Treatment of patients with hepatitis C and normal serum aminotransferase levels

Authors

  • Bruce R. Bacon M.D.

    Corresponding author
    1. Division of Gastroenterology and Hepatology, St. Louis University Liver Center, St. Louis University School of Medicine, St. Louis, MO
    Current affiliation:
    1. Dr. Bacon is a consultant for Schering Plough, Akros Pharma, and Maxim Pharmaceuticals. He has been an ad hoc consultant for Bayer Diagnostics and Serono International and is on the Scientific Advisory Board of Metaphore Pharmaceuticals, Genetrol Biotherapeutics, and Maxim Pharmaceuticals. He has received research support from Schering Plough, Hoffmann La-Roche, Gilead Sciences, Bristol-Myers Squibb, GlaxoSmithKline, and Amgen
    • St. Louis University Liver Center, St. Louis University School of Medicine, 3635 Vista Ave. at Grand Blvd., St. Louis, MO 63110–0250. fax: 314–577–8125
    Search for more papers by this author

Abstract

Approximately 30% of patients with chronic hepatitis C have normal serum alanine aminotransferase (ALT) levels and another 40% have ALT levels that are less than twice the upper limit of the normal range. Most patients with normal ALT levels have mild degrees of inflammation with mild or no fibrosis, and the rate of disease progression is reduced compared with that in patients with elevated ALT levels. Some patients with normal ALT levels have advanced fibrosis and cirrhosis on liver biopsy. Treatment of patients with normal ALT levels with either interferon monotherapy or interferon/ribavirin combination therapy has shown sustained virological response (SVR) rates that are equivalent to those achieved for patients with elevated ALT levels. Thus, patients with chronic hepatitis C should not be excluded from therapy based on ALT levels alone. The decision to initiate therapy with interferon and ribavirin should be based on a combination of factors independent of ALT levels including amount of fibrosis on liver biopsy, hepatitis C virus (HCV) genotype and viral level, patient age and motivation, and co-morbid illness, and the presence of other complicating conditions. (HEPATOLOGY 2002;36:S179–S184).

Ancillary

Advertisement