18. Chronic hepatitis C Flashcards
how is hep c transmitted ?
parenteral transmission
- mostly hospital related such as hemodualysisi and needle , tattooing
rarely sexual contacts and mother to child
describe the virus HCV ?
one single stranded positive sense RNA virus
7 HCV types
genotype 1 the most freq in europe and USA
HCV replicates in the CYTOSOL OF THE HEPATOCYTES = not directly cytopathic
is there a vaccination for HCV
NO
what are the clinical manifecstation with HCV ?
acute cases often asymptomatic vomitting , muscle and joint pain fever hepatomegaly and jaundice
chronic
after persisting 6 months
leads to chronic cases in 75 percent of cases and this is also a SLOWLY progressive ASYMPTOMATIC disease
and 20 percent develops cirrhosis in 30 years period time leading to HEPATOCELLULAR CARCINOMA
= once chronic established spontaneous clearance v low
what is the diagnosis of HCV ?
ACUTE HEP C
ELISA
anti HCV antibodies found found 4-8 weeks
= cannot determine if new , chronic or or resolved
neither are these antibodies protective
HCV rna - FOR DETERMINATION
detected with real time PCR early as 8 WEEKS
HCV genotype is MANDOTORY FOR TREATMNET
aminotransferase becomes elevated in 6-12 weeks after exposure
CHOLESTAISIS PRAMETERS : increase of - GAMMA -gt ,AP , bilirubin
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chronic hep c
there can be persistently normal alt
4) us fibroscan for hep c f0-f1 = mild = 2-7 f2 =moderate 8-9 f3 = severe= 10-14 f4= cirrhosis = >14 cirrhosis
for hep b
f3= 10-11
f4 = 18 or higher
negative anti HCV and negative HCV RNA= no infection
postive anti HCV and positive HCV rna = acute r chronic
negative anti - HCV and positive HCV RNA = early acute infection or immunosuppression of chronic disease
postive anti HCV and negative HCV RNA= resolved / low viremia / passively acquired antibodies
HCVrna the loss of it indicates cure
what are the extra hepatic manifestation of hepatitis C
cyroglobulinemia blood contains large amounts of pathological cold sensitive antibodies - in cold temp become insulobule
= rash , arthralgia , nephritis , neuritis , LYMPHOMA
cognitive impairment , depression
skin - porphyria cutanea tarda, lichen planus
endo - diabetes mellitus type2 = insulin resistance
autoimmune thyroiditis
rheumatoud arthritis , sjoren syndrome
what is associated with hepatitis c progression to chronic hepatitis and cirrhosis and progression to HCC
alcohol
male
got it at age 40 or higher
co infection of HBV or HIV
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risk factors for hcc
alcohol abuse
co infection as above
iron overload
what are the factors that DOES NOT INFLUENCE disease progression
VIRAL LOAD
ALT LEVEL
what are the non invasive ways for getting staging of fibrosis in a person who has HEP c
direct serum markers - hyaluronate , TIMP-1
acoustic radiation force impulse
trainsient elastography
which uses fibro scan - sheer wave conducted to liver
evaluation based on measuring the velocity called a ‘shear wave’ generated on the skin.
FIB-4 test
based on age , ALT , AST and platelet count
FIB-4 >3.25 positive prrediction 65 percent and over for advanced fibrosis
and fibrotest = five serum biochemical markers such as a2 macroglobulin haptoglobulin apoliporportine a1 bilirubin Gamma GT patinets age gender
what is the treatment for HCV ?
cure = hcv rna must remian negative for 3-6 months AFTER TREATMNET
pegylated alpfa interferon , ribivarin and portease inhibiitors no longer used
for genotypes 1,2,3,4,5,6 without cirrhosis and with = sofosbuvir/ velpatasvir = 12weeks
or
glecaprevir / pibrentasvir = 8 weeks
if it is with cirrhosis for genotype 3 = sofosbuvir / velpastasvir cannot be used
but
glecaprevir and pibrentasvir can be used = need for 12 weeks
when is sofossbuvir contraindicated ?
chronic kidney disease stage 4 and 5
an no dose is gfr <30ml/min
protease inhibitors should never never be used in ?
decompnesated
which patinets are difficult to treat
genotype 3 with decomnesated liver cirrhosis
pegylated inerferone alpfa
ribavarin combination type
