Serum alanine aminotransferase level and response to interferon-ribavirin combination therapy in patients with chronic hepatitis C.

Objective: To determine the difference in sustained virological response to interferon-ribavirin combination therapy between patients with normal ALT and those with raised ALT in chronic hepatitis C.

Design: Quasi-experimental study.

Place And Duration Of Study: Department of Gastroenterology and Hepatology, Shaikh Zayed Postgraduate Medical Institute, Lahore, from February 2004 to June 2005.

Patients And Methods: Patients with positive HCV RNA by PCR and compensated liver disease were included and divided in two groups. One group with ALT below upper normal limit (UNL= 65U/L) and second group with raised ALT (> 1x UNL). After treatment with standard interferon alpha 2a and ribavirin, both groups were checked for sustained viral response (SVR) six months after end of treatment and compared for response to therapy with Chi square test.

Results: Of the 70 patients included, 25 had normal ALT (< 1 x upper normal limit UNL) and 45 had ALT above upper normal limit (> 1 x UNL). Of these, 63 patients completed treatment. Sustained viral response (SVR) was seen in 13 of 22 patients with normal ALT who completed therapy and 22 of 41 patients with raised ALT who completed treatment. Difference in SVR in two groups was not significant (p 0.679). When patients with raised ALT were sub-classified, significantly better response was seen in patients with ALT > or = 2 times the upper normal limit (p 0.021).

Conclusion: Patients with normal baseline ALT respond equally well to combination therapy as is seen in patients with raised ALT.