Clinical

Liver fibrosis found in HIV/HCV-coinfected patients with normal ALT

Last Updated: 2006-02-10 16:11:21 -0400 (Reuters Health)

NEW YORK (Reuters Health) - One quarter of individuals infected with both HIV and hepatitis C virus (HCV) with persistently normal alanine aminotransferase (ALT) levels have liver fibrosis in need of treatment, report Italian investigators from the San Raffaele Scientific Institute in Milan.

"Little is known" about liver disease in the subpopulation of HIV/HCV-coinfected patients with persistently normal ALT values, Dr. Caterina Uberti-Foppa and colleagues explain in the January 1st issue of the Journal of Acquired Immune Deficiency Syndromes.

To "better define liver disease" in HIV/HCV-coinfected patients with persistently normal ALT levels, they reviewed liver biopsies from 326 coinfected patients of similar age, gender, and risk factors, who had persistently normal (n = 24) or elevated (n = 302) ALT values for 12 months before liver biopsy.

Analysis of liver biopsies revealed some degree of liver fibrosis in 70% of patients with persistently normal ALT values. Twenty-five percent of these patients required treatment.

Although overall histologic abnormalities in patients with persistently normal ALT levels were milder than those observed in patients with elevated ALT levels, roughly 12% of patients with consistently normal ALT readings had "incomplete and frank cirrhosis."

In these subjects, older age and CD4+ T-cell count less than 500 cells per microliter were independently associated with a stage of liver fibrosis fulfilling histologic criteria for anti-HCV treatment. "These parameters may help to select difficult-to-treat persistently normal ALT patients eligible for liver biopsy," the investigators suggest.

They also point out patients with normal ALT levels showed a "heterogeneous progression of HCV-related liver disease, ranging from high stable clinical status for 5 years after liver biopsy to fast progression and even lethal evolution during the same interval."

These observations "highlight the threat hidden by persistently normal ALT levels, which are too often considered a sign of well-balanced liver status in HIV-positive subjects with chronic HCV infection," Dr. Uberti-Foppa and colleagues conclude.

J Acquir Immune Defic Syndr 2006;41:63-67.