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A doctor friend was diagnosed with hepatitis C 18 months ago. All her liver functions are in the normal range; a sonogram showed no bnormalities. Her only symptom is somewhat increased fatigue. She would like to know how this is treated in the West.
Thank you for your inquiry, An important subset of patients with chronic hepatitis C have normal liver enzyme levels(ALT) despite having detectable HCV RNA in serum (a test to detect if someone has Hepatitis C). This is a somewhat controversial topic as the long-term outcome of this group of patients with chronic HCV infection is not known. These patients are usually asymptomatic, but on liver biopsy almost all have histological evidence of chronic hepatitis. The histological findings generally are mild, and cirrhosis is rare. Please note that the following information was obtained from research information that was published in recent years and that the most current recommendation should be obtained from a hepatologist as the recommendations might vary depending on the Western country where information was obtained... In small, uncontrolled trials of interferon-alpha in patients with normal liver enzymes (ALT levels), end-of-treatment virologic responses occurred in 42% of patients, and sustained responses 6 to 12 months afterwards in 13% of patients. These rates of response are not very different from those reported in patients with elevated ALT levels. Importantly, in most studies, serum ALT levels became elevated during interferon therapy in approximately one half of patients, and levels remained elevated in some of these patients after therapy. These findings suggest that interferon-alpha therapy is not usually beneficial and may be harmful in chronic hepatitis C patients with normal ALT levels. Combination therapy with interferon and ribavirin has not been evaluated in this group of patients but would be difficult to justify unless the sustained virological response was very high.
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