Curbside Consultation of the Liver: 49 Clinical Questions

Mitchell L. Shiffman, MD

Question 2: How Should A Patient Who Tests Positive For Chronic Hepatitis C But Has Persistently Normal Serum Aminotransaminases Be Evaluated? (continued)

Ramesh Ashwath, MD; Mitchell L. Shiffman, MD

Approximately 20% to 33% of patients with chronic hepatitis C virus (HCV) infection have persistently normal aminotransferase activity (PNAT). Historically, these patients were felt to have “milder” HCV and thought to be “less likely” to develop fibrosis progression and cirrhosis compared to patients with elevated aminotransferases (AT) activity. In addition, scattered brief reports demonstrated that some patients with PNAT developed elevations in serum AT activity during treatment. As a result of these observations, the first National Institute Health Consensus…