Clinical Significance of Elevated Serum Aminotransferases Levels in Asymptomatic Individuals with Hepatitis C Infection

Abstract

Background: Hepatitis C is a common and important cause of chronic liver disease that often remains asymptomatic and most of the times discovered incidentally by routine serologic or biochemical testing. Aminotransferases (AST and ALT) reflect alterations in liver function/inflammation in liver diseases. The current study was conducted to examine the utilization and limitations of these biochemical markers in subjects with asymptomatic HCV infection.
Aims and Objectives: To find out how many subjects with asymptomatic HCV infection have normal or elevated serum AST and ALT levels.
Subjects and Methods:
Study Design: Cross sectional.
Study Duration: Seven months from November 2008 to July 2009.
Study Universe: Services Hospital, Lahore.
Study Population: This study included 413 subjects attending the outpatient departments of hospital with minor complaints. The random population of subjects was referred to the clinical laboratory of Services Hospital, Lahore for LFTs, HBsAg and anti-HCV screening from OPD department of the hospital. A total of 413 persons of all ages were analyzed during this study. There were 263 subjects who were sero – positive for anti-HCV (141 females, 122 males; median age 35 ± 11.34 years) and 150 in the control group (80 of them were females and 70 males with median age 32 ± 12.97 years) were sero-negative for both HBsAg and anti – HCV.
Subjects Selection Criteria: In this study, only anti – HCV sero – positive subjects were included who was sero – negative for HBsAg or dual infection (both HBsAg and anti – HCV) and not on anti – viral therapy. Control group was sero – negative for both – HBsAg and anti – HCV antibodies.
Data Collection: We assayed levels of serum aminotransferases (AST and ALT) and screened blood for HBsAg and anti-HCV. ELISA technique was used for viral hepatitis markers.
Results: Out of 263 subjects tested positive for anti-HCV antibodies in their blood, 90.76 % and 87.45 % had elevated AST and ALT levels (ALT ≥ 40 U/L) respectively. Similarly, 9.23% and 12.54% had serum AST and ALT levels < 40 U/L. Fre-quency of elevated AST and ALT levels in individuals who were sero – negative for both infections (HBV or HCV) were 10.66% and 13.33%, respectively. 56.95% of anti – HCV antibody positive subjects had serum ALT elevation of less than two times the upper level of normal (ALT ≤ 80 U/L).
Conclusion: The current study revealed that 90.76% and 87.45% had elevated AST and ALT levels (ALT ≥ 40 U/L) respec-tively. We concluded from this study that biochemical markers (AST, ALT and AST: ALT ratios) are useful, dependable and highly specific parameters for monitoring HCV infected patients (particularly asymptomatic) and frequent retesting is recom-mended to assess progression or regression of chronic liver disease.
Key words: HCV infection, AST and ALT, clinical significance, prognosis.