Liver disease progression in hepatitis C virus carriers with normal alanine aminotransferase levels (2014)

We want to thank Claudio Puoti and Lia Bellis for their interest in our study regarding the natural course of hepatitis C virus (HCV) infection in the German hepatitis C (1b)-contaminated anti-D cohort at 35 years after infection.1 Their group has provided a substantial advancement in understanding the natural and treatment-induced course of so-called healthy HCV carriers, i.e., viremic HCV patients with persistently normal alanine aminotransferase (ALAT) levels and no clinical or histological liver disease during repeated follow-up visits.2, 3 The outcome of these patients in the German hepatitis C (1b)-contaminated anti-D cohort at 35 years after infection is depicted in Fig. 1. Of the original 26 HCV carriers which we described at 20 years after infection,4 HCV in-house polymerase chain reaction (PCR) emerged as false-positive in three patients, unraveling a spontaneous resolution of HCV infection in these patients. Among the remaining HCV carriers, seven patients developed chronic hepatitis C as determined by elevated transaminases and clinical or histological signs of liver damage. Among these patients with chronic hepatitis, four were considered for antiviral combination therapy with pegylated interferon and ribavirin and achieved a sustained virological response. Unfortunately, the remaining 16 patients of the original HCV carrier cohort have been lost to follow-up during our long-term observational study. In our experience, the majority of these otherwise healthy women did not feel the need for regular visits at the referral centers. Others were lost due to repetitive name or address changes between scheduled follow-up visits. However, considering previous studies by Puoti at al. showing a substantial proportion of liver disease progression in these patients, intensified efforts for further follow-up studies in this unique patient cohort are clearly warranted to aid attending physicians and patients in their mutual therapy decision even in the face of the new potent antiviral substances. Long-term follow-up of HCV carriers in the German HCV (1b)-contaminated anti-D cohort. Contributed by the joint project members from Sektion Hepatologie, Klinik und Poliklinik für Gastroenterologie und Rheumatologie, Universitätsklinikum Leipzig, Leipzig, Germany; Abteilung für Tropenmedizin, Infektionskrankheiten und Sektion Nephrologie, Universitätsmedizin Rostock, Rostock, Germany; Gastroenterologische Schwerpunktpraxis, Cottbus, Germany; Hepatologische Schwerpunktpraxis, Magdeburg, Germany; Klinik für Gastroenterologie und Infektiologie, E.-v.-Bergmann Klinikum, Potsdam, Germany, III. Medizinische Klinik, Krankenhaus Dresden-Friedrichstadt, Dresden, Germany; Klinik für Gastroenterologie und Hepatologie, Klinikum St. Georg GmbH, Leipzig, Germany, Klinik und Poliklinik für Innere Medizin I, Martin-Luther-Universität Halle-Wittenberg, Halle, Germany for the East German HCV Study Group. Tobias MÜller, M.D.Manfred Wiese, M.D. Thomas Berg, M.D. Sektion Hepatologie Klinik und Poliklinik für Gastroenterologie und Rheumatologie Department für Innere Medizin, Neurologie und Dermatologie Universitätsklinikum Leipzig, AöR Leipzig, Germany