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Hello Doctor Barbarathanks in advance for reply
Jul 3, 2009

I visited my doctor with symptoms of Jaundice on 14th April 2009. Following are the results of tests. Hepatitis A = Non reactive, Hepatitis B = Non reactive, Hepatitis E = Non reactive Hepatitis CReactive, S/CO.11.16 HCV by PCR (RNA)Detected Ultrasound Abdomen..Hepetomegaly LFT Total Bilirubin = 18.95 mg/dl, Direct Bilirubin = 16.23, AST = 1408 U/L,ALT = 1410 U/L Alk Phosphate116 U/L Latest results of Tests performed on 2nd June 2009 are as follows HCV by PCR (RNA)Detected LFT Total Bilirubin = 0.87, mg/dl, Direct Bilirubin = 0.39, AST = 32 U/L,ALT = 32 U/L Alk Phosphate67 U/L My questions are :- 1. Am I at Acute HCV stage? 2. How long should I wait if my virus is cleared by itself? (Should I wait for 6 months from 14th April 2009) 3. Should I start medication at this stage? (Although my LFT is normal) 4. What further tests I require before starting treatment? 5. Should I take vaccine for Hepatitis A and B prevention? Thank you

Response from Dr. McGovern

Well thought out questions.

Yes, you do have acute hepatitis C it appears. If you tested negative in the past and are now antibody positive this would be a definitive diagnosis. However, even without that information, your jaundice, high ALT and AST, and reactive hepatitis C antibody with detectable virus makes the diagnosis firmly.

You do need more tests - you need a quantitative HCV RNA to see if you are clearing the virus over time - If you continue to have virus in July, I would go on treatment for hepatitis C since the chance of eradicating virus is high if you act fast and the length of treatment is generally shorter. Then I would check a HCV RNA one month into treatment to see if you are clearing your viremia (virus in the blood). I would also get a HCV genotype.

Since your liver function tests are completely normal now, I would expect that your hepatitis C RNA may be clearing. This would be great news. That is why it is important to get an idea of how much virus you have. A test can be "detectable" even with only about a 100 copies of virus - and a low level would suggest you are just about to clear it on your own without treatment.

I would certainly get immunized for hepatitis A and B and also discuss with your doctor what you risk factor was since clearance of HCV does NOT protect you from getting it again. I would also get tested for HIV as well since I do that routinely in all my patients.



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