Please help me answering the
questions of this clinical case

A 49-year-old man comes to your
office, requesting testing for hepatitis C. He recently attended
his 25-year college reunion, where he heard from a mutual
acquaintance that an old friend was seriously ill with cirrhosis
due to hepatitis C. The patient became very concerned because he
had “partied” with this friend during a brief period of
experimentation with injection drugs while in college. The patient
is otherwise healthy and denies any symptoms except for occasional
fatigue after a long day at work. Physical examination of the
patient is unremarkable. There are no stigmata of chronic liver
disease. The patient returns several weeks later to discuss his
test results. His HCV antibody test is positive. A liver panel
obtained that day shows an ALT of 48 IU/L (normal range, 0-20) and
an AST of 39 IU/L (0-31). His albumin and total bilirubin are
within normal limits. He is extremely anxious about his liver, as
he has been in contact with his old college friend and learned that
his friend is now on the waiting list for a liver transplant.

Questions:

How do you interpret his tests (HCV Ab test, ALT, and ALS)?
Which of them is more indicative of liver damages?

Having established that the patient has hepatitis C with
elevated liver enzymes, the next step is to determine the severity
of his liver disease. What are the only direct means to evaluate
the extent of the liver injury?

What are the chances for this guy to develop cirrhosis?

The patient is concerned that he may transmit the virus to his
wife or children. They are tested and are found to be negative for
HCV antibody. He is relieved but asks for advice to prevent
infecting them. What are you going to tell him?

The patient’s liver biopsy shows mild to moderate inflammatory
activity and portal and periportal fibrosis (Stage 2). He is
relieved to find out that he does not have cirrhosis, but remains
very concerned about his hepatitis and wants to do everything
possible to “get rid of” the hepatitis C. He asks about treatment
for his HCV. What do you recommend?