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Re: To sean:
Mar 21, 2002
Hi Sis,

Boy,is this a confusing topic. There is some evidence that hep c carriers who consistently test within normal range on AST and ALT are less likely to progress to fibrosis, and past that to cirrhosis. This is especially ture if globulin tests are also low. There is also some, not clear, evidence, that these patients respond better to treatment, that is, achieve sustained viral elimination.


There is a body of opinion now that despite the better response to interferon, these patients should NOT be treated, since it is likely the virus will do no damage to their liver, at least for decades.

It is not clear cut, each case is different.
In general, higher liver panel numbers are a worry, and lower numbers a sign of improvement. The few studies that show reversal of fibrosis--after tx, this would usually be, also show lower liver panel scores. There are just so many individual variations that you can't count on it. In fact, one mystery in the data is that some people actually at the stage of cirrhosis will show "normal" or nearly normal ast and alt results.

Given all this uncertainty, it is still, in other words, essential (in my opinion) to get biopsy results to know what one's situation is.

If i had BOTH a reassuring biopsy, AND low-ish alt and ast numbers, though, I would certainly feel I was in the "most likely to be fine without intervention" group. Without the biopsy, real confidence is harder to come by.

This is one of the reasons for getting the biopsy, in fact: since so many of us have little or modest fibrosis, it is much more likely to give us relief than to give cause for worry. And if it does give reason to worry, at least we know it's for a real reason, and we should take real steps to deal with it.

Is this an answer? hope so.

sean





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