Assessment of liver histology in patients with hepatitis C and normal transaminase levels

Objective: To compare liver histology in patients with hepatitis C infection (HCV) between patients with normal and abnormal alanine aminotransferase (ALT) and examine its relationship with HCV genotype and route of infection. Methods: One hundred consecutive patients with known HCV presenting for diagnostic laparoscopy and liver biopsy were studied. Route of infection was noted and ALT measured on the day of biopsy and HCV genotype determined. Hepatic pathology was analysed using the Edinburgh scoring system (ESS). Results: Fifteen patients had normal ALT, of whom three (20%) had cirrhosis and 10 (66.7%) fibrosis. Of patients with raised ALT, cirrhosis and fibrosis were similarly found in 14 (16.5%) and 62 (72.9%) respectively. Severe, moderate and mild inflammation occured in one (6.7%), four (26.7%) and 10 (66.6%) patients with normal ALT compared with 17 (20%), 50 (58.8%) and 18 (21.2%) of those with raised ALT (P < 0.01). There was no significant difference in age, route of infection or genotype between those with normal and raised ALT levels. Conclusion: Of patients with normal ALT at time of liver biopsy, a significant minority have cirrhosis or significant hepatic inflammation. Liver biopsy is essential in HCV infection as a guide to both therapy and prognosis