What does elevated ALT in a patient with suspected HCV indicate?

Elevated alanine aminotransferase (ALT) levels in a patient with suspected hepatitis C virus (HCV) infection typically indicate acute liver injury. ALT is an enzyme found primarily in the liver, and its elevation signals that liver cells are damaged or inflamed. In the context of HCV, an increase in ALT is often associated with active viral replication and liver inflammation due to the infection.

While chronic liver disease can also be characterized by elevated ALT levels, the context of an acute presentation, combined with laboratory findings and clinical symptoms, would lean towards acute liver injury rather than chronicity. Increased risk of liver cancer and portal hypertension are potential long-term complications of chronic HCV infection but are not indicated by acute elevations in ALT.

In summary, in a patient with suspected HCV presenting with elevated ALT, it reflects an ongoing acute liver injury as the body responds to the viral infection and inflammation within the liver.