Hepatitis C virus (HCV) is a major public health problem and is considered themost common etiology of chronic liver disease in Egypt. Chronic hepatitis Cvirus (HCV) patients with persistently normal transaminases represent asubgroup of patients with mild, slowly progressive disease, natural history, andoptimal management of these patients needs to be investigated in Egypt.Aim of work: to assess the severity of hepatic fibrosis and response to therapyin a cohort of Egyptian HCV patients with normal transaminasesPatients and methods: Retrospective demographics, laboratory, histologicalfeatures and treatment outcome of patients included in the national program forthe control of viral hepatitis in Egypt since 2008-2012 were collected. Combinedpegylated IFN/ribavirin therapy was given for patients with fibrosis stage ≥ F1and elevated transaminases while those with normal transaminase; therapy wasinitiated only in patients with fibrosis stage ≥ F2.Results: Normal ALT and AST were detected in 1308/4277 (30.6%) and1662/4277 (38.9%) patients, respectively, while both enzymes were normal in943 patients (22%). Multivariate regression analysis showed that lower AFP andhigher platelets count (compared with elevated transaminases group) weresignificantly correlated with normal transaminases (P<0.01), however, HCVRNAlevels did not show such significance. The number of patients with HAIscore ≥ A1 was significantly lower in normal than elevated transaminases (36.5%vs 40.9%, respectively, P < 0.01) and patients with fibrosis ≥ F2 wassignificantly lower in normal than elevated transam-inases (36.4%) and (43%),respectively (P < 0.01). There was no significant correlation between baselinetransaminases levels and response to treatment. Conclusion: Normaltransaminases are frequently encountered in chronic HCV Egyptian patients(22%). They show low AFP level, mild degree of activity and stage of fibrosiswith no correlation with response to therapy