Summary
This study was designed to evaluate serum HCV-RNA, liver histology, and RIBA-II pattern in asymptomatic anti-HCV positive subjects with persistently normal or slightly (i.e. ≤1.5 times the upper limit of the normal range) elevated serum ALT levels. To this purpose, 22 asymptomatic anti-HCV positive subjects (11 men and 11 women, median age 40, range 21–70 years) underwent liver biopsy and determination of serum HCV-RNA. Positivity for anti-HCV was determined by ELISA-2 and by RIBA-II. Serum HCV-RNA was determined by PCR. Our data show that: 1) 9/22 symptom-free, anti-HCV positive subjects had histological features of chronic liver disease associated with ongoing HCV infection; 2) four subjects had no histological signs of chronic hepatitis and normal serum ALT levels despite positivity for serum HCV-RNA; 3) serum ALT levels did not discriminate HCV-RNA positive subjects with from those without chronic hepatitis; 4) in anti-HCV positive subjects with normal serum ALT levels, a positive RIBA-II pattern was not always predictive of HCV viraemia or chronic hepatitis while an indeterminate RIBA-II pattern was frequently associated with nonspecific liver changes or normal histology. In conclusion, based on these findings, “true” healthy carriers of HCV (i.e. subjects with normal serum ALT levels and no histological features of chronic hepatitis despite HCV viraemia) may exist.
Zusammenfassung
Bei asymptomatischen, anti-HCV positiven Personen mit andauernd normalen oder leicht (das heißt ≤1,5 fach über der oberen Normgrenze) liegenden Serum ALT-Spiegeln wurden die HCV-RNA im Serum, Leberhistologie und das RIBA-II-Muster untersucht. Bei 22 asymptomatischen, anti-HCV positiven Personen (11 Männern und 11 Frauen im mittleren Alter von 40; Bereich 21–70 Jahren) wurde eine Leberbiopsie durchgeführt und HCV-RNA im Serum bestimmt. Der Nachweis von anti-HCV wurde mit ELISA-2 und RIBA-II-Tests geführt. Die HCV-RNA im Serum wurde mittels PCR bestimmt. Unsere Untersuchungen zeigten, 1.) daß 9/22 asymptomatischen, anti-HCV-positiven Personen histologische Zeichen einer chronischen Lebererkrankung mit fortbestehender HCV-Infektion hatten. 2.) Vier Personen hatten keine histologischen Zeichen einer chronischen Hepatitis und normale Serum-ALT-Spiegel trotz Nachweises von HCV-RNA im Serum. 3.) Die ALT-Spiegel im Serum unterschieden HCV-RNA positive Personen mit chronischer Hepatitis nicht von denjenigen ohne chronische Hepatitis. 4.) Bei anti-HCV positiven Personen mit normalen ALT-Spiegeln ist ein positiver RIBA-II Test nicht immer mit einer HCV-Virämie oder einer chronischen Hepatitis assoziiert. Bei unklarem RIBA-II-Muster bestanden häufig unspezifische Leberveränderungen oder ein normaler histologischer Befund. „Wirklich“ gesunde Träger von HCV (das heißt, Personen mit normalem Serum ALT-Spiegel, ohne histologische Zeichen einer chronischen Hepatitis trotz HCV Virämie) können folglich vorkommen.
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Coltorti, M., Romano, M., Persico, M. et al. Hepatitis C virus RNA in serum and liver histology in asymptomatic anti-HCV positive subjects. Infection 23, 33–36 (1995). https://doi.org/10.1007/BF01710055
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DOI: https://doi.org/10.1007/BF01710055