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Natural Course of Hepatitis C Virus-infected Patients with
Normal ALT and the Effect of Interferon Therapy on Hepatocellular
Carcinoma in Those with Elevated ALT
A long-term follow-up study was performed
to identify the natural course of chronic HCV carriers with
persistently normal serum ALT level (PNAL >/= 30 U/L) and to clarify the effect of interferon
therapy on the inhibition of the development of
hepatocellular
carcinoma (HCC) in chronic hepatitis C patients with elevated ALT levels.
One
hundred twenty-nine HCV carriers with PNAL underwent liver biopsy, 69 were followed for more than 5 years, and 35 underwent serial
liver biopsies. We included 1246 chronic hepatitis C patients
(stage F1: 231, F2: 638, F3: 336, F4: 41) who received interferon
therapy and were followed for more than 2 years (mean, 7.7
years).
Results
Approximately 90%
of HCV carriers with PNAL had normal to mild liver histology,
and 30% developed symptomatic chronic hepatitis C within 5
years.
The frequency of
steatosis and iron loading was significantly lower
in these patients than in symptomatic chronic hepatitis C
patients.
The progression
rate of fibrosis was slower than in chronic hepatitis C patients
with elevated serum ALT levels.
HCC was noted in
157 chronic hepatitis C patients after interferon therapy,
and the development of HCC was significantly reduced in both
sustained
responders and transient biochemical responders compared
with nonresponders.
HCC
in sustained responders mainly developed in male patients
older than 55 years with advanced stage liver histology at
entry.
In
conclusion, the authors write, “Approximately 30% of HCV-infected
patients with PNAL become candidates for antiviral therapy
within 5 years.”
“Interferon
therapy lowers the rate of the development of HCC in both
sustained responders and transient biochemical responders.”
Department of Molecular Gastroenterology
and Hepatology, Graduate School of Medical Science, Kyoto
Prefectural University of Medicine, Kyoto, Japan.
10/20/05
Reference
T
Okanoue and others. Natural course of asymptomatic hepatitis
C virus-infected patients and hepatocellular carcinoma after
interferon therapy. Clinical Gastroenterology and Hepatology 3 Suppl 2: S89-91. October 2005.
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