8 Hepatitis C

Question 1

Hepatitis E. virus RNA family

Answer 1

RNA virus – herpesvirus family

Question 2

hep E spread

Answer 2

faecal-oral spread

Question 3

is hep E a chronic infection

Answer 3

if immunocompromised it is chronic

Question 4

effect of hep E on pregnancy

Answer 4

higher mortality than HAV – especially in pregnancy

Question 5

what is hep E associated with

Answer 5

usually associated with travel abroad, but endogenous infection increasingly recognised

Question 6

which animal transmits hep E

Answer 6

zoonosis – genotype 3 virus found in pigs

Question 7

hep C family

Answer 7

flavivirus

Question 8

hep C RNA

Answer 8

+ve ss linear

Question 9

what is the hep C capsid

Answer 9

icosaedric capsid

Question 10

Quasispecies

Answer 10

swarm of closely related sequences within an individual

Question 11

HCV genetic diversity: consequence - Diagnosis

Answer 11

may result in false negativity

Question 12

HCV genetic diversity: consequences - pathogenicity

Answer 12

all genotypes equally dangerous

Question 13

HCV genotypes: UK

Answer 13

Predominantly types 1 and 3

Some type 2

Question 14

Anti-HCV positive

Answer 14

Evidence of infection at some time

Question 15

problem with anti-HCV positive

Answer 15

Gives no indication as to when infection occurred

Gives no indication as to whether infection was cleared or is still present

Question 16

Anti-HCV: Negative

Answer 16

No evidence of infection with HCV

Question 17

problem with anti-HCV negative

Answer 17

BUT - be aware of possible false negatives

• if infection very recent (window period)
• if patient immunosuppressed at time of infection

Question 18

Genome Detection

Answer 18

Look for the viral genome

Question 19

what does genome detection require

Answer 19

Requires amplification e.g. Reverse Transcriptase Polymerase Chain Reaction

Question 20

benefit of genome detection

Answer 20

Technically more exacting

Question 21

con of genome detection

Answer 21

expensive

Question 22

Interpretation RT/PCR result - Positive

Answer 22

• infectious
• risk of chronic liver disease
• requires liver biopsy

Question 23

Interpretation RT/PCR results - negative

Answer 23

• not infectious
• not at risk of chronic liver disease
• no biopsy required

Question 24

Hepatitis C virus routes of transmission

Answer 24

strongly linked to blood
Parenteral
- injecting drug use
- blood/blood products
- other needles
- failure of infection control e.g. outbreaks
Prevalence of anti-HCV amongst blood donors

Question 25

HCV infection clearance %

Answer 25

20

Question 26

HCV infection chronic infection %

Answer 26

80

Question 27

Chronic HCV infection: Predictors of disease progression

Answer 27

Male sex
Older age at infection (aging liver doesn’t handle virus well)
Increase alcohol intake

Question 28

Needlestick transmission of blood-borne hepatitis viruses

Answer 28

Infected patient to healthcare worker
or
Infected healthcare worker to patient

Question 29

Protection of HCWs: HCV

Answer 29

• no vaccine, no passive immunisation
• treatment of acute infection = very high clearance rates
• encourage reporting of needlestick exposures
• monitor for evidence of HCV infection
• treat