Hepatitis C

Question 1

What type of virus is HCV?

What is its main route of transmission?

Answer 1

RNA virus
Transmitted via infected blood:
-IVDU
-haemophiliacs in 1980s receiving donated infected blood
-people receiving regular blood transfusions
-healthcare workers i.e. needle stick injury
-vertical tranmission (mum-> neonate)
-sexual partner of HCV-infected i.e. MSM at highest risk

Question 2

What is the disease course for HCV?

Answer 2

1/4= fights off virus and makes full recovery
3/4= becomes chronic
<1% develop fulminant hepatitis
Chronic progresses to liver cirrhosis after 10-20 years of chronic HCV
Liver cirrhosis-> HCC or hepative decompensation -> death

Question 3

What are the 2 main causes of death in those with chronic HCV infection?

Answer 3

Hepatocellular carcinoma (HCC)
Hepatic decompensation

Question 4

What are risk factors for increasing the rate of cirrhosis associated with HCV?
What are protective factors against development of cirrhosis?

Answer 4

Risk factors:

• high alcohol intake
• co-infections i.e. HIV
• > 40 yo
• insulin resistance
• steatosis

Protective factors:

• > 3 cups of coffee per day
• female
• <30 yo
• no cirrhosis to begin with

Question 5

What clinical features are associated with acute and chronic HCV infection?
What is the significant of this?

Answer 5

Largely asymptomatic in the acute and chronic phase with potentially only some non-specific chronic fatigue

Will only develop symptoms once reached cirrhosis stage 10-20 years post infection meaning significant damage already done by the time it is detected

Question 6

How is HCV diagnosed?

How many different genotypes are there of HCV and what is the significance of this?

Answer 6

HCV RNA testing
-also used to calculate the viral load and assess the genotype

6 genotypes
-influences the type of treatment

Question 7

What 3 factors can influence the treatment used for HCV?

Answer 7

Genotype

Amount of fibrosis

Morbidities

Question 8

How is someone with HCV managed?

Answer 8

Refer to gastro 
Inform public health
Educate about reducing transmission 
Use FibroScan to determine the degree of cirrhosis 
Us USS to determine if HCC present 
Antiviral treatment (DAA)
Liver transplant at end stage

Question 9

What is the difference between antiviral treatment used in HCV compared with HBV?

Answer 9

Antivirals are CURATIVE in 90% of patients in HCV

Question 10

What antivirals are used to treat HCV?

Answer 10

Direct acting antivirals

• tailored to specific viral genotype
• taken for 8-12 weeks

Target NS3-proteases and NS5B-polymerase to inhibit these proteins i.e. key proteins in HCV life cycle