Ambreen Arif, Waquaruddin Ahmed, Syed Ejaz Alam, Huma Qureshi.
Active disease in chronic hepatitis C patients with normal alanine aminotransferase.
J Coll Physicians Surg Pak Jan ;22(8):488-91.

Objective: To quantify liver damage using Metavir score, in chronic hepatitis C patients having normal alanine aminotransferase (ALT) to determine active disease requiring treatment. Study Design: An analytical study. Place and Duration of Study: Pakistan Medical Research Centre, JPMC, Karachi, from January 2007 - December 2010. Methodology: Patients suffering from hepatitis C with positive PCR, having persistently normal ALT on 3 separate occasions over a 6 months period and also having normal platelets and albumin were included in the study. After written consent, all patients underwent a liver biopsy and the degree of damage was assessed using Metavir scoring system. Results: A total of 99 patients suffering from chronic HCV were included in the study. A majority of the patients (55.6%) were females. Using Metavir score, minimal fibrosis of ² 1 was seen in majority (78.8%) of the patients. Only 21.2% patients had fibrosis score ³ 2, with 16 (47.1%) of these also having inflammatory score ³ 2 (p < 0.001). The age of patients (mean 38.1 ± 10.2 years) had a significant association with the severity of liver damage (p < 0.001) as compared to younger age group (mean 33.1 + 9.8 years). Conclusion: A large proportion of patients with normal ALT have insignificant fibrosis indicating non active disease and thus questions the blanket use of interferon in all HCV RNA cases. It is strongly recommended that a liver biopsy should be done in all cases with normal ALT before deciding antiviral therapy.

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