disease and, in fact, all RIBA-positive patients had abnormal liver histological results.
As yet unanswered is the question of whether histological liver disease in the absence of biochemical abnormalities suggestive of hepatic inflammation can progress to more advanced liver disease, including cirrhosis and ultimately HCC. It is possible that in the future a liver biopsy may need to be considered in biochemically normal anti-HCV-positive persons with a positive RIBA result with a view to obtaining prognostic information and even perhaps to considering treatment with &-interferon. Similar to Esteban et al., van der Poel et al. (6) found that 40% of blood donors positive for anti-HCV by ELISA but with normal ALT levels had abnormal liver biopsies. Further clarification of the importance of this finding will await more widespread experience with liver biopsy in anti-HCV-positive individuals with normal liver biochemical test results. The fluctuating yet progressive nature of posttransfusion non-A, non-B hepatitis described before the discovery of HCV may need to be expanded to include histological activity even in the absence of elevated aminotransferase levels (7), an observation that suggests that perhaps no such condition as a "healthy" HCV carrier exists .