It
has traditionally been assumed that individuals with persistently normal alanine
and aspartate aminotransferase (ALT and AST) levels have mild liver disease, and
physicians have traditionally recommended that such patients did not need treatment
for hepatitis C.
However,
it is well known that a proportion of individuals with normal aminotransferases
do nevertheless progress to advanced liver disease, and the development of more
effective hepatitis C therapy has shifted the risk-benefit calculation.
Past
studies have shown that chronic hepatitis C virus (HCV) infection is associated
with a reduction in health-related quality of life (HRQoL), but there has been
little research on quality of life specifically in patients with persistently
normal ALT/AST.
As
reported in the December 2006 Journal of Viral Hepatitis, German researchers
assessed quality of life in 115 patients with chronic hepatitis C (45 with persistently
normal ALT/AST and 70 with elevated aminotransferases) and 50 healthy HCV negative
subjects.
Emotional
and psychological states were assessed using the Profile of Mood States (POMS)
scale and HRQoL was assessed using the Everyday Life questionnaire (EDLQ), a validated
questionnaire related to the SF-36 Health Survey.
Results
"
Impaired HRQoL was observed in chronic hepatitis C patients with persistently
normal ALT compared with HCV negative subjects. " There were significant
differences for depression and anger scores on the POMS scale, as well as for
items related to body, relationship to partner, self-confidence, and zest of life
on the EDLQ. " Overall, no differences in scores were observed between
chronic hepatitis C patients with persistently normal versus elevated ALT. "
The sole exception was that hepatitis C patients with elevated aminotransferase
levels had a worse mean POMS anger score compared to those persistently normal
aminotransferases. " No association was observed between quality of life
and severity of liver disease.
Conclusion
In
conclusion, the authors wrote, "Impairment of HRQoL by chronic infection
with HCV is similar in patients with [persistently normal aminotransferases] and
those with elevated aminotransferase levels."
Klinik
fur Innere Medizin II, Universitatsklinikum des Saarlandes, Homburg, Germany.
1/19/07
Reference M
Von Wagner, J H Lee, B Kronenberger, and others. Impaired health-related quality
of life in patients with chronic hepatitis C and persistently normal aminotransferase
levels. Journal of Viral Hepatitis 13(12): 828-834. December 2006.
