Long-term follow-up of patients with hepatitis C with a normal alanine aminotransferase

An attempt was made to identify factors influencing the cumulative probability of an increased alanine aminotransferase (ALT) level and hepatocarcinogenesis in hepatitis C patients with a normal ALT level initially. A total of 398 consecutive patients with a normal ALT level initially for 6 months or more and follow-up period longer than 3 years during the period January 1995 to December 2004 were included. Patients were classified by ALT level into three groups: Group A (3–20 IU/L), Group B (21–30 IU/L), and Group C (31–35 IU/L). Factors associated with the cumulative probability of increased ALT level and hepotocarcinogenesis were evaluated. Women in groups B and C and men in Group C showed high cumulative probabilities of increased ALT levels. Factors associated with increased ALT were a high ALT level (Group B, relative risk; 1.758 [95% confidence interval: 1.290–2.392], P < 0.001, Group C, 3.328 [2.256–4.909], P < 0.001), high lactate dehydrogenase level (2.352 [1.445–3.829], P = 0.001), or low total cholesterol level (1.957 [1.330–2.882], P = 0.001). Factors associated with incidence of hepatocellular carcinoma were increased age (3.088 [1.025–9.308], P = 0.045), high ALT level (Group C, 5.803 [1.530–22.066], P = 0.010), and high total bilirubin level (8.309 [2.235–30.888], P = 0.002). In patients with hepatitis C with a normal ALT level initially, an ALT level of 21–35 IU/L is a risk factor for an increased ALT level and hepatocarcinogenesis. J. Med. Virol. 81:446–451, 2009. © 2009 Wiley-Liss, Inc.