Monitor Your Liver Health in People with Chronic HCV

Although the natural history of the hepatitis C virus (HCV) is poorly understood, liver damage due to chronic HCV infection is thought to typically occur slowly, over a decade or more. However, not everyone infected with the virus will advance to liver disease. Currently, it is believed that only 20 to 25 percent of people chronically infected with HCV will advance to cirrhosis.

Liver specialists have not resolved the question of whether to treat patients with chronic HCV infection who show no signs of liver damage. Although the protocols vary among health care facilities, many liver specialists recommend monitoring the health of the liver for signs of liver damage before considering alfa interferon treatment, the only FDA-approved treatment for chronic HCV infection. Therefore, patients with chronic HCV may be advised to have regular checkups and blood tests to monitor the health of their liver.

The Checkup

During a checkup, the patient may be asked about the severity of any symptoms, such as fatigue, associated with chronic HCV infection. During the clinical exam, a physician will look for signs of liver and spleen enlargement. The physician will also check to see if the liver and spleen area are sensitive or painful to the touch. He or she may also examine the patient's skin for small, spider-shaped clusters of red blood vessels that can arise when the liver is damaged.

The Lab Work

Myriad tests monitor the health and function of the liver. Many of these tests are done once a patient is known to have liver damage. Below are some of the lab tests that patients chronically infected with HCV, with no signs of liver damage, may encounter.

Blood Platelet Count

The physician may monitor the patient's blood platelet count to ensure healthy levels. Blood platelets help blood clot. A persistent decrease in a patient's blood platelet count may indicate more advanced disease. A low blood platelet count increases the patient's risk of hemorrhage, or uncontrolled bleeding.

Liver Enzyme Levels

When liver cells are damaged or die, they release more than normal amounts of certain enzymes into the blood stream. A blood test can reveal if these liver enzyme levels are normal or high. Alanine aminotransferase (ALT) is one such enzyme physicians monitor in patients with chronic HCV infection. Although a high ALT level indicates potential liver damage, it is not a definitive marker, so the test is usually repeated. If high ALT levels persist, a liver biopsy may be performed to assess liver damage. Another blood enzyme that may be monitored in patients with HCV is aspartate aminotransferase (AST). However, a high AST level is not an exclusive indicator of liver damage, as AST is also released from damaged muscle, heart, kidney, and brain tissue.

Alpha-Fetoprotein Level

Alpha-fetoprotein is a blood protein capable of stimulating an immune response. High alpha-fetoprotein levels in the blood can also indicate liver damage.

Liver Biopsy

If these or other tests suggest potential liver damage, the patient may undergo a liver biopsy. Generally patients undergo a needle biopsy procedure under local anesthesia. The needle is inserted through the abdomen, into the liver, and a sample of liver tissue is extracted. The liver tissue is then evaluated. If the tissue confirms liver damage due to HCV infection, treatment options will be considered.

"Approach to the Patient with Abnormal Liver Chemistries," Richard H. Moseley, in Textbook of Internal Medicine, 3rd edition, 1997, Lippincott-Raven Publishers, Philadelphia.

"The Dilemma of Whether to Treat the Hepatitis C Patient," Eugene R. Schiff, M.D., Liver Update, Function & Disease, Vol. 10 No. 1; Winter/Spring 1996, American Liver Foundation.

Harrison's Principles of Internal Medicine, Thirteenth Edition, 1994, McGraw-Hill, Inc.