I am a nuclear-medicine technologist who was infected with hepatitis C as a result of a needle-stick accident. Over the past nine years, I have had my liver enzymes checked every six months and, to date, they have never been elevated. Does this mean my liver is not being damaged? I have never had a liver biopsy. The doctor I had several years ago stated that unless my enzymes were elevated, there was no need to biopsy. Is this correct? Am I safe just getting my enzymes checked?

Mary

Hepatitis C is the most common cause of chronic viral hepatitis in the United States. In general, the course of hepatitis C is one of fluctuations in the level of the liver enzymes in the blood. What that means is that in any given patient, enzymes can occasionally rise to abnormal levels and then drop back down to normal.

Most of the data on hepatitis C support a combination therapy using the antiviral drugs interferon and ribavirin in patients with elevated liver enzymes. In the last few years, some researchers have examined the possibility of treating even patients with normal enzyme levels. The rationale for this approach is based on the fact that patients who have less scarring in the liver and lower amounts of viral particles in the blood respond better to treatment.

Thus, despite normal enzyme levels, if the virus can be found in the blood, many hepatologists will do a liver biopsy to assess the degree of damage to the patient's liver. Based on the biopsy findings, some will decide to treat the hepatitis C infection. This approach has not been standardized yet, and the decision to treat will depend on the individual patient's situation and the individual doctor's views. Risks to consider include the medications' possible side effects, such as the worsening of preexisting depression. If you have not yet been referred to a liver specialist, you should get this consultation.