{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,9,23]],"date-time":"2026-09-23T19:03:41Z","timestamp":1790190221280,"version":"4.1.0"},"reference-count":31,"publisher":"Ovid Technologies (Wolters Kluwer Health)","issue":"5","license":[{"start":{"date-parts":[[2015,9,1]],"date-time":"2015-09-01T00:00:00Z","timestamp":1441065600000},"content-version":"tdm","delay-in-days":5783,"URL":"http:\/\/doi.wiley.com\/10.1002\/tdm_license_1.1"}],"content-domain":{"domain":["lww.com","ovid.com"],"crossmark-restriction":true},"short-container-title":[],"published-print":{"date-parts":[[1999,11]]},"abstract":"<jats:sec>\n            <jats:title\/>\n            <jats:p>Approximately one third of patients with chronic hepatitis C virus (HCV) infection have normal alanine transaminase (ALT) levels. We studied the clinical, biochemical, virological, and histological features in patients with persistently normal ALT. A case-control study was conducted on 275 patients with chronic HCV infection, including 75 patients with persistently normal ALT and 200 patients with abnormal ALT. Persistently normal ALT was defined as 4 consecutive ALT values in each patient within a period of 12 months. The average age of the patients was 44 years (range 18 to 69 years). More non-Hispanic whites had persistently normal ALT. The mean serum ferritin level was significantly lower in patients with persistently normal ALT as compared with abnormal ALT (128 \u00b1 92 ng\/mL and 224 \u00b1 128 ng\/mL), respectively (<jats:italic toggle=\"yes\">P<\/jats:italic>= .017). The mean HCV-RNA level was significantly lower in patients with persistently normal ALT as compared with abnormal ALT (12 \u00d7 10<jats:sup>5<\/jats:sup> \u00b1 2.8 \u00d7 10<jats:sup>6<\/jats:sup> copies\/mL and 33 \u00d7 10<jats:sup>5<\/jats:sup> \u00b1 8.0 \u00d7 10<jats:sup>6<\/jats:sup>), respectively (<jats:italic toggle=\"yes\">P<\/jats:italic>= .02). Histologically, patients with persistently normal ALT had less severe portal inflammation (<jats:italic toggle=\"yes\">P<\/jats:italic>&lt; .05), lobular inflammation (<jats:italic toggle=\"yes\">P<\/jats:italic>= .003), piecemeal necrosis (<jats:italic toggle=\"yes\">P<\/jats:italic>= .002), fibrosis (<jats:italic toggle=\"yes\">P<\/jats:italic>&lt; .05), lower prevalence of cirrhosis (<jats:italic toggle=\"yes\">P<\/jats:italic>= .007), as well as a slower fibrosis progression rate (<jats:italic toggle=\"yes\">P<\/jats:italic>&lt; .001). Chronic hepatitis C patients with persistently normal ALT have low-activity grade and stage on liver biopsy. In these patients the hepatitis C RNA level was lower compared with abnormal ALT patients, which may explain the slower fibrosis progression rate.<\/jats:p>\n          <\/jats:sec>","DOI":"10.1002\/hep.510300526","type":"journal-article","created":{"date-parts":[[2004,7,28]],"date-time":"2004-07-28T07:40:08Z","timestamp":1091000408000},"page":"1307-1311","update-policy":"https:\/\/doi.org\/10.1097\/lww.0000000000001000","source":"Crossref","is-referenced-by-count":105,"title":["Clinical features of hepatitis C-infected patients with persistently normal alanine transaminase levels in the southwestern United States"],"prefix":"10.1097","volume":"30","author":[{"given":"Mazen M.","family":"Jamal","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Anurag","family":"Soni","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Patrick G.","family":"Quinn","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Donald E.","family":"Wheeler","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Sanjeev","family":"Arora","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"David E.","family":"Johnston","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"276","reference":[{"key":"BIB1","doi-asserted-by":"crossref","first-page":"1899","DOI":"10.1056\/NEJM199212313272702","volume":"327","author":"Alter","year":"1992","journal-title":"N Engl J Med"},{"key":"BIB2","doi-asserted-by":"crossref","first-page":"563","DOI":"10.1136\/gut.44.4.563","volume":"44","author":"Datz","year":"1999","journal-title":"Gut"},{"key":"BIB3","doi-asserted-by":"crossref","first-page":"34s","DOI":"10.1002\/hep.510260706","volume":"26","author":"Di Bisceglie","year":"1997","journal-title":"Hepatology"},{"key":"BIB4","first-page":"1206","volume":"45","author":"Fattovich","year":"1998","journal-title":"Hepatogastroenterology"},{"key":"BIB5","doi-asserted-by":"crossref","first-page":"1507","DOI":"10.1093\/clinchem\/43.8.1507","volume":"43","author":"Urdea","year":"1997","journal-title":"Clin Chem"},{"key":"BIB6","doi-asserted-by":"crossref","first-page":"43s","DOI":"10.1002\/hep.510260708","volume":"26","author":"Gretch","year":"1997","journal-title":"Hepatology"},{"key":"BIB7","doi-asserted-by":"crossref","first-page":"590","DOI":"10.1002\/hep.510290219","volume":"29","author":"Inglesby","year":"1999","journal-title":"Hepatology"},{"key":"BIB8","doi-asserted-by":"crossref","first-page":"21s","DOI":"10.1002\/hep.510260704","volume":"26","author":"Seeff","year":"1997","journal-title":"Hepatology"},{"key":"BIB9","doi-asserted-by":"crossref","first-page":"41s","DOI":"10.1007\/BF02087875","volume":"41","author":"Tassopoulos","year":"1996","journal-title":"Dig Dis Sci"},{"key":"BIB10","first-page":"543","volume-title":"Clinics in Liver Disease","volume":"1","author":"Gretch","year":"1997","unstructured":"Use an interpretation of HCV diagnostic tests in the clinical setting. 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