A 42 years old male patient presented with jaundice. His AST was 48 U, ALT was 51 U, ALP, GGTP were normal. Ultrasound of liver was suggestive of cirrhosis. Viral markers were done and the following results were obtained.TestResultAnti-HAVNegativeAnti-HBsAgNegativeAnti-HBeAgNegativeAnti-HBcAg IgGPositiveAnti-HBcAg IgMNegativeHBsAgNegativeAnti-HCVPositiveAnti-HEVNegativeWhat is the next best step in management of this patient?
(A) Sta interferon therapy (B) Liver biopsy (C) -PCR for hepatitis C virus (D) PCR for HBV-DNA
(C) Ans: C. -PCR for hepatitis C virus(Ref Harrison 19/e p2017, 2018: 18/e p2551)Positive Anti-HBcAg IgG:Mere indicator of hepatitis B infection in past.Positive Anti-HCV antibody:Most sensitive indicator of HCV infection - Presence of HCV.Presence of Anti-HCV antibody points to hepatitis C infection a Hence HCV-RNA levels determined to establish chronic hepatitis C diagnosis before staing Interferon therapy.Requires molecular amplification by PCR.Testing for HCV RNA or repeat anti-HCV testing later stages - Necessary to establish diagnosis.