- Home>
- Specialties>
- Infectious Diseases>
- Summary and Comment
HIV/HCV Coinfection and Normal ALT Levels
Normal ALT levels in HIV/HCV-coinfected patients are not a reliable indicator that liver disease is mild.
Hepatitis C virus (HCV) coinfection is an important cause of liver-related morbidity and mortality in HIV-infected patients. In coinfected patients, are normal alanine aminotransferase (ALT) levels a reliable indicator that liver disease is mild? HCV-monoinfected patients with normal ALT levels have less necroinflammation and slower fibrosis progression than do those with elevated ALT. However, liver disease progresses more rapidly in HCV/HIV-coinfected patients than in HCV-monoinfected individuals.
In a cross-sectional study, researchers in New York City reviewed the medical records of 89 consecutive HIV/HCV-coinfected patients and 117 HCV-monoinfected patients, all of whom underwent liver biopsies. Similar proportions of HIV/HCV-coinfected and HCV-monoinfected individuals had normal ALT levels, averaged over the course of 1 year (21% and 18%, respectively). However, coinfected patients had significantly more-advanced necroinflammation and fibrosis than did HCV-monoinfected patients. As seen in previous studies, necroinflammation grades were lower in HCV-monoinfected individuals with normal ALT than in those with elevated ALT (P=0.01). In contrast, rates of advanced necroinflammation were similar between HIV/HCV-coinfected patients with normal ALT and those with elevated ALT (32% vs. 37% with grade 3 or 4 necroinflammation). Normal ALT levels were not associated with less-extensive hepatic fibrosis in either group.
Comment: Although a prospective longitudinal study would be more definitive, these findings demonstrate that HIV/HCV-coinfected patients with normal ALT levels frequently have advanced hepatic necroinflammation. A normal ALT level in this population is not a reliable indicator that necroinflammation is mild or moderate. Thus, in HIV/HCV-coinfected patients, normal ALT levels should not dissuade physicians from recommending further evaluation, including a staging liver biopsy.
— Rajesh T. Gandhi, MD
Dr. Gandhi is Assistant Professor of Medicine, Harvard Medical School, and Director of HIV Clinical Services and Education, Massachusetts General Hospital.
Published in Journal Watch Infectious Diseases June 22, 2006
Citation(s):
Gonzalez SA et al. HIV/hepatitis C virus–coinfected patients with normal alanine aminotransferase levels. J Acquir Immune Defic Syndr 2006 Apr 15; 41:582-9.
Your Remark:
To ensure that your Reader Remark is not formatted as one long paragraph, precede new paragraphs with either a blank line or an indentation.