What is the best way to manage a patient with documented hepatitis C whose liver function tests fluctuate between 100 and 150 units/L and whose hepatitis B virus DNA polymerase chain reaction is undetectable?
—Nilesh N. Patel, MD, West Covina, Calif.

Your patient probably has chronic active hepatitis C. Hepatitis B infection should be diagnosed with the appropriate serologic assays and not by molecular diagnostics (www.cdc.gov/ncidod/diseases/hepatitis/b/hbv_silent_killer.pdf. Accessed June 11, 2008). The clinical approach to this patient should be based on prevention and therapy. Prevention efforts should focus on vaccinations for other hepatitis viruses, if applicable, and also on the complete abstinence from alcohol. Therapeutic options must be considered once the patient’s liver biopsy, HCV genotype, psychosocial profile, and HIV status have been determined (www.aasld.org/eweb/docs/hepatitisc.pdf. Accessed June 11, 2008). If pegylated interferon is appropriate, consultation with an experienced specialist should be obtained prior to the initiation of therapy.
—Cedric W. Spak, MD, MPH (117-7)