the HCV-RNA-positive patients showed eight cases of CPH (one case ofgenotype 1a; four cases type 1b; three cases type 2),six cases of CAH (three cases type 1b, three cases type2), one case of CLH (type not determined), and one case of normal liver (NL) (type 1b).Histology of the HCV-RNA-negative patients showed fourcases of CPH, one case of CAH, two cases of CLH, andseven cases of NL. During the follow-up period ninepatients (30%) presented slight increases in ALT values(<2 × N), and in particular, flares of ALT wereobserved four times in the CAH and five times in the CPHpatients, who were all viremic, but never in the NL subjects. These results indicate that subjectspositive on RIBA II, but with persistently normal ALTvalues, had a high probability of being serumHCV-RNA-positive and that almost all these viremicsubjects presented histologic signs of liver disease. Incontrast, RIBA II indeterminate subjects had a moderateprobability of being HCV-RNA-positive, but a number ofthese may present signs of liver disease. In both cases there was no association withgenotype or HCV-RNA serum levels. The other nonviremiccases included subjects with hepatic changes goingtoward resolution or with normal liver in whom hepatic biopsy can be avoided. Only one case was a truecarrier since he was viremic with normal liver andpersistently normal ALT values.