Accordingly, follow-up and deferring therapy has been suggested in this patient group. A recent review of three large randomized trials has shown that patients with NALT have significantly lower inflammation and fibrosis scores on liver biopsy than patients with elevated ALT [9]. Nevertheless, these patients can have progressive liver disease and develop advanced fibrosis or cirrhosis http://www.selleckchem.com/products/Imatinib-Mesylate.html [3,10]. These studies suggest that patients with chronic HCV with NALT should be evaluated similarly to patients with elevated ALT levels because they are at risk for developing significant liver disease [9]. Using periodic liver biopsies to determine if and when to use antiviral treatment is unlikely to elicit a favourable patient response and can lead to higher costs, increased cumulative cirrhosis incidence and decreased survival rates in comparison with ��empirically based�� treatments [11,12].

Although considered the gold standard for assessment of liver fibrosis, liver biopsies have limitations, including inter-observer variability, sampling error and risks for complications. Reliable and inexpensive noninvasive methods to assess disease progression are a necessity in this setting [12]. Breath testing is based on the principal that an ingested substrate is metabolized, and a measurable metabolite is then expelled by the respiratory system. An ideal compound for this purpose is metabolized solely by the liver and therefore reflects liver function. Breath testing has been used experimentally and clinically for several decades [10], including for follow-up on patients with chronic liver disorders.

The major drawbacks of these tests are the need for traditional, cumbersome isotopic ratio mass spectrometry methods, a prolonged testing time and patient inconvenience. The BreathID? continuous online 13C-methacetin breath test (MBT), which reflects hepatic microsomal function (CYP1A2), is a laser-based technology that creates an infrared emission precisely matching the absorption spectrum of CO2 and can detect variations of less than 1/1000 in the 13CO2/12CO2 ratio measurement. The system is based on the measurement of CO2 by molecular correlation spectroscopy. This test offers several advantages: It is an office-based, noninvasive tool for the assessment of both liver inflammation and fibrosis does not involve a blood test and can provide an immediate result at the point-of-care.

The aim of the present study was to determine its accuracy in assessing the degree of liver fibrosis and inflammation in patients with chronic HCV infection and NALT. Methods Study population Patients From 1 March 2006 to 31 May 2006, we enrolled 100 consecutive, unselected, patients with previously untreated, chronic HCV. Cilengitide All were anti-HCV and HCV RNA positive, with a normal serum ALT level (�ܡ�2 ULN) on two separate tests during the preceding 6 months.