Evaluation of liver histology, ALT elevation, and HCV RNA titer in patients with chronic hepatitis C

Objective: Hepatic histological evaluation is currently the gold standard to determine the degree of liver injury in chronic hepatitis C. It is unclear whether degree of serum ALT elevation or quantitative hepatitis C virus (HCV) RNA can predict level of histological damage. Methods: Fifty nine biopsies from 44 patients with chronic hepatitis C were reviewed. The amount of liver damage was quantified using the Histology Activity Index (HAI) and was compared with serum ALT and, in 26 biopsies, quantitative HCV RNA (branched DNA amplification, Quantiplex, Chiron). Results: A statistically significant linear relationship was noted between degree of ALT elevation and amount of liver injury based on HAl score (p < 0.05) although this relationship was not statistically strong (r(s) = 0.4900). No significant correlation was noted between serum ALT and HCV RNA titer (r(s) = 0.4044) or between quantitative HCV RNA titer and HAl score (r(s) = 0.3506). No individual component of the HAI correlated with ALT or HCV RNA. Conclusions: Although there is a correlation between serum ALT and degree of hepatic injury based on HAI score, this relationship is weak and probably of no clinical use. There is no significant correlation between HCV RNA and serum ALT or HCV RNA and degree of hepatic injury in individual patients. Hepatic histological evaluation continues to be required for clinical assessment of patients with chronic hepatitis C.