11 Hepatitis C Park Flashcards
What type of Virus is Hepatitis C?
An enveloped, single stranded, positive sense RNA virus
What is the incubation period for Acute Hepatitis C?
Averages 6-10 weeks
What is the most characteristic feature of Acute Hepatitis C?
Elevations in serum ALT levels, often in a fluctuating pattern
What happens after the Acute Hepatitis C infection?
15-25% of persons resolve their infection without sequelae. As many as 70-90% of infected people fail to clear the virus during the acute phase of the disease and become chronic carriers
What can Chronic Hepatitis C be defined as?
A continuing disease without improvement for at least 6 months
How many people with Chronic Hepatitis C have symptoms?
Most persons (60-80%) have no symptoms
What is Chronic Hepatitis C’s rate of progression to cirrhosis?
Usually slow, with 20 or more years elapsing between infection and the development of serious complications
What are the signs and symptoms of Chronic Hepatitis C infection?
Unexplained fatigue. Malaise. Jaundice. Anorexia. Fluid retention. GI bleeding, discomfort. Hepatomegaly. Splenomegaly. Unexplained signs of portal hypertension. Extrahepatic manifestations of HCV infection
What is diagnosing HCV Infection like?
Some persons may not test positive for 6-9 months after the onset of illness. A correct diagnosis can only be made by testing patient’s sera for the presence of specific anti-viral antibodies. Diagnosis is not based solely on elevated transaminases (NON-SPECIFIC). The diagnosis of acute and chronic hepatitis C is based on both anti-HCV detecting using enzyme immunoassays (EIA) and HCV RNA detection using a sensitive molecular biology-based technique
What do HCV Positive persons have?
Antibodies to Hepatitis C virus (anti-HCV) in their blood (generally not detectable before 8-12 weeks following exposure). AND/OR. HCV RNA or HCV core antigen detected in their blood (identified as early as 1-2 weeks following exposure). HCV RNA, as detected by PCR or HCV core antigen detection, becomes positive within days of inoculation
What has become the method of choice for early diagnosis of Hepatitis C infection?
PCR
Which genotypes of HCV tend to respond the best to treatment?
Genotype 2 (favorable genotype). Genotype 3
Which genotype of HCV is “less favorable”?
Genotype 1. Most resistant to treatment. Requires higher doses of RBV
What is the definition of treatment response?
Treatment responses are defined by a surrogate virological parameter rather than a clinical endpoint. Several virological responses may occur
What is the goal of treatment for HCV?
Sustained Virological Response (SVR): HCV RNA negative 24 weeks AFTER cessation of treatment. Prevent complications and death from HCV infection
What is Rapid Virological Response (RVR)?
HCV RNA negative at treatment week 4
What percentage of people achieve SVR with Genotype 1, 2, and 3?
1 ~ 40-50%. 2,3 ~ 80%
What are the three medication classes for HCV?
Interferon (IFN). Nucleoside Analog (Ribavirin). Protease Inhibitors (Boceprevir, Telaprevir)
Which HCV medication can only be used for Genotype 1?
Protease Inhibitors (in combination with IFN + RBV)
What is the dosing of Pegylated IFN alfa-2a (Pegasys) like?
180 micrograms injected SQ once per week
What is the dosing of Ribavirin (Copegus) like?
1,200mg = > 75kg in genotype 1. 1,000mg = < 75kg in genotype 1. 800mg for genotypes 2,3 regardless of weight
What is the dosing of Boceprevir (Victrelis) like?
800mg TID Q7-9 hours with food (start on week 5 of HCV treatment)