Approach to patients with hepatitis C and persistently normal alanine aminotransferase levels

Hepatitis C virus (HCV) infection is a common disease in the United States, with an overall prevalence of 1.8%. HCV accounts for ~20% of patients with acute hepatitis and 70% of those with chronic hepatitis. Chronic hepatitis C is a major cause of cirrhosis and hepatocellular carcinoma. In addition, HCV-related end-stage liver disease is the most common indication for liver transplantation. With this disease having such an impact on our healthcare system, treatment of chronic HCV and prevention of its complications assume utmost importance. Current therapy for hepatitis, although effective in some patients, remains problematic and is still evolving. Additionally, the decision to treat, although easy in some individuals, continues to be difficult and confusing in others. The decision is especially difficult in the group of patients with chronic HCV infection and persistently normal alanine aminotransferase (ALT) levels.