HCV Flashcards
What family of viruses does Hepatitis C Virus (HCV) belong to?
Flavivirus
What type of genetic material does HCV have?
Single-stranded RNA (ssRNA)
Is Hepatitis C Virus (HCV) enveloped or non-enveloped?
Enveloped
How is HCV primarily transmitted?
Bloodborne transmission (IV drug use, transfusions before 1992)
What is the most common method of transmission of HCV in the developed world?
Hepatitis C virus (HCV) is transmitted most efficiently through percutaneous exposure to blood. As such, most cases in the Western world arise in those with a history of intravenous drug use.
Is HCV commonly transmitted sexually?
Rarely, but possible
What percentage of HCV infections become chronic?
Approximately 50% in adults, 90% in neonates
What is the most common presentation of HCV?
Initial infections are usually asymptomatic, but most lead to chronic hepatic infection, putting patients at risk for cirrhosis and hepatocellular carcinoma.
What are the common symptoms of acute HCV infection when it is symptomatic?
Although HCV is often asymptomatic, HCV can present with mild flu-like symptoms, fatigue, myalgia, arthralgia, nausea, and jaundice.
What is the most severe complication of chronic HCV infection?
Cirrhosis and hepatocellular carcinoma
What test is used for screening HCV infection?
Anti-HCV antibodies (ELISA).
HCV antibody testing is used for screening, as it identifies those exposed to the virus. To determine which patients have ongoing, active disease, further testing is required to document HCV RNA in the blood. This is accomplished with HCV nucleic acid testing (NAT). Patients with positive HCV NAT are candidates for treatment with antiviral therapy.
Why does HCV screen require further workup?
A positive serologic test for hepatitis C virus (HCV) requires further investigation to evaluate for chronic infection. In asymptomatic patients, 3 potential explanations should be considered: persistent infection, cleared infection, or false-positive antibody test. Diagnosis of chronic CV requires both a positive serologic test and a confirmatory nucleic acid test to confirm HCV RNA in the blood.
What test is used to confirm active HCV infection?
HCV RNA PCR
HCV antibody testing is used for screening, as it identifies those exposed to the virus. To determine which patients have ongoing, active disease, further testing is required to document HCV RNA in the blood. This is accomplished with HCV nucleic acid testing (NAT). Patients with positive HCV NAT are candidates for treatment with antiviral therapy.
Which serologic marker indicates active HCV replication?
HCV RNA
Which test determines HCV genotype for treatment selection?
HCV genotype testing.
Patients with positive HCV NAT should undergo further evaluation to identify the HCV genotype and the extent of liver fibrosis (eg, liver biopsy); aminotransferases do not provide a clear picture of disease progression. Confirmation with HCV NAT is required.
What is the most common genotype of HCV?
Genotype 1
What is the primary treatment for chronic HCV infection?
Direct-acting antiviral (DAA) therapy using a NS3/4A protease inhibitor plus NS5A inhibitor
What are examples of NS3/4A protease inhibitors used in HCV treatment?
Glecaprevir, Paritaprevir, Simeprevir, Telaprevir
What are examples of NS5A inhibitors used in HCV treatment?
Ledipasvir, Pibrentasvir, Velpatasvir
What is an example of an NS5B inhibitor used in HCV treatment?
Sofosbuvir
What is the recommended regimen for Genotype 1 HCV?
- Glecaprevir-pibrentasvir
- Ledipasvir-sofosbuvir
- Sofosbuvir-velpatasvir
What is the recommended regimen for Genotype 2 HCV?
Sofosbuvir-velpatasvir
What is the role of interferon and ribavirin in HCV treatment today?
No longer first-line; replaced by direct-acting antivirals (DAAs)
Why is HCV-associated liver disease dangerous?
Chronic inflammation leads to fibrosis, cirrhosis, and hepatocellular carcinoma
Can HCV be prevented with a vaccine?
No, there is no vaccine for HCV
What is the major reason HCV lacks a vaccine?
High genetic variability and rapid mutation rate
How long should patients with HCV be monitored after treatment?
Sustained virologic response (SVR) at 12 weeks post-treatment indicates cure
