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JAMA Diagnostic Test Interpretation

Diagnostic Challenges of Hepatitis C

Monica A. Konerman, MD
Anna S. Lok, MD

A healthy woman in her 50s without diabetes or obesity presented for an annual physical examination. Her primary care physician recommended hepatitis C virus (HCV) testing because she was born between 1945 and 1965, screening parameters based on recommendations from the Centers for Disease Control and Prevention (CDC) and the US Preventive Services Task Force (USPSTF). The patient’s hepatitis C antibody (anti-HCV) result was positive. Additional tests performed to evaluate the extent of liver disease were unremarkable: alanine aminotransferase of 34 U/L (reference range, 7-35), aspartate aminotransferase of 28 U/L (reference range, 8-30), total bilirubin of 0.4 mg/dL (reference range, 0.2-1.2), alkaline phosphatase of 95 IU/L (reference range, 30-130), and albumin of 4.0 g/dL (reference range, 30-130). She had a hemoglobin level of 14.5 g/dL (reference range, 12-16), white blood cell count of 7.1 ×109/L (reference range, 4-10), platelet count of 210 ×109/L (reference range, 150-400), and INR of 1.0. A baseline abdominal ultrasound to look for features of cirrhosis showed mild increased echogenicity of the liver. The liver was not nodular and the spleen not enlarged. The patient was asymptomatic. Other laboratory values are shown in the Table.

Laboratory Test Value Reference Range
Hepatitis C virus RNA
1 764 200 IU/mL
Not detected
Hepatitis C virus genotype
1a
Not applicable
Hepatitis B surface antigen
Negative
Negative
Anti-HIV Negative Negative

See the full article for an explanation and discussion.

Author Affiliations: Drs Konerman (konerman@med.umich.edu) and Lok are affiliated with the Division of Gastroenterology, Department of Internal Medicine, University of Michigan Health System, Ann Arbor.