HCV Viral Load & ALT Predicts Death

HCV Viral Load & ALT Predicts Death


Increased rate of death related to presence of viremia among hepatitis C virus antibody-positive subjects in a community-based cohort study - (08/05/09)



HCV RNA levels have also been reported to be associated with the progression of chronic hepatitis C.[41][42] Although the level of HCV RNA was not quantified in this study, HCVcAg levels, which are known to correlate with HCV RNA levels,[21] were assessed by fluorescence enzyme immunoassay. We observed that high HCVcAg levels were predictive of liver-related mortality, including death due to HCC, in the HCV carriers. The precise mechanism underlying HCV infection-dependent hepatocarcinogenesis is not clear. However, a study of transgenic mice that express the HCV core protein demonstrated that this protein was important in HCC development.[43] Of interest, Moucari et al. reported that insulin resistance is a specific feature of chronic hepatitis C and associated with high serum HCV RNA levels.[44] A significant increase in the incidence of diabetes has also been seen in subjects with high titer of HCV core protein compared to subjects who were negative for anti-HCV.[45] Moreover, significant fibrosis is associated with insulin resistance,[44] and diabetes mellitus is known to increase the risk of primary liver cancer in the presence of other risk factors such as hepatitis C.[46] Thus, HCVcAg levels might be associated with liver-related mortality through the development of HCV-induced insulin resistance or diabetes mellitus.

We have previously shown that elevated ALT levels are an important predictor of HCC among HCV carriers in this study population.[19] In the current analysis, ALT, aspartate aminotransferase, and GGT levels at enrollment were significantly higher in subjects who died due to a liver-related disease compared with subjects who died from other causes (data not shown). In addition, after adjusting for age and sex, overall mortality (HR, 2.23) and liver-related death (HR, 11.0) were significantly higher for HCV carriers with persistently elevated ALT than for those with persistently normal ALT.