Oxidative stress in symptom-free HCV carriers: relation with ALT flare-up

Background The reason why some hepatitis C virus carriers with normal aminotransferase activity present, during time, an activation of the disease, is unknown. The aim of this study was to assess the oxidative balance in such patients and to evaluate its possible role on the severity of disease. Materials and methods Histology, glutathione and malondialdehyde were determined in the liver of 30 HCV-RNA positive patients with persistently normal aminotransferase. Patients were followed-up for 18 months with plasmatic determinations of aminotransferase, ferritin, glutathione, malondialdehyde, carbonyl and sulphydryl protein levels (every 2 months) and serum HCV-RNA (every 3 months). Results Four subjects had normal histology, whereas the remaining 26 showed mild/moderate chronic hepatitis. Hepatic glutathione and malondialdehyde concentrations were normal in 16 patients and clearly altered in the other 14. The hepatic redox state did not correlate with histology whereas it correlated with plasmatic oxidative markers. During the study, aminotransferase flared up in 11 patients, 9 of these (82%) having at enrolment an altered hepatic oxidative balance. Patients with aminotransferase elevation showed increased blood indices of oxidative stress, which occurred earlier than aminotransferase flare-ups. No oxidative stress was observed in the remaining subjects. Discussion This study suggests that symptom-free HCV carriers with impaired redox state have a higher risk of aminotransferase flare-up; therefore the impaired oxidative balance may have a prognostic significance on disease activity.