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TREATENT OUTCOMES OF HEPATITIS C INFECTED PATINETS WITH DIFFERENT AMINOTRANSFERASE (ALT) LEVELS
J Farley, L Chinybayeva
INTRODUCTION: Testing for serum aminotransferase (ALT) levels 1.5 times upper of normal (ULN) is still used by some guidelines and justifications for determining the eligibility for treatment of patients with chronic hepatitis C patients despite the lack of evidence to support this recommendation. This approach denies treatment to many who require it and in fact may have severe disease. To address this we conducted a retrospective review of individuals treated for HCV between June 2001 to June 2007, and for whom complete data are available.
OBJECTIVE: To determine the treatment outcomes of hepatitis C virus infected patients with different ALT levels. To compare the outcomes of those with ALT one and one half ULN versus those with ALT less then one and one half ULN.
DESIGN: retrospective study with chart review.
PLACE OF THE STUDY: Dr. John Farley Inc. Medical clinic, Vancouver, BC.
MATERIALS AND METHODS: The 367 HCV patients included in the study have been divided into four groups according their pretreatment ALT level: the group one with ALT >1.5 × ULN (209 patients), the group two with ALT level between 1.5 – 1.0 × ULN (79 patients), group three with ALT levels in range 0.5 – 1.0 × ULN (72 patients) and the group four with the ALT level <0.5 × ULN (7 patients). All were treated according to internationally accepted protocols and standards of care. SVR was determined six months after treatment completion. Treatment response was compared using Chi-square test.
RESULTS: of 367 patients reviewed, 230 had complete records and were included into analysis. In groups one, SVR was attained in 74 of 136 (54%); group two, in 27 of 46 (58 %); group three, in 20 of 44 (45 %) and group four (75 %) of individuals. The difference in SVR in four groups was not statistically significant (Chi-squire =2.42; df=3; p =0.49).
CONCLUSION: Individuals with normal baseline ALT responded equally well to combination therapy as the those with elevated ALT (1.5 × ULN). There is no rationale for guidelines using 1.5 times UNL on which to base eligibility for treatment. This should be revised promptly to address the important hepatitis C public health problem.