Hepatitis C and normal liver biopsy results

[heatherjdavis]

I received 2 units of blood in 1988.  In 1990, 1991, and 1992 I had mildly elevated liver enzymes during routine blood tests.  I was tested for hepatitis but it came back negative.  (They weren't testing for HepC back then).  I found out this past summer that I have Hep C.  It was positive by PCR.  My viral load was 261,580.  I've had 3 children in the past 7 years and my liver enzymes have been normal consistently and still are.  I had a liver biopsy which came back inconclusive because the specimin was fragmented.  I had another one done 2 months later.  3 samples were taken.  There was still some fragmentation but he got one really good specimin.  The results came back as:  "No identifiable disease process."  My doctor was amazed that there was absoultely no inflammation on staining.  I'm a stage 0.  Is this possible?  Could I have the virus in my blood but it just hasn't taken effect?  Should I feel comfortable living with this?  My doctor suggested another biopsy in 2 years and offered a clinical trial if I want.  In all the litetature on-line I've never seen hep c with a normal liver biopsy.  I've had this since 1988, 15 years.

[Kevin Pho, MD]

Hello - thanks for asking your question.

Please understand my limitations over the internet as I have neither met nor examined you. This information is for patient education only. Please see your personal physician for further evaluation.

There is a possibility of normal liver enzymes in those with hepatitis C.  Up to 1/3 of hepatitis C patients have a normal ALT.

The time course from diagnosis of hepatits C to liver damage on biopsy is tremendously variable.  Some studies do not show liver damage for 30-50 years after diagnosis of hepatits C.  

Thus it is definitely possible that you do not have inflammation or signs of biopsy-proven liver damage yet.  A majority of hepatitis C patients with normal liver enzymes also have a normal biopsy, as long as they abstain from alcohol.  Approximately 10% of patients will have evidence of liver damage even with normal enzymes.

Please ensure that you continue to be followed closely (i.e. having regular liver function tests and biopsies) and completely abstain from alcohol.

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.