A 74-Year-Old Man with End-Stage Renal Disease Who Is Receiving

A 74-year-old man with end-stage renal disease who is receiving hemodialysis is found to have elevated liver transaminase levels.  He has had no fever or jaundice.  The patient does not drink alcohol and has received a complete vaccine series for hepatitis B.  Vital signs are normal.  BMI is 24 kg/m².  Physical examination shows anicteric sclerae and no hepatosplenomegaly.  Laboratory results are positive for hepatitis C virus RNA.  Six months previously, he tested negative for hepatitis C.  Without treatment, which of the following is the most likely outcome in this patient?

A) Acute liver failure
B) Decompensated liver cirrhosis
C) Hepatocellular carcinoma
D) Lifelong persistent infection
E) Spontaneous viral clearance

Correct Answer:

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