British researchers advised that liver biopsy be performed in all patients with chronic hepatitis C infection.

The purpose of the procedure is to accurately assess the degree of fibrosis as well as current disease activity, stated C.J. Healey, Radcliffe Hospital, Oxford, United Kingdom, and colleagues ("Liver Histology in Hepatitis C Infection: A Comparison between Patients with Persistently Normal or Abnormal Transaminases," GUT, 1995; 37:274- 278).

In this study we have shown that significant liver disease can be found in hepatitis C infection despite persistently normal transaminases (nearly 50 percent) in our series, Healey et al. wrote.

A previously reported study of Italian patients with hepatitis C infection also showed ongoing normal liver function during a time period of 7 to 28 months, yet more than 60 percent of the patients had chronic persistent or active hepatitis (Bruno, S., et al, "Normal Aminotransferase Concentrations in Patients with Antibodies to Hepatitis C Virus," BMJ, 1994;308:697).

The researchers indicated that hepatitis C virus (HCV) infection could become a growing problem and that continued active assessment and follow-up of all infected patients should be conducted.

"Liver biopsy should be offered as a routine part of this assessment to all cases, as repeatedly normal liver transaminases do not exclude significant liver involvement in many cases," wrote Healey et al. "This will allow for identification of patients suitable for antiviral treatments, reassurance of the patients with normal or minimal disease, and intervention in simple lifestyle measures (for example, reduction in alcohol intake and avoidance of hepatotoxic treatment)."

In the study reported by Healey et al., they investigated 42 cases of confirmed HCV infection with liver histology available. While 55 percent (23/42) of the patients showed abnormal liver function tests, 45 percent (19/42) had liver transaminase levels that were persistently normal.

While the researchers observed serious pathology more frequently in the abnormal transaminase group, they said that they found significant liver pathology - in the form of chronic persistent hepatitis or chronic active hepatitis - in nine of 19 (47 percent) of the patients with repeatedly normal transaminase levels.

The corresponding author for this study is Dr. C.J. Healey, Department of Gastroenterology, John Radcliffe Hospital, Headley Way, Headington, Oxford, OX3 9DU, United Kingdom.

Source: Blood Weekly, 01-01-1995, pp 5.