Histological findings and interferon treatment outcomes in patients with normal ALT levels and high viral load of HCV genotype 2

Abstract

Some cases of chronic hepatitis C with persistently normal ALT levels show an advanced stage of hepatic fibrosis when examined histologically. Thus the indication of antiviral therapy for this category of patients, particularly for those infected with HCV genotype 2 in view of its high sensitivity to interferon (IFN), has been much argued in recent years. We investigated for a correlation (s) between histologically determined stage of fibrosis (F0 to F3) and the IFN treatment outcomes in 24 patients with high viral load of HCV genotype 2, divided into two groups: 12 patients who had had persistently normal ALT levels (PNALT) and another 12 who had shown transient upsurges of ALT occasionally. As for fibrosis, just before treatment, there were 9 cases (75%) with F1 and 3 (25%) with F2, but none with F0 or F3 in each of the two groups of patients. Rate of sustained virological response (SVR) to the IFN-alpha 2b+ ribavirin therapy was similarly high in both groups (75% in PNALT and 83% in the other), while the time interval between initiation of therapy and disappearance of viremia was significantly shorter in the PNALT group. These findings warrant an indication of IFN therapy for PNALT patients with high viral load of HCV genotype 2.