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Since the discovery of hepatitis C virus and its serologic markers, an identification of a subgroup of patients with persistent normal ALT (PNALT) was done. It has been estimated that this group accounts to 25% of patients with chronic hepatitis C. It is not recommended to biopsy or initiate treatment because of the natural history of the disease is benign with slow progression. However, recent studies have shown mild to moderate histologic abnormalities in nearly 80% of the patients. Interferon treatment as monotherapy has not shown significant results and there are not enough data to support combined therapy. It is recommended clinical follow up every 3 to 6 months combined with liver function tests. Biopsy and antiviral treatment should only be considered for patients included in clinical trials.