Preventive Female Sex Factors Against The Development of Chronic Liver Disease

HCV Carriers With Normal Alanine Aminotransferase Levels

Author(s): Claudio Puoti

Pp: 37-50 (14)

DOI: 10.2174/978160805293611201010037

* (Excluding Mailing and Handling)

Abstract

Approximately 30% of patients with chronic hepatitis C virus (HCV) infection show persistently normal alanine aminotransferase (ALT) levels. Although formerly referred to as ‘healthy’ or ‘asymptomatic’ HCV carriers, and thus historically excluded from antiviral treatment, it has now become clear that the majority of these patients have some degree of histological liver damage.

Although liver disease is usually minimal/mild and fibrosis is generally absent or minimal, the natural history of HCV carriers with persistently normal ALT levels (PNALT) is probably not always so benign, and the possibility of a more severe evolution of liver disease among patients with PNALT cannot be ruled out. Several studies reported a significant progression of fibrosis in approximately 20- 30% of the patients with well-defined ALT normality, and the development of hepatocellular carcinoma in some cases has been described, despite persistent ALT normality. Sudden worsening of disease with ALT increase and histological deterioration has been described after up to 15 years of follow-up.

Recent studies have shown that combined antiviral treatment with pegylated interferon plus ribavirin might allow a sustained virological response in up to 70-80% of patients harboring HCV type 2 or 3, and approximately 50% of those infected with genotype 1. Thus, the advent of these new therapeutic options has shifted treatment targets toward eradication of underlying infection, with therapy decision based on age, severity of disease and likelihood of response rather than on aminotransferase levels.


Keywords: Alanine aminotransferase, carrier, cirrhosis, fibrosis, HCV, Hhpatitis, healthy, interferon, normal, ribavirin, virological response

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      • 13. vendor/laravel/framework/src/Illuminate/Routing/Controller.php:54
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      • 11. app/Models/ContentAccess.php:647
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      • 13. app/Models/UserAccess/UserAccess.php:1266
      • 14. app/Http/Controllers/ChapterController.php:1518
      • 15. vendor/laravel/framework/src/Illuminate/Routing/Controller.php:54
      • 16. vendor/laravel/framework/src/Illuminate/Routing/ControllerDispatcher.php:43
      • 17. vendor/laravel/framework/src/Illuminate/Routing/Route.php:260
    • (select j.user_access_id,j.volume_id,j.user_id,j.from_ip,j.to_ip,j.type,j.track,"Trial Access" as access_base_text, CASE j.type WHEN 111 THEN true ELSE false END as terms_popup, "S" as content_download_type, null as restricted_user_access_key, null as restricted_user_access_type, CASE j.track WHEN 0 THEN false ELSE true END as tracksAccessByVolume,"chapter" as access_level, j.chapter_id from `user_access_chapter_trail` as `j` inner join `user_access_info` as `info` on `j`.`user_access_id` = `info`.`user_access_id` where ((j.from_ip <= 51271683 and j.to_ip >=51271683 )) and ((j.from_date <= 1740774520 and j.to_date >= 1740774520 and j.perpetual= 0) or (j.from_date is null and j.to_date is null and j.perpetual= 1)) and j.chapter_id = 430) union (select j.user_access_id,j.volume_id,j.user_id,j.from_ip,j.to_ip,j.type,j.track,"Subscribed" as access_base_text, false as terms_popup, "S" as content_download_type, null as restricted_user_access_key, null as restricted_user_access_type, CASE j.track WHEN 0 THEN false ELSE true END as tracksAccessByVolume,"chapter" as access_level, j.chapter_id from `user_access_chapter_corporate` as `j` inner join `user_access_info` as `info` on `j`.`user_access_id` = `info`.`user_access_id` where ((j.from_ip <= 51271683 and j.to_ip >=51271683 )) and ((j.from_date <= 1740774520 and j.to_date >= 1740774520 and j.perpetual= 0) or (j.from_date is null and j.to_date is null and j.perpetual= 1)) and j.chapter_id = 430) union (select j.user_access_id,j.volume_id,j.user_id,j.from_ip,j.to_ip,j.type,j.track,"Token Based Access" as access_base_text, false as terms_popup, "R" as content_download_type, j.uc_id as restricted_user_access_key, "v" as restricted_user_access_type, CASE j.track WHEN 0 THEN false ELSE true END as tracksAccessByVolume,"chapter" as access_level, j.chapter_id from `user_access_chapter_token` as `j` inner join `user_access_info` as `info` on `j`.`user_access_id` = `info`.`user_access_id` where ((j.from_ip <= 51271683 and j.to_ip >=51271683 )) and ((j.from_date <= 1740774520 and j.to_date >= 1740774520 and j.perpetual= 0) or (j.from_date is null and j.to_date is null and j.perpetual= 1)) and j.chapter_id = 430)
      600μsalphaeurekaselec_live_10_06_2022UserAccess.php#1266
      Backtrace
      • 13. app/Models/UserAccess/UserAccess.php:1266
      • 14. app/Http/Controllers/ChapterController.php:1549
      • 15. vendor/laravel/framework/src/Illuminate/Routing/Controller.php:54
      • 16. vendor/laravel/framework/src/Illuminate/Routing/ControllerDispatcher.php:43
      • 17. vendor/laravel/framework/src/Illuminate/Routing/Route.php:260
    • select b.banner_link, b.banner_name, b.banner_script, b.banner_remarks, b.banner_file_name, b.banner_placement, bd.content_type, bd.content_id from `tbl_banner` as `b` inner join `tbl_banner_detail` as `bd` on `bd`.`banner_id` = `b`.`banner_id` inner join `users` as `u` on `u`.`id` = `b`.`updated_by` where `b`.`banner_ebook` = 1 and `bd`.`content_type` = 'B' and `bd`.`content_id` = 821 and `b`.`banner_from_date` <= 1740774520 and `b`.`banner_to_date` >= 1740774520 and `b`.`banner_status` = 'A' order by `b`.`banner_id` desc
      1.2msalphaeurekaselec_live_10_06_2022Banner.php#95
      Bindings
      • 0: 1
      • 1: B
      • 2: 821
      • 3: 1740774520
      • 4: 1740774520
      • 5: A
      Backtrace
      • 13. app/Models/Banner.php:95
      • 14. app/Http/helpers.php:404
      • 17. vendor/laravel/framework/src/Illuminate/Filesystem/Filesystem.php:124
      • 18. vendor/laravel/framework/src/Illuminate/View/Engines/PhpEngine.php:58
      • 19. vendor/laravel/framework/src/Illuminate/View/Engines/CompilerEngine.php:73
    • select count(*) as aggregate from `uc_cart_products` where cart_id='90f20bea59ec2fa0715f994a1dbf7162'
      430μsalphaeurekaselec_live_10_06_2022Cart.php#271
      Backtrace
      • 15. app/Models/Cart.php:271
      • 16. view::layouts._header:291
      • 18. vendor/laravel/framework/src/Illuminate/Filesystem/Filesystem.php:124
      • 19. vendor/laravel/framework/src/Illuminate/View/Engines/PhpEngine.php:58
      • 20. vendor/laravel/framework/src/Illuminate/View/Engines/CompilerEngine.php:73
    App\Models\Keywords
    11Keywords.php#?
    App\Models\Chapter
    1Chapter.php#?
    App\Models\Ebook
    1Ebook.php#?
        _token
        JCfK8C5CLZ25L1GTFf6cwlGFcYHuN2b5DgF9m0cz
        uc_cart_id
        90f20bea59ec2fa0715f994a1dbf7162
        _previous
        array:1 [ "url" => "https://alpha.eurekaselect.com/chapter/430" ]
        _flash
        array:2 [ "old" => [] "new" => [] ]
        PHPDEBUGBAR_STACK_DATA
        []
        path_info
        /chapter/430
        status_code
        200
        
        status_text
        OK
        format
        html
        content_type
        text/html; charset=UTF-8
        request_query
        []
        
        request_request
        []
        
        request_headers
        0 of 0
        array:17 [ "x-https" => array:1 [ 0 => "1" ] "host" => array:1 [ 0 => "alpha.eurekaselect.com" ] "priority" => array:1 [ 0 => "u=0, i" ] "cookie" => array:1 [ 0 => "wayfindertarget=eyJpdiI6IkwyVXVhN29OamlvM1pQNTYxR2o0S1E9PSIsInZhbHVlIjoid3dkSUJCMTM4MW1rcmYyOUovQ0pML3QrcVMwUUVPNnlkbHlPYWRnL1RVND0iLCJtYWMiOiIxYjc2MzE2Y2U0NzU4M2FmM2QzZmU0MzY2M2VhNDkzYmFlNTkxMWIzOTFiMmQ0NjRjZWIwNjk5NmYxZWNmM2NmIiwidGFnIjoiIn0%3Dwayfindertarget=eyJpdiI6IkwyVXVhN29OamlvM1pQNTYxR2o0S1E9PSIsInZhbHVlIjoid3dkSUJCMTM4MW1rcmYyOUovQ0pML3QrcVMwUUVPNnlkbHlPYWRnL1RVND0iLCJtYWMiOiIxYjc2MzE2Y2U0NzU4" ] "accept-encoding" => array:1 [ 0 => "gzip, deflate, br, zstd" ] "sec-fetch-dest" => array:1 [ 0 => "document" ] "sec-fetch-user" => array:1 [ 0 => "?1" ] "sec-fetch-mode" => array:1 [ 0 => "navigate" ] "sec-fetch-site" => array:1 [ 0 => "none" ] "accept" => array:1 [ 0 => "text/html,application/xhtml+xml,application/xml;q=0.9,image/avif,image/webp,image/apng,*/*;q=0.8,application/signed-exchange;v=b3;q=0.7" ] "user-agent" => array:1 [ 0 => "Mozilla/5.0 AppleWebKit/537.36 (KHTML, like Gecko; compatible; ClaudeBot/1.0; +claudebot@anthropic.com)" ] "upgrade-insecure-requests" => array:1 [ 0 => "1" ] "sec-ch-ua-platform" => array:1 [ 0 => ""Windows"" ] "sec-ch-ua-mobile" => array:1 [ 0 => "?0" ] "sec-ch-ua" => array:1 [ 0 => ""HeadlessChrome";v="129", "Not=A?Brand";v="8", "Chromium";v="129"" ] "cache-control" => array:1 [ 0 => "no-cache" ] "pragma" => array:1 [ 0 => "no-cache" ] ]
        request_cookies
        0 of 0
        array:1 [ "wayfindertarget" => null ]
        response_headers
        0 of 0
        array:5 [ "content-type" => array:1 [ 0 => "text/html; charset=UTF-8" ] "cache-control" => array:1 [ 0 => "no-cache, private" ] "date" => array:1 [ 0 => "Fri, 28 Feb 2025 20:28:40 GMT" ] "set-cookie" => array:2 [ 0 => "XSRF-TOKEN=eyJpdiI6IlJETTR4WXlReHB2TnhHbkQ4TUdoQVE9PSIsInZhbHVlIjoidFdNWXhxTzlrK2NDQWx5ekpjVmNmZnA0L21IUVBrSDdZZUNydWlTQXA2THRqUGxHTjgzbldHNzUyZllxSU92MURZUk5oNnF5ZTNDY2g1RWhGWkZyRFRNM1EzY1NKbjZOZE9nQ2VjVEZMQWpmbE04bnRDbFVyNVVpbGlTOThwY2IiLCJtYWMiOiIxNmIyMjdiZmJmODRjNzc0ZWEwYmRmZjBjMzllMjRmMTBmYTQyNzRjZDI2YTg3ODYzZmVlMzQ2YmNmMTMwZWQ3IiwidGFnIjoiIn0%3D; expires=Mon, 03 Mar 2025 08:28:40 GMT; Max-Age=216000; path=/; secure; samesite=laxXSRF-TOKEN=eyJpdiI6IlJETTR4WXlReHB2TnhHbkQ4TUdoQVE9PSIsInZhbHVlIjoidFdNWXhxTzlrK2NDQWx5ekpjVmNmZnA0L21IUVBrSDdZZUNydWlTQXA2THRqUGxHTjgzbldHNzUyZllxSU92MURZUk5oN" 1 => "alphaeurekaselectnet_session=eyJpdiI6IlE4cWxkZS9VSVZBaDFCb0xuWjFVL2c9PSIsInZhbHVlIjoiVkhCaTFuUTBOTWNLRzA0NzNicThYem9QcSswbTcrTS9uMm9BdE42ZWNXQmkyNUN5TjNyT09rckZYV2VlbnFOTFppdWFMQmRmeHJpU3lMaGY0RC9zeFh3bDNkOS8zK2xDN0tGZEZnZmV6TVMreGhTcFEzbDM3SDZPNXREWkN1MjciLCJtYWMiOiI2ODE1OTExMzA1MTQ0ZDdlMDdhM2NlZWYxODEzZjAzYzNmNjEyODc1ZDVmMzg5ZmM0MWYzN2Q1OTUyMjA5M2U2IiwidGFnIjoiIn0%3D; path=/; secure; httponly; samesite=laxalphaeurekaselectnet_session=eyJpdiI6IlE4cWxkZS9VSVZBaDFCb0xuWjFVL2c9PSIsInZhbHVlIjoiVkhCaTFuUTBOTWNLRzA0NzNicThYem9QcSswbTcrTS9uMm9BdE42ZWNXQmkyNUN5TjNyT09rckZ" ] "Set-Cookie" => array:2 [ 0 => "XSRF-TOKEN=eyJpdiI6IlJETTR4WXlReHB2TnhHbkQ4TUdoQVE9PSIsInZhbHVlIjoidFdNWXhxTzlrK2NDQWx5ekpjVmNmZnA0L21IUVBrSDdZZUNydWlTQXA2THRqUGxHTjgzbldHNzUyZllxSU92MURZUk5oNnF5ZTNDY2g1RWhGWkZyRFRNM1EzY1NKbjZOZE9nQ2VjVEZMQWpmbE04bnRDbFVyNVVpbGlTOThwY2IiLCJtYWMiOiIxNmIyMjdiZmJmODRjNzc0ZWEwYmRmZjBjMzllMjRmMTBmYTQyNzRjZDI2YTg3ODYzZmVlMzQ2YmNmMTMwZWQ3IiwidGFnIjoiIn0%3D; expires=Mon, 03-Mar-2025 08:28:40 GMT; path=/; secureXSRF-TOKEN=eyJpdiI6IlJETTR4WXlReHB2TnhHbkQ4TUdoQVE9PSIsInZhbHVlIjoidFdNWXhxTzlrK2NDQWx5ekpjVmNmZnA0L21IUVBrSDdZZUNydWlTQXA2THRqUGxHTjgzbldHNzUyZllxSU92MURZUk5oN" 1 => "alphaeurekaselectnet_session=eyJpdiI6IlE4cWxkZS9VSVZBaDFCb0xuWjFVL2c9PSIsInZhbHVlIjoiVkhCaTFuUTBOTWNLRzA0NzNicThYem9QcSswbTcrTS9uMm9BdE42ZWNXQmkyNUN5TjNyT09rckZYV2VlbnFOTFppdWFMQmRmeHJpU3lMaGY0RC9zeFh3bDNkOS8zK2xDN0tGZEZnZmV6TVMreGhTcFEzbDM3SDZPNXREWkN1MjciLCJtYWMiOiI2ODE1OTExMzA1MTQ0ZDdlMDdhM2NlZWYxODEzZjAzYzNmNjEyODc1ZDVmMzg5ZmM0MWYzN2Q1OTUyMjA5M2U2IiwidGFnIjoiIn0%3D; path=/; secure; httponlyalphaeurekaselectnet_session=eyJpdiI6IlE4cWxkZS9VSVZBaDFCb0xuWjFVL2c9PSIsInZhbHVlIjoiVkhCaTFuUTBOTWNLRzA0NzNicThYem9QcSswbTcrTS9uMm9BdE42ZWNXQmkyNUN5TjNyT09rckZ" ] ]
        session_attributes
        0 of 0
        array:5 [ "_token" => "JCfK8C5CLZ25L1GTFf6cwlGFcYHuN2b5DgF9m0cz" "uc_cart_id" => "90f20bea59ec2fa0715f994a1dbf7162" "_previous" => array:1 [ "url" => "https://alpha.eurekaselect.com/chapter/430" ] "_flash" => array:2 [ "old" => [] "new" => [] ] "PHPDEBUGBAR_STACK_DATA" => [] ]
        ClearShow all
        Date ↕MethodURLData
        #12025-02-28 20:28:40GET/chapter/4301121913