Significance of normal liver enzymes in patients with hepatitis C virus.

Background: Hepatitis C Virus (HCV) infection is a common universal problem especially in the Arab World.

Objective: To assess the significance of persistently normal liver enzymes in patients who were anti HCV positive and suggest the proper approach for this group of patients.

Method: 56 patients who were anti HCV positive with persistently normal liver enzymes for more than one year underwent liver biopsy to assess their liver histology after excluding other possible causes of chronic liver disease. METAVIR scoring system was used and the degree of fibrosis (F0-F4) was considered as reflection of severity.

Results: Out of 56 patients, only 52 patients had liver biopsies; 44 (84.6%) patients had abnormal liver histology and eight (15.4%) patients had normal liver biopsy. Out of the 44 patients with abnormal liver biopsy, 23 (44.2%) patients had mild histology (F1-F2); 15 (28.8%) patients had severe histology (F3); two (3.8%) patients had cirrhosis (F4); four (7.7%) patients had non-specific changes (Al/FO).

Conclusion: Normal liver enzymes in patients who were anti HCV positive does not carry prognostic implication and patients should have a liver biopsy to assess their liver histology, though the chance of having mild histology with minimal inflammation is more than 50%.