ABSTRACT
Introduction: Approximately 30 to 40% of patients with Chronic Hepatitis "C" [CHC] have persistently normal serum alanine aminotransferase [ALT] levels. Historically, these patients have been classified as healthy or asymptomatic and have not received any treatment for CHC infection. However, definition and clinical significance of persistently normal ALT in CHC have been recently revised as new information on liver disease which is now getting available
Aims: To evaluate the histological feature of liver of patients suffering from CHC with persistently normal ALT levels
Methods: In this prospective observational study we recruited consecutive patients infected with CHC with persistently normal ALT since last six months, visited our hepatology clinic from September 2004 to April 2005. The METAVIR scoring system was used for liver histology grading [degree of inflammation] and staging [degree of fibrosis]
Results: A total of 55 patients were recruited from outpatient clinic with normal ALT during a follow up of six months. Mean age of these patients was 36.7+/- 9.78 years; out of these 39 [70.9%] were male. All these patients were diagnosed to have hepatitis C by HCV RNA PCR method. There were 24 [43.6%] patients with stage [fibrosis] equal or greater than 2 and 33 [60%] had biopsy grade equal or greater than 2. Eighteen [32.7%] patients had steatosis on liver biopsy. Twelve patients with stage > 2 had steatosis while 6 patients with stage < 2 had steatosis [p< 0.01]
Conclusion: There was no correlation found between the transaminase level and biopsy scores. Approximately 44 % of the patients have fibrosis equal to or greater than stage 2. The extent of steatosis is directly related to the biopsy score of the patients