A Prospective, Community–Based Evaluation of Liver Enzymes in Individuals With Hepatitis C After Drug Use

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Abstract
Serum alanine transaminase (ALT) levels are used to select hepatitis C virus (HCV)–infected patients for treatment and liver biopsy. However, the natural history of these measurements is poorly understood. To examine the hypothesis that ALT levels vary over time in HCV–infected patients, serial serum ALT levels were prospectively measured in a cohort of 1,235 persons with a history of prior illicit drug use. Over 25 months of follow–up, there was a median of four evaluations per patient. ALT values were higher in 1,164 (94%) HCV–infected individuals than in 71 (6%) HCV–uninfected individuals. The remainder of the analysis focused on these HCV–infected individuals, 647 (62%) of whom had normal ALT values at their initial visit. However, 323 (49%) of these had at least one elevated ALT over the next 25 months. Of the 395 patients whose ALT was initially abnormal, 332 (84%) had at least one normal value over the next 25 months. Overall, among individuals with four or more visits, ALT values were persistently normal in 42%, persistently elevated in 15%, and intermittently elevated in 43%. Because serum ALT levels have high visit–to–visit variability, single assessments should not be used to manage HCV–infected individuals. Further investigation is needed to ascertain the correlation of serial ALT trends with important disease outcomes.