Alpha fetoprotein

  Have a past HCV infection (confirmed by RIBA). LFTs always WNL x10yrs. Never treated with IFN or anything else. Biopsy in 1996 with Knodell score of 2 (mild portal inflammation=1, minimal lobular inflammation=1). HCV by PCR neg in 1996 &97. Alpha fetoprotein in 1993=4.6 and increased to 6.6 in 1997. Should I have further workup for maybe  early stage HCC or some other cause or just monitor this on a regular basis??

[HFHS-MD-dm]

Dear Wes:
Your question points out a lot of the complexities of hepatitis C but I like the question because it gives me an opportunity to talk about these complexities.  
First and foremost, Wes, I have to wonder if you really have hepatitis C.  Approximately 10 to 15% of patients with hepatitis C will actually clear the infection themselves without any therapy.  Many of these patients will continue to have a positive hepatitis C antibody (RIBA) because this is just a test that tells us that patients been exposed to the virus but not necessarily that there is a persistent infection.  The way we determine that these patients have cleared their virus is by looking for the virus directly by PCR.  If in fact, your HCV RNA is negative by PCR on two separate occasions, if these PCR