Review article: management of patients with chronic hepatitis C virus infection and ‘normal’ alanine aminotransferase activity

Abstract

Summary Background Hepatitis C virus infection, a major cause of chronic liver disease, occurs with normal serum alanine aminotransferase activity in approximately 25% of patients. These patients have historically remained untreated but substantial evidence indicates liver damage, progression of disease and impaired quality of life in some individuals. Aim To review the current management of patients with chronic hepatitis C and normal alanine aminotransferase activity. Methods This review represents the summary of discussions at a Clinical Workshop with a comprehensive literature searching of available databases (PubMed and Embase). Results Current limits defining normal serum alanine aminotransferase activity are not representative of a ‘healthy’ status. Most patients with hepatitis C and normal alanine aminotransferase levels have histologically proven liver damage that, although generally mild, may be significant (≥F2) in up to 20% of patients and progresses at approximately 50% of the rate in patients with elevated alanine aminotransferase levels. Some patients have persistently normal alanine aminotransferase activity and may have a more benign outcome, but a significant proportion (≥20%) experience periods of increased serum alanine aminotransferase activity which may be associated with enhanced disease progression. Conclusions A treatment approach that considers host and virus‐related variables and optimizes patient and cost benefits may therefore provide more effective management of patients with chronic hepatitis C and normal alanine aminotransferase activity.