I have recently been diagnosed with active HepC after donating blood. My present HCV RNA, PCR (copies/ml is 1,020,000 and my HCV RNA, PCR (IU/ml is 379,000. My alt is 29. My GI doctor says that since he will not treat me because people with normal ALT levels usually get worse with treatment, there is no need for a liver biopsy. He is testing me monthly to see if it spikes, if not in 6 months will refer me to a study of cases like mine. What are your thoughts on this??

Normal ALT does not guarantee the absence of active liver disease. I usually biopsy my patients with normal ALT which often helps guide how aggressive one should be with treatment. Recent data suggests that normal ALT patients respond as well to therapy as those with abnormal ALT and will not get worse during treatment. Our knowledge in this area is evolving and more data is needed about these patients who remain with persistently normal ALT.