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Using the Prevalence of an Elevated Serum Alanine Aminotransferase Level for Identifying Communities With a High Prevalence of Hepatitis C Virus Infection
Chong-Shan Wang, MD, MPH;
Shan-Tair Wang, PhD;
Pesus Chou, DrPH
Arch Intern Med. 2001;161:392-394.
Background Antibody to hepatitis C virus (anti-HCV) is a widely accepted method
for the diagnosis of HCV infection. However, it is too expensive to use in
large-scale health surveys.
Objective To investigate the use of the serum alanine aminotransferase (ALT) level
to predict the prevalence of HCV infection.
Patients and Methods A sample of 6095 residents aged 35 years old or older in a small township
of southern Taiwan, Republic of China, were examined in a community health
survey. These persons were walk-ins to the government-sponsored stations after
an intensive health promotion for this survey. Blood samples were obtained
and analyzed for serum ALT levels. The presence of hepatitis B surface antigen
and anti-HCV were determined by enzyme immunoassay methods.
Results The overall prevalences of hepatitis B surface antigens(+), anti-HCV(+),
and elevated ALT levels were 11.8%, 15.0%, and 7.5%, respectively. Among the
13 villages in this community, the prevalence of hepatitis B surface antigen(+)
ranged from 6.8% to 17.3%, anti-HCV(+) ranged from 7.2% to 37.6%, and an elevated
ALT level ranged from 5.8% to 16.5%. A strong positive correlation was found
between the prevalence of an elevated ALT level and anti-HCV(+) (r=
0.91, Spearman rank correlation; P<.001). However, nearly
0 correlation (r= -0.05, P= .87) was obtained
between the prevalence of an elevated serum ALT level and hepatitis B surface
antigen(+).
Conclusion The prevalence of an elevated serum ALT level in a community is a strong
indicator of its prevalence of anti-HCV(+), even in areas where there is a
similar prevalence of hepatitis B virus infection. This result is useful for
economically identifying hyperendemic communities with HCV infection.
From the A-Lein Community Health Center, Kaohsiung (Taiwan) County
(Dr C.-S. Wang); Department of Public Health, College of Medicine, National
Cheng Kung University, T'ai-nan, Taiwan (Drs C.-S. Wang and S.-T. Wang); and
the Community Medicine Research Center and Institute of Public Health, National
Yang-Ming University, Taipei, Taiwan (Dr Chou).
Corresponding author and reprints: Pesus Chou, DrPH, National Yang-Ming
University, Institute of Public Health, Shih-Pai, Taipei 112, Taiwan, Republic
of China (e-mail: pschou{at}ym.edu.tw).
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