Do you treat hepatitis C patients with normal liver tests?


Topic: Hepatitis C, June 2000

Dr. Lee:
In the past several years, I have NOT been recommending treatment for patients whose liver enzyme tests (SGOT, SGPT) are normal. Do you treat hepatitis C patients with normal liver enzyme tests?

Dr. Edward Block:
You're right that hepatitis C patients with normal liver tests (SGOT and SGPT) in general seem to have mild disease. On liver biopsy, they tend to show mild to minimal inflammation, and more importantly the biopsy will not show any evidence of scarring or fibrosis. But unfortunately, by withholding treatment, you can miss treating some patients who are at risk for developing chronic hepatitis and late complications like cirrhosis and liver failure.

My approach to hepatitis C patients with normal liver tests and active virus infection as measured by the hepatitis C RNA (HCV RNA) test is to perform a liver biopsy. If liver biopsy shows mild or minimal inflammation, it may be appropriate not to recommend treatment. However, if liver biopsy shows significant liver disease with some increase in fibrosis or a fair amount of inflammation, I think it would be more appropriate to treat these patients.

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