I was diagnosed with chronic hepatitis C, but I don’t feel any abnormalities and my liver function test results are also normal. Why is this? Do I require treatment and what kind?

This phenomenon is actually quite common. Hepatitis C virus (HCV) causes damage to the liver by first evading the immune system and then attacking the liver cells, leading to hepatitis (inflammation of the liver). When liver cells are attacked, liver function will be affected and become abnormal. However, if a person infected with HCV has strong immunity and is able to generate a strong cellular immune response against the virus, the virus will not be able to damage liver cells and affect liver function. [1]

People often think that when hepatitis virus is present in the body, the liver will be damaged and that the higher the viral count, the more severe the damage. This is a misconception. The amount of HCV RNA present in blood should not be used to measure the degree of damage in liver cells. A high viral load does not imply serious liver damage, similarly, a low viral count does not equal little liver injury. [2]

If patients infected with HCV have normal liver function (regardless of viral load), there is no rationale for treatment. [3][4] (The decision should be made based on taking together all laboratory data and overall health factors such as HCV viral load, liver enzymes, age, etc.) However, patients must ensure and maintain strong immunity and monitor liver health and function by having regular checkups.

Patients should pay attention to their ALT & AST levels, as these enzymes are commonly used as indicators of liver injury. When these enzymes are within the normal range, there is a high possibility that liver function is normal. But in some cases, these enzyme levels may also be within the normal range even in the presence of liver damage, e.g. cirrhosis. Therefore, patients should look at the overall results of Liver Function Tests (LFTs) to assess the general state of the liver.