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Pattern of histological findings in chronic hepatitis C with alanine transaminase levels below twice the normal value.

OBJECTIVES
To assess the pattern of liver histology in chronic hepatitis C, with serum alanine transaminase levels persistently upto twice the normal range, and to identify factors associated with minimal and clinically significant histological disease categories.


METHODS
This study was carried out at Ziauddin University Karachi and Pakistan Medical Research Council, Karachi, from January 2007 to July 2009. Biopsy specimens were staged and graded according to METAVIR scoring system. A fibrosis score of > or = F2 and activity score of > or = A2 was considered significant. Overall disease severity groups; minimal disease (less than F2 and A2) and significant disease (F2 or A2 and above), were compared for their association with different variables.


RESULTS
Out of 83 patients, 32 had significant fibrosis and 15 had significant activity. Twenty three patients with significant fibrosis belonged to F2 stage. Nine had F3 fibrosis and none of our patients had cirrhosis. Overall 33 (40%) patients had significant disease. Age of the patient, alanine transaminase levels, number of the portal tracts and severity of the portal inflammation in liver biopsy were significantly associated with severity of the liver disease. Gender of the patient and steatosis in liver biopsy were not significant.


CONCLUSION
A substantial proportion of patients with alanine transaminase levels within twice the upper limit of normal had significant liver disease.