HIV/hepatitis C virus-coinfected patients with normal alanine aminotransferase levels

Background and Aims: The significance of normal alanine aminotransferase (ALT) levels in patients with HIV/hepatitis C virus (HCV) coinfection is not well understood. Methods: We performed a cross-sectional retrospective analysis on consecutive HIV/HCV-coinfected patients (n = 89) who underwent a liver biopsy during a 2-year period. Similar data were also collected on HCV-monoinfected patients (n = 117). Results: Mean ALT levels and the percentage of patients with normal ALT (≤40 U/L) levels were similar in HIV/HCV-coinfected (mean ± SD, 81.7 ± 56.1 U/L; 21%) and HCV-monoinfected patients (97.3 ± 100.7 U/L; 18%; P = 0.19 and 0.54, respectively). Coinfected patients, however, had significantly advanced necroinflammation (P = 0.001) and fibrosis (P = 0.02) compared with monoinfected patients. The percentage of patients with advanced necroinflammation (grades 3 or 4) was lower in HCV-monoinfected patients with normal ALT levels compared with those with elevated ALT (5% vs 20%, respectively). In contrast, the percentage of coinfected patients with advanced necroinflammation was similar whether the patient had normal or elevated ALT levels (32% vs 37%, respectively). Conclusions: In coinfected patients, normal ALT levels are not an indicator of mild necroinflammation and may not portend a more benign disease course.