ALT a poor indicator of active liver inflammation?

Question

Dr McGovern,

I have a question about the correlation of ALT and the degree of liver inflammation. I read that such correlation is quite weak. An ALT level of say 300 IU versus 100 IU might actually reflect the same level of inflammation activity in the same person. Worse, some HCV patients have normal liver enzymes while their livers undergoes significant damage. Many of those patients don't even have cirrhosis yet!

I thought ALT, by itself, does not say much about the overall conditions of one's liver. It only reflect the level of inflammation at a specfic point in time. But some articles are proposing that degree of ALT elevation correlate weakly with inflammation level (with or without cirrhosis).

So my question is this:

For mono-infection, and excluding any other causes of liver injuries,

Does HBV-DNA level give a decent estimate on inflammation (at the time the sample was taken)

Also,

Does HCV-RNA level provides somewhat accurate information on the inflammation level?

Any insight is deeply appreciated.

Thanks

Answer

Excellent question.

  1. ALT is a good indicator IN GENERAL of liver inflammation. Many studies do show a correlation. HOWEVER...having a normal ALT does not assure a patient that they do not have liver inflammation. You are absolutely correct in pointing out that a patient can even have cirrhosis and have normal ALT.

  2. In hepatitis B, the level of ALT is often used to help determine if treatment should be considered or if a liver biopsy should be considered. Patients with an elevated ALT often respond to treatment better than someone with a normal ALT.

  3. In HCV, the HCV RNA (virus) does not tell you anything about the degree of inflammation.