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enquiry about hepatitis
Nov 25, 2006

hello doctor , in sep2005 I developed malaria and un conjucated hyperbilirubinamia. my docotor done liver biopsy reported as :there is mild sinusoidal dilatation and portal triadititis. hepatocytes show frequent binucleation. no piecemal necrosis is noted. there is a single focus of spotty necrosis. and HbsAg negative, anti HCV negative, anti HBC reactive on 3/3/06 and HCVRNA POSITIVE done by normal method , HBV DNA NEGATIVE , BUT the HCVrna test was repeated by pcr real time method was found negative on 10/10/06. my bilirubin level always varies from 3-4 and sgopt and sgpt always varies, doctor what could be the reasons for this variation . i shall be highly thankful to you.

Response from Dr. McGovern

This is extremely complicated and I cannot give you a firm answer, but suspect prior hepatitis B and C infections.

1. The bilirubin that is elevated could be related to something benign called Gilbert's syndrome, which just refers to people that can have a mild elevation of birubin due to a difference in their metabolizing enzymes. This is not clinically important. If more blood tests were drawn, I would check to see if you have an "indirect" bilirubin elevation.

2. Hepatitis C: Since your RNA was positive when your antibody was negative, I wonder if you had acute hepatititis C when this was drawn. I would follow up with an hepatitis C antibody. I suspect this will now be positive, but you may have cleared your infection since follow-up RNAs were negative. Your liver biopsy could have been abnormal at this time due to acute hepatitis. You did not mention significant scarring of your liver, but you may want to discuss this with your physician.

3. The hepatitis B profile can indicate past exposure with clearance. 3.



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