HCV Flashcards

1
Q

What are the most common HCV genotypes in UK?

A

Genotypes UK
1a (32%)
1b (15%)
3a (37%)

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2
Q

What are the common 3 drug targets for DAAs?

NS3A/4A
NS5A
NS5B

A

NS3A/NS4A - Protease inhibitor - prevent cleavage polyprotein

NS5A - unknown - essential for replication

NS5B - RNA dependent RNA polymerase

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3
Q

What are common drug examples?

NS3A/ 4A

A

NS3A/NS4A - Protease inhibitor - prevent cleavage polyprotein

Grazeprovir

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4
Q

What are common drug examples?

NS5A

A

NS5A - unknown - essential for replication

Elbasavir
Velpatasvir

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5
Q

What are common drug examples?

NS5B

A

NS5B - RNA dependent RNA polymerase

Sofosbuvir

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6
Q

What are components of Child-Pugh score?

Used to predict mortality risk in patients with cirrhosis.
Stratify who needs treatment, and who may need transplant

A

Child-Pugh Score

Bil
Alb
INR
Ascites
Encephalopathy

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7
Q

What is mortality rate of these Child Pugh classes?

A
B
C

A

1 year mortality

A - 13%
B - 65%
C - 69%

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8
Q

What are normal and abnormal fibroscan ranges?

A

<7 kPa - normal (Metavir 0/1)

7 - 9.5 kPa - mild (Metavir 2)

9.5 - 12.5 kPa - moderate (Metavir 3)

> 12.5 kPa - severe (Metavir 4)

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9
Q

What is Metavir score?

A

histological staging

used to evaluate the severity of fibrosis seen on a liver biopsy
from a person who has hepatitis C

F0 - no fibrosis
F1 - fibrosis occasional
F2 - fibrosis with occasional bridging
F3 - fibrosis, marked bridging between zones
F4 - cirrhosis

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10
Q

What is Ishak score?

A

histological staging

  • 0 no fibrosis
  • 1 fibrous expansion of some portal areas, with or without short fibrous septa
  • 2/3/4 fibrous expansion in portal areas
  • 5 marked bridging between fibrous areas with occasional nodules (incomplete cirrhosis)
  • 6 cirrhosis, probable or definite
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11
Q

What are transmission routes of HCV?

A

Blood - IVDU, transfusion
Sexual
Transplacental - possible but inefficient

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12
Q

How many patients with acute HCV infection develop acute hepatitis?

A

10% develop acute hepatitis
occurs about 6 weeks after HCV exposure

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13
Q

What percentage of patients infected with HCV develop chronic HCV infection?

A

Chronic defined as HCV RNA detectable >6 months after infection

20% clear spontaneously
80% chronic infection

Chronic infection tends to be progressive, than relapsing remitting

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14
Q

80% of those infected with HCV develop chronic infection.

20% of those with chronic infection develop cirrhosis within 10-30 years

What are risk factors for progression to cirrhosis?

A

HIV/ HBV co-infection
smoking
obesity
alcohol use
male
older age at time of diagnosis

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15
Q

Patients with HCV and cirrhosis, are at risk of HCC
(if no cirrhosis, no risk of HCC)

What proportion of patients develop HCC?

A

The annual risk of HCC in HCV with cirrhosis is 3 to 5%

Even after HCV infection is cleared, patients with cirrhosis will still require follow up 6 monthly USS for HCC

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16
Q

Patient with needlestick injury

When and what blood tests should be taken?

A

At baseline - bloods for storage

6 weeks - HCV RNA

12 weeks - anti-HCV and HCV RNA

24 weeks - anti-HCV

17
Q

HCV workup

What other testing is required?

A

HCV RNA
HCV genotyping

HAV immunity
HBV immunity

USS liver - check for cirrhosis

Other liver screen - liver autoantibodies, immunoglobulins, Alpha-1-antitrypsin, caeruloplasmin, ferritin, HbA1c

FBC, UE, LFT, Coag

18
Q

What are indicators of advanced or decompensated cirrhosis?

A

Definitions of advanced or decompensated cirrhosis -

  • Evidence of present or previous decompensated cirrhosis with an episode of ascites, variceal bleeding, or encephalopathy
  • Child Pugh Score ≥ or = 7
  • The patient is at significant risk of death or irreversible damage. For example, patient is currently listed for liver transplantation
  • The patient has biochemical or haematological indicators of advanced cirrhosis and/or significant portal hypertension eg albumin < 35, platelets < 50.
19
Q

What are extra-hepatic manifestations of HCV?

A

Dermatology -
- Lichen planus
- Porphyria cutanea tarda

Liver -
- Diabetes mellitus

Lymphotropism -
- Cryoglobulinaemia
- Vasculitis
- Non-Hodgkin’s Lymphoma - B cell

Renal -
- Membranoproliferative glomerulonephritis

20
Q

When is HCV infection classified as chronic?

A

Detectable HCV RNA >6 months

21
Q

When picking an HCV RNA PCR assay, what is an acceptable lower limit of detection?

22
Q

At what prevalence would it be recommended to start routine population/ cohort screening?
e.g antenatal screening

A

2% - 5% would indicate intermediate to high seroprevalence

23
Q

What percentage of patients with SVR12 relapse?
(not reinfected)

A

<1%

99% of patients with SVR12 will have permanently cleared the virus

24
Q

HCV positive patient, normal ALT

Why do they need non-invasive assessment of liver fibrosis?

A

Since significant fibrosis may be present in patients with repeatedly normal ALT, evaluation of disease severity should be performed regardless of ALT levels.

25
HCV genotyping is required before starting treatment Why is resistance testing not performed initially?
Difficult to perform - genotypic only Even is they has Resistance Associated Substitutions (RASs), most first line DAAs are still effective, in treatment naïve population
26
What are the rules regarding organ donation in patients who are HCV RNA positive?
HCV RNA positive can be transplanted into HCV RNA negative patients Recipient must start HCV DAA rapidly following transplantation
27
PWID who have cleared HCV infection. How often should they be offered HCV RNA screening?
If ongoing risk factors for infection, screen every 6-12 months
28
What is the nucelotide difference percentage between these terminologies? Genotype Subtype Quasispecies
Genotype - genetic heterogeneity among different HCV isolates 65%-75% similar Subtype - closely related isolates within each of the major genotypes >75% similar Quasispecies - complex of genetic variants within individual isolates >90% similar