Viral and metabolic factors influencing alanine aminotransferase activity in patients with chronic hepatitis C

Daniele Prati, Mitchell L. Shiffman, Moisés Diago, Edward Gane, K. Rajender Reddy, Paul Pockros, Patrizia Farci, Christopher B. O'Brien, Pilar Lardelli, Steven Blotner, Stefan Zeuzem

Research output: Contribution to journalArticlepeer-review

44 Scopus citations


Background/Aims: In chronic hepatitis C, disease progression and clinical manifestations are heterogenous. To clarify the role and interactions of viral and host factors in inducing liver cell injury, we examined the associations of several virological and metabolic variables with serum alanine aminotransferase levels. Methods: Patients with chronic hepatitis C enrolled in three phase III clinical trials of peginterferon alfa-2a (40KD) plus ribavirin (two studies analysing 'elevated' and one persistently 'normal' alanine aminotransferase) were included. Results: Multivariate analyses of 2881 patients before treatment and of 1403 patients with a sustained virological response indicated that gender, viral factors (genotype, HCV RNA titer) and indicators of metabolic syndrome (body mass index, blood pressure, blood glucose, cholesterol and triglyceride concentration) were associated with alanine aminotransferase levels. In addition, hepatitis C virus infection influenced serum lipids concentration according to a genotype-specific effect. Conclusions: Heterogeneity in alanine aminotransferase levels in patients with chronic hepatitis C partially depends on the degree of derangement of fat and carbohydrate metabolism. As this is the result of an interaction of chronic hepatitis C infection with the patient's individual characteristics, treatment decisions should not be based on alanine aminotransferase level alone but rather on global evaluation of the patient.

Original languageEnglish (US)
Pages (from-to)679-685
Number of pages7
JournalJournal of Hepatology
Issue number4
StatePublished - Apr 2006


  • Cholesterol
  • Peginterferon alfa-2a (40KD)
  • Ribavirin
  • Sustained virological response
  • Triglyceride

ASJC Scopus subject areas

  • Gastroenterology


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