Hep C

Question 1

What medication used in treatment of Hepatitis C is contraindicated in pregnancy?

Answer 1

Ribavarin

Question 2

What is the risk of transmission of HepC with amniocentesis?

Answer 2

5-10%

Question 3

What is the most common mode of HepC transmission in Canada?

Answer 3

IVDU

Question 4

What are examples of:
High Risk (over 205)
Moderate Risk (1-20%)
Low Risk (<1%)

Answer 4

High risk:

• IVDU (30% risk if ever used IVDU)
• unscreeen bld products
• transfusion of bld products that did not under go viral inactivation

Moderate Risk:

• Newborns of HVC + mothers
• hemodialysis
• Recipients of bld from unscreened donors
• Recipients of organ transplants
• contaminated instruments

Low Risk:

• high risk sexual activity
• sexual partners of HCV positive individuals (low 2.5%)
• rituals (excision, circumcision)
• household contact
• tattooing

Question 5

Risk of obtaining Hep C from infected blood products versus needle stick injury

Answer 5

> 90% with known infected blood product

4% needle stick with contaminated needle

Question 6

Risk of vertical transmission with Hep C

Answer 6

8%

40% with co-infection HIV

Question 7

Risk of cirrhosis and hepatocellular cancer

Answer 7

20% cirrohsis at 20 years

1-3% HCC at 30 years

Question 8

Main complication of cirrhosis (4)

Answer 8

• portal hypertension
• esophageal varices
• ascites
• hepatic failure

Question 9

What is the most important external cofactor in HepC disease progression?

Answer 9

Alcohol

Question 10

Individuals to be offered screening for HVC

Answer 10

IVDU
Organ transplant before 1992
Blood transfusions 
hemodialysis
persistently elevated ALT
clotting factors before 1988
blood or organs from HCV + individual
prisoners
infants of HCV infected mothers
HIV positive individuals 
tattoos (especially those done in prison)

Question 11

Gynecologic infection related to interferon use

Answer 11

Yeast infections

Question 12

If using HRT, which form should be used? Why?

Answer 12

transcutaneous

To avoid first pass effect (in liver)

Question 13

Risk of transmission to neonate if otherwise healthy versus HIV infected?

Answer 13

5-6% otherwise healthy

44% co-infected HIV +

Question 14

How to diagnose Hep C?

Answer 14

Liver biopsy gold standard
HCV antibodies–> become positive 3 months post expsoure
HCV RNA testing should be done in patients who test positive and have normal ALT

Question 15

Treatment of HepC (2)

Is this recommended in pregnancy?

Answer 15

inferteron and ribavarin
NO–> not recommended and ribavarin is teratogenic
Should be compelted 6 months prior to pregnancy

Question 16

What important factors on history with women HCV?

Answer 16

Diagnosis, stage and course of disease
Hx of transfusions, cholestasis, HELLP
Hepatotoxic meds, interferon, ribavarin
EtOH history
Immunity to Hep A,B

Question 17

Prenatal care
Laboratory investigations (8)
How often

Answer 17

LFTs
Albumin
INR
pTT
Bilirubin
Anti-HBs
Anti-HA total or IgG
HCB RNA

Question 18

Intrapartum management (4)

Answer 18

Avoid scalp clips/fetal scalp blood sampling
Prolong ARM
Avoid episiotomy

Question 19

When should infants of HCV positive mothers be tested?

Answer 19

9-12 months (as maternal antibodies will be present earlier than this)
HCV RNA PCR can be tested earlier at 2-3 months of age

Question 20

What immunization should infants born to hep C + mothers?

Answer 20

Hepatitis A and B (given at 1 year)