Prevalence of Liver Disease in a Population of Asymptomatic Persons with Hepatitis C Virus Infection

17 December 2002 | Volume 137 Issue 12 | Pages 961-964

Background: The prevalence of significant liver disease in persons with asymptomatic hepatitis C virus (HCV) infection is unclear.

Objective: To determine the prevalence and severity of HCV infection in asymptomatic persons.

Design: Population-based cross-sectional study.

Setting: Northeastern Italy.

Patients: 4820 apparently healthy Telecom Italy employees or their relatives who underwent screening for cardiovascular risk factors.

Measurements: Initial screening for anti-HCV by enzyme-linked immunosorbent assay followed by HCV RNA testing by polymerase chain reaction and monitoring of alanine aminotransferase levels in viremic persons (92% of viremic persons also had liver biopsies to assess their METAVIR scores).

Results: 116 persons (2.4% [95% CI, 1.97% to 2.84%]) were positive for anti-HCV and 85 (1.76% [CI, 1.39% to 2.14%]) were also viremic. The ALT level was persistently normal in 39 (46%) of viremic patients and elevated in 46 (54%). Significant hepatic histologic abnormalities were detected in 19% (CI, 7.21% to 36.4%) of persons with persistently normal ALT levels and in 61% (CI, 45.4% to 74.9%) of viremic persons who had elevated ALT levels (P < 0.001). The prevalence of HCV infection and number of persons with chronic liver fibrosis increased with age (P = 0.003).

Conclusions: Hepatitis C is histologically active and progressive in up to 40% of asymptomatic persons with HCV infection. The severity of liver disease correlates with abnormal ALT levels and increases with age.

Editors' Notes Context Many persons infected with hepatitis C virus (HCV) are asymptomatic. The extent of liver disease in these persons is unclear. Contribution The researchers tested 4820 apparently healthy persons in Italy for hepatitis C virus. Among the 116 (2.4%) who tested positive, 85 were viremic; only about half of these 85 patients had elevated alanine aminotransferase (ALT) levels. Liver biopsy showed substantial inflammation or fibrosis in 19% of persons with normal ALT levels and 61% of persons with abnormal ALT levels. Implications The substantial prevalence of abnormal liver histology among asymptomatic persons is a provocative but incomplete rationale for screening for HCV. The prevalence of infection and the effectiveness of treatment are also important considerations. –The Editors

 

Author and Article Information

From University of Padova, Padova, Italy.

Grant Support: By a grant from the Consiglio Nazionale delle Ricerche (CNR), Rome, Italy.

Requests for Single Reprints: Alfredo Alberti, MD, Department of Clinical and Experimental Medicine, Clinica Medica 5, University of Padova, Via Giustiniani 2, 35100 Padova, Italy; e-mail, alfredo.alberti{at}unipd.it.

Current Author Addresses: Drs. Alberti, Noventa, Benvegnù, Boccato, and Gatta: Department of Clinical and Experimental Medicine, Clinica Medica 5, Via Giustiniani 2, 35128 Padova, Italy.

Author Contributions: Conception and design: A. Alberti.

Analysis and interpretation of the data: A. Alberti, L. Benvegnù.

Drafting of the article: A. Alberti.

Critical revision of the article for important intellectual content: A. Gatta.

Final approval of the article: A. Alberti, F. Noventa, L. Benvegnù, S. Boccato.

Provision of study materials or patients: S. Boccato.

Statistical expertise: F. Noventa.

Obtaining of funding: A. Alberti.

Collection and assembly of data: A. Alberti, F. Noventa.