HCV/HIV

Question 1

What is the rate of HCV positivity in HIV positive IVDU?

Answer 1

83% (7% in HIV-MSM)

Question 2

Why is there an overlap between HIV and HCV?

Answer 2

due to transmission routes

Question 3

How many HCV genotypes are there?

Answer 3

6

Question 4

What is the most prevalent genotype across the world?

Answer 4

genotype 1

Question 5

Where is HCV genotype 6 found?

Answer 5

south east asia

Question 6

What is the difference between the genotypes seen in general UK and HIV positive populations?

Answer 6

general- G1 and G3; HIV-positive- G1 and G4

Question 7

How many people with acute HCV infection undergo spontaneous clearance?

Answer 7

5-20%

Question 8

What are the outcomes 30 years after acute HCV in patients who have chronic HCV?

Answer 8

30% no liver disease; 40% liver fibrosis; 30% cirrhosis; HCC

Question 9

What are the major risk factors for disease progression?

Answer 9

male; older age at acuisition; alcohol

Question 10

does HIV affect the progression in HCV?

Answer 10

there is a suggestion that HIV patients can have very rapid fibrosis in acute infection but resutls are conflicting and imperfect (surrogate measures); is faster even with HAART?; increased reinfection and recurrence

Question 11

what is the rate of lvier-related deaths due to HCV in HIV patients in developed coutnries?

Answer 11

10%

Question 12

What is fibroscan?

Answer 12

ultrasound that estimates liver stiffness as a surrogate marker of fibrosis

Question 13

What are the differences in acute HCV presentation in HIV patietns?

Answer 13

often asymptomatic; antibody development can be very late so molecular testing is needed (v. expensive)

Question 14

What is a problem with fibroscan?

Answer 14

can be confounded by inflammation

Question 15

What are the risk factors for HCV acquisition in HIV positive MSM?

Answer 15

recreational drug use; higher numbers of sexual partners/ group sex; high risk sexual practices- fisting; bloody sex

Question 16

Why does HCV prevention remain crucial?

Answer 16

no sign of effective vaccine in the near future

Question 17

What are the non-viral aspects of managing HCV in HIV positive patietns?

Answer 17

co-medication; weight; HAV and HBV vaccinations; alcohol intake; optimise HAART

Question 18

Why can HBV infection not be fully eradicated?

Answer 18

persistence of viral cccDNA in host cells

Question 19

Why is cccDNA a problem if not integrated into the cellular genome?

Answer 19

has a long half-life and is able to transmit to progeny cells; reservoir for viral reactivation

Question 20

Why can a sustained virologic response be achieved in HCV?

Answer 20

has an entirely cytoplasmic life cycle and does not have a known form of persistence or latency in host cells

Question 21

What does cccDNA stand for?

Answer 21

covalently closed circular DNA

Question 22

When is HCV deemed to have achieved cure?

Answer 22

if 12 weeks after end of treatment there is no virus in the blood

Question 23

What is the effect of SVR on mortality?

Answer 23

greatly reduces mortality compared to contorl, especially when coinfected with HIV or when have cirrhosis

Question 24

What are the problems with curing HCV?

Answer 24

chance of failure; serious AE of Rx and quality of life during Rx; costs

Question 25

What is the mode of action of pegylated interferon?

Answer 25

directly hinders the replication process of the virus; enhances the immune repsonse

Question 26

What is pegylation?

Answer 26

a large molecular chain is attached to the integeron to slow the rate at which it is broken down

Question 27

What is the function of ribavirin?

Answer 27

synthetic antiviral nucleoside analogue that works with interferon but not on its own and inhibits viral growth

Question 28

What was the problem with all first generation protease inhibitors?

Answer 28

activity against genotype 1, some against 2 and 4 but no activity against 3

Question 29

What is sofosbuvir?

Answer 29

specific nucleotide analog inhibitor of HCV NS5B

Question 30

what is the benefit of sofosbuvir?

Answer 30

potent with broad genotype coverage with or without inteferon; high barriers to resistance

Question 31

What is the current rate of SVR?

Answer 31

94-99%

Question 32

What was the drug regimen for SVR in 2015?

Answer 32

peg interferon; ribavirin; protease inhibitor

Question 33

What are the 3 classes of directly acting antivirals for HCV?

Answer 33

NS5a inhibitors; protease inhibitors and polymerase inhibitors

Question 34

What are the benefits of the newer drugs for HCV?

Answer 34

shorter duration; fewer SEs; better efficacy; avoid inteferons

Question 35

How many deaths does viral hepatitis cause globally?

Answer 35

7th leading cause of death

Question 36

What type of virus is hep C?

Answer 36

RNA flavivirus