A patient is being evaluated for jaundice and liver fibrosis. His AST=87 IU/mL and ALT=81 IU/mL. His serological tests are given below. Which of the following is the next step in the diagnosis? IgM Anti- HbcAg Non- reactive IgG Anti- HbcAg Reactive HbsAg Non-Reactive HBeAg Non-Reactive Anti-HCV Reactive

The serological status of this patient shows HCV infection since anti-HCV antibody is reactive. Hepatitis B surface antigen is negative and IgG Anti- HBcAg is reactive indicating remote infection with hepatitis B. Recovery is the rule in hepatitis B. In contrast hepatitis C results in development of cirrhosis. Even if transaminases are normal, hepatitis C results in long term damage to the liver. Hence the reason for elevated liver enzymes with development of liver fibrosis points to HCV being the culprit. The next step shall be to perform a PCR-HCV RNA and initiate treatment based on prevalent genotype in the area. Liver biopsy is ruled out as question says patient is already having fibrosis