Hepatitis C

Question 1

what is the definition of hep C

Answer 1

Hepatitis C virus (HCV) is an infectious, hepatotropic virus belonging to the Flavivirus family

Question 2

what is the epidemiology of hep C?

Answer 2

Hepatitis C appears to be endemic in most parts of the world, although the prevalence is not evenly distributed.
Injecting drug use continues to be the most important risk factor for infection. In Europe, the prevalence ranges from 0.5% to 2.0%

Question 3

what is the aetiology of hep C?

Answer 3

Hepatitis C virus (HCV) belongs to the Flavivirus family. It is a single-stranded, enveloped RNA virus with a genome about 10,000 nucleotides in length.
The virus is transmitted by percutaneous blood exposure. Unsafe healthcare procedures (including unsafe injection practices) and injection drug use were the leading causes of new infections in 2015. Less frequently it is spread through sexual activity, perinatally, intranasal drug use, or after accidental blood contact (e.g., haemodialysis).

Question 4

what are the risk factors for hep C?

Answer 4

Unsafe medical practice
IV drug use 
Blood transfusion 
Heavy alcohol use
IL-28B gene polymorphism 
HIV
incarceration

Question 5

what is the pathophysiology of hep C?

Answer 5

Following acute infection, up to 45% of young, healthy patients may develop a vigorous antibody and cell-mediated immune response, which leads to the spontaneous eradication of the virus. However, the majority of infected patients fail to clear the virus. This results in chronic infection and progressive liver damage.

Question 6

what are the key presentations of hep C?

Answer 6

Presence of risk factors

Question 7

what are the signs of hep C?

Answer 7

Jaundice
Ascites
Signs of hepatic encephalopathy
Extrahepatic manifestations

Question 8

what are the symptoms of hep C?

Answer 8

Constitutional symptoms

Question 9

what are the first line and gold standard tests for hep C?

Answer 9

Hep C virus antibody EIA - pos
Hep C virus PCR - pos
Serum aminotransferases - elevated

Question 10

what are the differential diagnoses for hep C?

Answer 10

Chronic hep B
ALD
Steatohepatitis
Haemochromatosis

Question 11

how is hep C managed?

Answer 11

Antiviral therapy

Question 12

how is hep C monitored?

Answer 12

Monitoring during treatment:
Full blood count: after 4 weeks of treatment and as clinically indicated, particularly in patients on ribavirin.
Renal function: after 4 weeks of treatment and as clinically indicated.
Hepatic function: patients on elbasvir/grazoprevir should be monitored at 8 weeks and again at 12 weeks if receiving 16 weeks of treatment.
Hep C RNA
Haemoglobin
Pregnancy test
Blood glucose levels
INR

Question 13

what are the complications of hep C?

Answer 13

Treatment related Hep B reactivation
Cirrhosis
hepatoma

Question 14

what is the prognosis of hep C?

Answer 14

5-year survival was 91% and 10-year survival was 79% among patients who had hepatitis C and compensated cirrhosis