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Persistently Abnormal Liver Function Tests May Be Marker Of Occult Hepatitis C

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  • claudine intexas
    This is rather interesting, and also scary, if you consider that in THIS instance they are looking at people with ABNORMAL LFT s. How many people with NORMAL
    Message 1 of 1 , Jan 13, 2004
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      This is rather interesting, and also scary, if you consider that in
      THIS instance they are looking at people with ABNORMAL LFT's. How
      many people with NORMAL LFT's are walking around with HCV, but
      testing negative for it??? (We already know that it is fairly common
      for someone with HCV to have normal LFT's.) This is the second study
      I've seen recently that finds that sometimes people are walking
      around for LONG periods of time testing negative for HCV when they
      actually have the disease. So much for a safer blood supply.

      DGNews

      Persistently Abnormal Liver Function Tests May Be Marker Of Occult
      Hepatitis C

      ALEXANDRIA, VA -- January 5, 2004 -- Patients with persistently
      abnormal liver function tests but no serologic evidence of liver
      disease may nevertheless have hepatitis C virus (HCV) infection,
      according to a study published in the January 1 issue of The Journal
      of Infectious Diseases, available online now.

      Such occult (meaning hidden or concealed) infection is not supposed
      to occur--the conventional wisdom is that the virus leaves markers in
      serum or plasma, including specific antibodies and viral RNA, which
      have been the serologic cornerstones for diagnosing and monitoring
      HCV-infected patients. Although occult HCV infection generally
      appears to be mild, some patients have shown evidence of serious
      chronic liver injury. In addition, occult infection raises the
      possibility of disease spread via blood donations, hemodialysis and
      other procedures. Fortunately, the study also suggests a minimally
      invasive approach to detect occult infection.

      The study, reported by a group headed by Vicente Carre�o, MD, in
      Madrid, Spain, involved 100 patients with abnormally high levels of
      aspartate aminotransferase (AST), alanine aminotransferase (ALT) or
      gamma glutamyl transpeptidase (GGTP) for at least 12 months in whom
      all causes of liver disease, including HCV infection, had ostensibly
      been excluded. All three liver enzymes were elevated in eight
      patients, two of the enzymes in 48 and one enzyme in 44. For
      comparison, 30 patients with liver damage known to be of non-viral
      origin were also studied.

      The investigators relied on two assays to demonstrate the presence or
      absence of HCV infection. First, using reverse
      transcription-polymerase chain reaction (RT-PCR) with primers from
      one region of the HCV genome, they detected the virus's RNA in liver
      biopsies from 57 (57%) of the patients with abnormal liver enzymes of
      unknown etiology, compared to none of the biopsies from control
      patients. When primers from another region of the genome were used in
      the RT-PCR assay, HCV RNA was found in liver biopsies from 40 (70%)
      of the 57 patients. The second method used was in situ hybridization,
      which demonstrated positive-strand HCV RNA in liver biopsies from the
      same 57 patients, but in none of those from the controls, and
      negative-strand HCV RNA in 48 (84%). The investigators noted that the
      latter finding suggested viral replication, which involves synthesis
      of a negative RNA intermediary.

      The RT-PCR assay also detected HCV RNA in peripheral-blood
      mononuclear cells from 40 (70%) of the 57 patients with occult
      infection. The clinical implication of this finding, the
      investigators noted, is that a high percentage of patients with
      occult HCV infection may be more easily and more safely identified by
      obtaining and testing blood cells rather than liver cells.

      In an accompanying editorial, Herv� Lerat, MD, and F. Blaine
      Hollinger, MD, of Baylor College of Medicine, Houston, commented that
      the distribution of hepatic enzyme elevations in the study population
      implied that clinicians should use both ALT and GGT to identify
      patients who may qualify for peripheral-blood mononuclear cell
      testing for occult HCV infection. They cautioned, however, that many
      issues about such infections remain to be resolved, including the
      central issue of whether the detected viral genomic material is
      infectious.


      SOURCE: Infectious Diseases Society of America


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