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lüll Review article: management of patients with chronic hepatitis C virus infection and "normal" alanine aminotransferase activity Zeuzem S; Alberti A; Rosenberg W; Marcellin P; Diago M; Negro F; Prati D; Puoti C; Roberts SK; Shiffman MLAliment Pharmacol Ther 2006[Oct]; 24 (8): 1133-49BACKGROUND: Hepatitis C virus infection, a major cause of chronic liver disease, occurs with normal serum alanine aminotransferase activity in approximately 25% of patients. These patients have historically remained untreated but substantial evidence indicates liver damage, progression of disease and impaired quality of life in some individuals. AIM: To review the current management of patients with chronic hepatitis C and normal alanine aminotransferase activity. METHODS: This review represents the summary of discussions at a Clinical Workshop with a comprehensive literature searching of available databases (PubMed and Embase). RESULTS: Current limits defining normal serum alanine aminotransferase activity are not representative of a "healthy" status. Most patients with hepatitis C and normal alanine aminotransferase levels have histologically proven liver damage that, although generally mild, may be significant (> or =F2) in up to 20% of patients and progresses at approximately 50% of the rate in patients with elevated alanine aminotransferase levels. Some patients have persistently normal alanine aminotransferase activity and may have a more benign outcome, but a significant proportion (> or =20%) experience periods of increased serum alanine aminotransferase activity which may be associated with enhanced disease progression. CONCLUSIONS: A treatment approach that considers host and virus-related variables and optimizes patient and cost benefits may therefore provide more effective management of patients with chronic hepatitis C and normal alanine aminotransferase activity.|Alanine Transaminase/*blood[MESH]|Antiviral Agents/therapeutic use[MESH]|Drug Therapy, Combination[MESH]|Genotype[MESH]|Health Care Costs[MESH]|Hepatitis C, Chronic/*blood/drug therapy/pathology[MESH]|Humans[MESH]|Interferon alpha-2[MESH]|Interferon-alpha/therapeutic use[MESH]|Liver/pathology[MESH]|Motivation[MESH]|Polyethylene Glycols/therapeutic use[MESH]|Prognosis[MESH]|Recombinant Proteins[MESH]|Ribavirin/therapeutic use[MESH] |