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Prediction of a favorable clinical course in hepatitis C virus carriers with persistently normal serum alanine aminotransferase levels: A long-term follow-up study


Correspondence: Dr Yoshito Itoh, Molecular Gastroenterology and Hepatology, Kyoto Prefectural University of Medicine, Graduate School of Medical Science, Kawaramachi-Hirokouji, Kamigyou-ku, Kyoto 602-8566, Japan. Email:



This study examined serum alanine aminotransferase (ALT) levels at first visit and their relationship with long-term normal serum ALT levels in hepatitis C virus (HCV) carriers with persistently normal ALT (PNALT).


HCV carriers with PNALT were identified as those patients with positivity of serum HCV RNA, ALT levels of 30 IU/L or less over a 12-month period on at least three different occasions, platelet count of more than 15 × 104 μl/mL and body mass index of 30 kg/m2 or less. Outcome was retrospectively studied in 49 HCV carriers with PNALT, who were followed up for more than 10 years.


During the mean follow-up period of 14.7 ± 2.5 years, ALT levels of 30 IU/L or less were preserved in only eight patients (8/49; 16.3%). Among the 17 patients with initial ALT levels of 19 IU/L or less, nine patients remained with ALT levels of 30 IU/L or less after 10 years (9/17; 52.9%). The probability of ALT levels in PNALT being maintained at 30 IU/L or less was significantly higher (P = 0.001) in these patients than in those with initial ALT levels of 20 IU/L or more (n = 32). Abnormal ALT levels were more common in female PNALT patients aged 45–55 years, which is usually the time of menopause onset.


Because antiviral therapy in the treatment of chronic hepatitis C is rapidly advancing, waiting for more effective and safer treatments may be an option. The results of this study provide an important insight into this issue.