Information on hep C

I am a 30 year old who was dx. w/hep C in 1993.  I believe to have contracted the virus approx. 7 years prior to that time.  In 2000, I visited a liver specialist and had extensive testing done, including qualitative and quantitative blood work.  My viral load was negative and no active viral replication was observed.  A liver biopsy revealed "excellent" results.  At that time, my husband and I were under the assumption that the virus was not chronic; therefore, I did not need to continue to monitor my liver status.  I remember the doctor telling me I was one in a percentage of people that kick the virus on their own.

I went on to lead my life normally.  I still drank alcohol on occassion.  I also took the medication Nortriptyline, which can cause liver damage in some individuals.  

Now I have heard that I should continue to monitor my liver status b/c the virus could become active again.  

I recently had blood work done for an annual physical, and all results (albumin, total bilirubin, SGOT) were within normal limits, but my total bilirubin level was right on the edge of being high 1.2, with the normal range being .2 - 1.3.  Could this be a red flag?  Can other things cause an increase in bilirubin levels?

Thank you for your time.

[Kevin Pho, MD]

On a side note, if you are positive for hepatitis C, I would suggest abstaining from alcohol until you can be sure that the virus is no longer present.

There are many reasons why an isolated bilirubin level can be elevated.  Of course, any type of liver or gall bladder disease can cause this.  An abdominal ultrasound can be a reasonable inital study to evaluate for this.  

Other causes can be divided into disorders associated with bilirubin overproduction (such as hemolysis and ineffective erythropoiesis) and disorders related to impaired hepatic uptake/conjugation of bilirubin (such as Gilbert's disease, Crigler-Najjar syndrome and the effects of certain drugs).

If hemolysis (i.e. breakdown of red blood cells) has been ruled out, and all the other tests for liver disease are negative, then you may want to consider Gilbert's syndrome.  This is an asymptommatic disease that does not require treatment.  You may want to discuss this with your personal physician.
Followup with your personal physician is essential.

This answer is not intended as and does not substitute for medical advice - the information presented is for patient education only. Please see your personal physician for further evaluation of your individual case.

Thanks,
Kevin, M.D.

Bibliography:
Chowdhary.  Gilbert's syndrome and unconjugated hyperbilirubinemia due to bilirubin overproduction.  UptoDate, 2004.