A 30-year-old patient presents 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:
Correct Answer: Do liver biopsy and sta antiviral drugs accordingly.
Description: Chronic infection with hepatitis C is common even in those patients with return of aminotransferases to normal. Aminotransferases continue to fluctuate and can be normal in patients with long-standing disease * A pretreatment liver biopsy to assess histologic grade and stage provides information about progression of hepatitis C & has prognostic value for future progression. In patients with mild chronic hepatitis C, the rate of progression is slow, and monitoring without therapy is an option; however, such patients respond just as well to combination PEG IFN plus ribavirin therapy as those with severe hepatitis. Therefore final decision for therapy should be considered and decision made based on factors as patient motivation, genotype, stage of fibrosis, age, and co-morbid conditions.
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