HEPATOLOGY WATCH®
JANUARY 2003
HEPATITIS C VIRUS
(HCV) INFECTION
Predictive value of
alanine aminotransferase (ALT) levels for histological findings. Approximately one third of patients with chronic HCV
infection have persistently normal ALT levels; thus, the association between
ALT levels and histological hepatic findings is an important issue. Pierre Pradat and colleagues retrospectively
reviewed data from 864 HCV RNA-positive patients in a collaborative European
study. They observed that virtually all
HCV RNA-positive patients with elevated ALT levels had hepatic fibrosis (99%
with a METAVIR score of ³ F1, and 76% with a score of ³
F2). In patients with persistently
normal ALT levels, 65% had a METAVIR score of at least F1, 26% a score of >
A1F1 and 14% a score of ³ F2.
These data show that although the degree of hepatic fibrosis is usually
mild in patients with persistently normal ALT levels, some show more marked
histological disease and thus current indications for liver biopsy should be
revisited. (Pradat P, et al. Hepatology 2002;36:973-977)
Cryoglobulinemia and cirrhosis. Zeid Kayali and coworkers conducted a meta-analysis of 19
studies of patients with chronic HCV (n=2,323) published between 1994 and 2001
to investigate if the development of detectable serum cryoglobulins is
predictive of progressive liver disease.
Cryoglobulinemia was identified in 1,022 (44%) patients. Cirrhosis was present in 40% of patients with
cryoglobulinemia compared to only 17% of patients without cryoglobulinemia
(p<0.001). The odds ratio for the
incidence of cirrhosis in cryoglobulinemia-positive vs.
cryoglobulinemia-negative patients, after adjusting for age, gender, and
estimated duration of disease by logistic regression, was 4.87 (95% CI: 3.32 -
7.15). These analyses indicate that the
presence of cryoglobulinemia may be a useful indicator for progressive liver
disease in chronic HCV infection.
(Kayali Z, et al. Hepatology 2002;36:978-985)
Kidney transplantation and liver fibrosis. The natural history of hepatic
fibrosis progression in HCV patients following kidney transplantation remains
controversial. Laurent Alric et al.
performed a cohort study in which patients who had received kidney
transplantation during HCV infection (group 1; n = 30) were matched by factors
prognostic for hepatic fibrosis at first liver biopsy with HCV patients
undergoing hemodialysis (group 2; n = 30), and nontransplanted, nonhemodialyzed
HCV patients (group 3; n = 30). Results from a second liver biopsy revealed
that the METAVIR and Knodell scores and the annual rate of fibrosis progression
were lower in the kidney transplant group than in group 3 (p <0.01 and p =
0.03, respectively). These findings
indicate a low rate of hepatic fibrosis progression in HCV-infected kidney
transplant recipients. (Alric L, et al. Gastroenterology 2002;123:1494-1499)
Treatment of recurrent hepatitis C in liver transplant recipients. Roberto Firpi and associates at the
MISCELLANEOUS
Radiologic imaging in nonalcoholic fatty liver disease (NAFLD). S. Saadeh and colleagues at the
Cleveland Clinic Foundation conducted a study in which consecutive patients
with biopsy-proven NAFLD underwent abdominal ultrasonography, computerized
topography, and magnetic resonance imaging.
The presence of >33% fat on liver biopsy was found to be optimal for
detecting steatosis by radiological imaging.
However, none of the radiological modalities were able to detect
features of nonalcoholic steatohepatitis (NASH) (e.g., hepatocyte ballooning,
fibrosis) or distinguish NASH from simple steatosis. These findings demonstrate that although
radiologic imaging was able to determine a level of severity of steatosis in
the livers of patients with NAFLD, it was not able to detect any distinguishing
features of NASH. (Saadeh S, et al.
Gastroenterology 2002; 123:745-750)
Coffee intake and risk of gallstone disease. Coffee affects several metabolic
processes involved in cholesterol lithogenesis, and coffee drinking has
previously been associated with a lower risk of symptomatic gallstone disease
in men. M. Leitzmann et al.
prospectively examined the association of coffee drinking and cholecystectomy
in a cohort of 80,898 women aged 34 to 59 years. During 20 years of follow-up (from 1980 to
2000) 7,811 women had a cholecystectomy.
The multivariate relative risks (adjusted for risk factors) of
cholecystectomy for those who consistently drank 0, 1, 2-3, and ³ 4 cups
of caffeinated coffee daily were 1.0, 0.91, 0.78, and 0.72, respectively
(p<0.0001 for the decreasing trend).
The intake of decaffeinated coffee was not associated with a decreased
risk of cholecystectomy. These data
suggest that the consumption of caffeinated coffee may decrease the risk for
symptomatic gallstone disease in women.
(Leitzmann MF, et al. Gastroenterology
2002;123:1823-1830)
NIH Consensus Statement. An update of the 1997 NIH Consensus Statement regarding the
management and treatment of HCV resulting from the June 2002 NIH Consensus
Development Conference on Management of Hepatitis C has been published recently
in Gastroenterology. (Gastroenterology 2002;123:2082-2099)
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