ABSTRACT
Approximately 30% of patients with chronic hepatitis C have normal serum alanine transaminase [ALT] levels; most of those patients have mild degrees of inflammation with mild or no fibrosis and the rate of disease progression is reduced compared to that in patients with elevated ALT levels. Is to study the histopathological characteristics of anti-HCV positive subjects with persistently normal aminotransferase levels in comparison with those patients having elevated aminotransferase levels. A comparative case control study was conducted on 80 patients who asked medical advice in outpatient clinics of National Liver Institute, Menoufiya University and Specialized Medical Hospital, Mansoura University. They were classified into two groups. Group I: were forty anti-HCV-positive subjects with normal enzymes. They were 28 males, 12 females. Their age ranged from 18 to 50 years with a mean age of 31 +/- 8.47 years. Group II: were forty chronic hepatitis C patients [31 males and 9 females] their age ranged between 17-53 years with a mean age 32.12 +/- 7.70 years with elevated ALT levels [one and half or more times of the upper limit of normal for at least six months], Both groups were subjected to thorough history taking and physical examination, complete blood counts [CBC], routine liver tests, abdominal ultrasound and percutaneous ultrasound guided liver biopsy to assess the severity of the necro-inflammatory process using histological activity index [HAT] of Knodell et al. and modification of Ishak et al. This research showed that the majority of anti-HCV positive patients with persistently normal ALT have histological features of minimal to mild necro-inflammation [HAT]. The severity of histological necro-inflammation is reduced in anti-HCV positive patients with persistently normal ALT compared with that of patients with elevated ALT levels. Also they have no or minimal to mild stage of fibrosis compared with that in patients with elevated ALT levels. Persistently normal ALT patients with steatosis had higher HAT grades and fibrosis stages than patients without steatosis and a significant correlation was found between steatosis and increased BMI. Moderate significant correlation was found between low platelet counts and fibrosis stage in patients with elevated ALT levels. The majority of anti-HCV positive patients with persistently normal ALT have histological-pathological changes of variant degrees of severity specially patients having steatosis. So it is recommended that patients with chronic hepatitis C should not be excluded from therapy based on ALT levels alone and the treatment must be individualized according to each patient