Increases in ALT Late in the Course of Interferon-based Therapy for Chronic Hepatitis C Predicts Relapse

By Liz Highleyman

ALT is an enzyme produced by hepatocytes (liver cells) under conditions of inflammation. Measured as an indicator of liver health, elevated ALT can signal liver injury due to a variety of causes including viral hepatitis and drug-related liver toxicity.

Monica Basso and colleagues from the University of Genoa in Italy studied 173 chronic hepatitis C patients who achieved virological clearance while undergoing interferon/ribavirin combination therapy.

Results

141 patients (58%) achieved SVR and 32 patients (13%) were initial responders who later relapsed.

Overall, 33% of study participants with undetectable HCV RNA had elevated ALT measured during at least 1 scheduled visit during a 24- or 48-week follow-up period (depending on HCV genotype).

The researchers found no association between ALT elevations during treatment and demographic features including age or sex, or with baseline clinical or viral parameters.

ALT elevations during the early weeks of treatment were not associated with sustained treatment response versus relapse.

From week 12 until the end of treatment, however, ALT elevations were 10 times more common among initial responders who relapsed than among sustained responders (90% vs 9%, respectively).

"The occurrence of elevated ALT levels in HCV-RNA-negative patients during pegylated interferon and ribavirin therapy is a fairly frequent and unpredictable phenomenon," the study authors concluded. "Although ALT elevation per se is not associated with a greater risk of relapse, its occurrence in the later phases of therapy is more common in relapsing patients."

7/17/09

Reference
M Basso, EG Giannini, F Torre, and others. Elevations in alanine aminotransferase levels late in the course of antiviral therapy in hepatitis C virus RNA-negative patients are associated with virological relapse. Hepatology 49(5): 1442-1448. May 2009.