Subjects positive for hepatitis C virus RNA with normal aminotransferase levels, a “trompe l'oeil” clinical picture?

Abstract

Background. Quite often subjects affected by chronic hepatitis C virus infection have no clinical signs of liver disease and serum aminotransferase values never go beyond the upper limit of normal. Yet these subjects, defined “asymptomatic HCV carriers”, often have active viral replication and various degrees of histological damage. Aims. To verify, in a population of antibody to hepatitis C virus carriers, if normal serum aminotransferase values in hepatitis C virus-RNA positive differed considerably from those in hepatitis C virus-RNA negative subjects. Subjects/Methods. We followed 24 anti-hepatitis C virus-positive subjects (15 hepatitis C virus-RNA positive and 9 negative) by measuring alanine and aspartate aminotransferase levels at 3-month intervals for a median of 40 months (range 6–77). Results. Determinations resulted repeatedly and rigorously within the normal range in all participants. Alanine aminotransferase values were higher in hepatitis C virus-RNA positives than in negatives (mean ± SD: 0.609±0.172 vs 0.434±0.153 times the upper limit of normal; p<O.001). Aspartate aminotransferase values in both groups reflected the same consistent difference (mean ± SD: 0.652±0.170 vs 0.528±0.151 times the upper limit of normal; p<0.001). Conclusions. Our findings demonstrate that biochemical activity exists in asymptomatic hepatitis C virus-RNA positive carriers, but it is so slight that serum aminotransferase levels do not go beyond the upper limit of normal. With the prevailing range of normality, serum aminotransferase determination is a helpful but not reliable marker of disease activity in chronic hepatitis C virus infection. The normal range for aminotransferases needs to be redefined in order to set up a more accurate diagnostic profile of subjects with chronic hepatitis C virus infection.