Few cases of CPH progressing to CAH were documented. Recently, this thinking has been challenged, particularly for cases involving chronic viral hepatitis. Therefore, CPH and CAH may be considered different stages of the same process rather than different entities. Since most cases are asymptomatic until end stage liver disease is imminent and the aminotransferases can fluctuate considerably, a number of cases may be missed or the seriousness underestimated. CPH is not always the benign disease we once thought.
Several points are worth noting.
Abnormal aminotransferases cannot be ignored or glibly rated. Cases associated with elevated aminotransferases and a positive anti-HCV should be postponed pending further investigation, including liver biopsy. If the liver biopsy shows CPH, an HCV-RNA should be obtained. This is based upon the fact that, although the likelihood of progression to CAH is reduced, the test is still new and long term validation studies have not been performed. It is too early to ascertain how well patients with CAH treated with interferon-alpha will do.