A 30 year old patient with H/O antibodies to HCV for 6 months duration and his AST/ALT is normal. There is no symptom or stigmata of liver disease. The most appropriate approach:
Answer is D (Do liver biopsy and sta antiviral treatment accordingly): Antibodies against HCV (anti- HCV) in the blood indicate infection with the HCV. Persistance of antibodies fir 6 months suggests a diagnosis of chronic hepatitis C. Patients with chronic hepatitis C, even with normal ALT levels are candidates for Liver biopsy to establish a histo-pathological diagnosis of chronic hepatitis. Patients with at least moderate grade and stage are candidates for antiviral therapy with PEG IFN and ribararin regardless of the ALT levels 'Although patients with persistantly normal ALT levels tend not to progress histologically, they respond to antiviral therapy just as well as do patients with elevated ALT levels. Such patients are potential candidates for antiviral therapy' Chronic hepatitis : 'Evidence Based medicine Guidelines' Increased serum ALT 6 months after the onset of symptoms: (normal ALT does not, however, rule out chronic hepatitis). A patient with a positive HCV-PCR-test and permanently elevated ALT most probably has a mild chronic hepatitis and treatment decisions can be made without liver biopsy in genotypes 2 and 3. Liver biopsy is indicated in a patient with positive HCV-PCR- test and normal ALT, and with genotypes 1 and 4 before considering therapy. Signs of chronic hepatitis in the biopsy are an indication for treatment. Information on the genotype of the virus is impoant to guide treatment decisions. Treatment is more effective for genotypes 2 or 3 than for genotypes 1 and 4. Treatment with a combination of interferon alpha or pegylated interferon alpha and ribavirin is used for 48 weeks for genotypes 1 and 4 and for 24 weeks for genotypes 2 and 3. When treating genotypes I or 4. If there is no response at 12 weeks (HCV-PCR still positive), the treatment is discontinued. Liver transplantation is indicated if the expected survival is about 6 months
Reassure the patient
Repeat titre every three years
Repeat enzymes every year
Do liver biopsy & sta antiviral drugs accordingly.