A 49-year-old man comes to your office, requesting testing for hepatitis C. He r
ID: 99211 • Letter: A
Question
A 49-year-old man comes to your office, requesting testing for hepatitis C. He recently attended his 25-year college reunion, where he heard from a mutual acquaintance that an old friend was seriously ill with cirrhosis due to hepatitis C. The patient became very concerned because he had "partied" with this friend during a brief period of experimentation with injection drugs while in college. The patient is otherwise healthy and denies any symptoms except for occasional fatigue after a long day at work. Physical examination of the patient is unremarkable. There are no stigmata of chronic liver disease. The patient returns several weeks later to discuss his test results. His HCV antibody test is positive. A liver panel obtained that day shows an ALT of 48 IU/L (normal range, 0-20) and an AST of 39 IU/L (0-31). His albumin and total bilirubin are within normal limits. He is extremely anxious about his liver, as he has been in contact with his old college friend and learned that his friend is now on the waiting list for a liver transplant. How do you interpret his tests (HCV Ab test, ALT and ALS). Which of them is more indicative of liver damages? Having established that the patient has hepatitis C with elevated liver enzymes, the next step is to determine the severity of his liver disease. What is the only direct means to evaluate the extent of liver injury? What are the chances for this guy to develop cirrhosis? The patient is concerned that he may transmit the virus to his wife or children. They are tested and are found to be negative for HCV antibody. He is relieved but asks for advice to prevent infecting them. What are you going to tell him? The patient's liver biopsy shows mild to moderate inflammatory activity and portal and periportal fibrosis (Stage 2). He is relieved to find out that he does not have cirrhosis, but remains very concerned about his hepatitis and wants to do everything possible to "get rid of" the hepatitis C. He asks about treatment for his HCV. What do you recommend?Explanation / Answer
Please find the answers below:
Answer 1: The hepatitic C antibody test is a highly specific and generic test which uniquely identifies hepatitis C antigens in the body. On the other hand, ALT and AST are general serum tests which identify the changes in levels of these biomolecules in the serum. Whereas hepatitis C antibody test is specific to anti-hepatitis C antigens in the body which are exclusively related to liver damage, the increase in levels of ALT and AST might also arise due to other pathological damages such as kidneys and heart. Thus, keeping this in mind, it can be concluded that hepatitic C antibody test is highly specific test for this kind of pathology.
Answer 2: Since no in vivo technique is available these days except liver-segment or whole liver anatomical analysis by ultrasound, this remains the only terminal and most reliable method to analyse extent of liver damage. Further, doppler's enhanced MRI can also be performed for analysis of specific kind of liver damages.
Answer 3: The appearance of hepatitic C positive antibodies indeed deciphers liver infection. However, to develop this disease into liver cirrhosis, the health history and lifestyle of the patient play a very crucial role. If the patient is on unhealthy diet, high fat diet and alcohol, it is very likely that he might develop cirrhosis.
Answer 4: The information clearly suggests that the family of the patient is negative for hepatitic C virus but still, proper health-care and sanitation with refrainment from direct transfer of body fluids should be absolutely avoided form this patient.
Answer 5: The patient must be carefully and periodically monitored for his liver profile, maintain a healthy diet and placed on an anti-viral and anti-inflammatory drug schedule under expert supervision. The life-style and food habits of the patient should also be tightly regulated for an extended period of time to avoid any further recurrent infections.
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