Approximately 30 percent of patients with chronic HCV infection have normal ALT levels, and another 40 percent have ALT levels less than two times the upper limit of normal. Although most of these patients have mild disease, histologically, some may progress to advanced fibrosis and cirrhosis. Experts differ on whether to biopsy and treat these patients.
Numerous factors must be considered in recommending treatment, including favorable genotype, presence of hepatic fibrosis, patient motivation, symptoms, severity of comorbid illness, and the patient's age. When patients with normal or minimally elevated ALT levels are treated with monotherapy, their SVR (sustained viral response) rates are similar to those of patients with higher ALT levels. Studies of pegylated interferon with ribavirin have not been completed in patients with normal ALT levels.
Have you done a biopsy and have you determined the genotype involved.
Dr. Tamer Fouad, MD
MB, BCh, MSc Internal Medicine.
Consultant of Hematology - Oncology.