• antiviral therapy;
  • chronic hepatitis C;
  • hepatitis C virus carriers;
  • normal serum aminotransferase;
  • platelet count

Aim:  We aimed to identify the candidates for antiviral therapy, among patients who are hepatitis C virus (HCV) carriers with normal serum aminotransferase (ALT), focused on the inhibition of hepatocellular carcinoma (HCC).

Methods:  Four hundred and sixty-four HCV carriers with normal serum ALT and 129 HCV carriers with persistently normal ALT (PNALT) and platelet (PLT) counts ≥150 000/μL who received liver biopsies were enrolled. HCV carriers with normal serum ALT were divided into four groups according to their ALT levels (≤30 U/L or 31–40 U/L) and PLT counts (≥150 000/μL or <150 000/μL).

Results:  In 129 HCV carriers with PNALT, the rate of progression of fibrosis stage was 0.05/year and no HCC was detected during the follow up for 10 years. Approximately 20% of patients with ALT ≤40 U/L and PLT counts ≥150 000/μLwere at stage F2–3; however, approximately 50% of patients with ALT ≤ 40 U/L and PLT counts <150 000/μL were at stage F2–4. An algorithm for the management of HCV carriers with normal serum ALT was advocated based on ALT and PLT counts.

Conclusion:  The combination of ALT and PLT counts is useful for evaluating the fibrosis stage in HCV carriers with normal serum ALT. Most patients with PLT counts <150 000/μL are candidates for antiviral therapy, especially those with ALT levels ≥31 U/L when we focus on the inhibition of the development of HCC.