Hepatitis C

Question 1

What is the definition of acute and chronic HCV?

Answer 1

Acute - infection that develops during first 6 months following exposure
Chronic - infection that persists beyond 6 months following exposure

Question 2

What are the routes of transmission for HCV?

Answer 2

Maternal to infant route
Sexual transmission
Sporadic transmission - source of transmission is unknown
Unsafe injection practices

Question 3

What are the risk factors for HCV?

Answer 3

Injecting drugs with unsterilised needles
Blood transfusions
Receiving clotting factor concentrates
Hemodialysis in kidney failure
Needle stick accident with infected person
Multiple sex partners
Intranasal use of cocaine using shared equipment

Question 4

What are the acute clinical features of HCV?

Answer 4

Incubation period - 2 weeks to 6 months

Acute course - asymptomatic in 80% of cases otherwise its malaise, fever, myalgias, arthalgias, RUQ pain, tender hepatomegaly, nausea, vomiting, diarrhoea, jaundice, possibly pruritis

Question 5

What are the chronic clinical features of HCV?

Answer 5

Chronic course - findings often mild and non specific, liver cirrhosis (25%) within 20 years of infection.
Extra hepatic features (common) - lymphoma, mixed cryoglobulinemia, ITP, autoimmune haemolytic anaemia, monoclonal gammopathies
Renal - glomerulonephritis
Rheumatological - polyarteritis nodosum, sjogren syndrome
Dermatological - porphyria cutanea tarda
Endocrine - diabetes Mellitus
Vascular - leukocytoclastic vasculitis

Question 6

What is the screening for HCV infection for individuals without risk factors?

Answer 6

One time screening upon diagnosis with HIV
Repeat screening after recent exposure to HCV
Annual screening - for those who inject recreational drugs

Question 7

What are the serological tests for HCV?

Answer 7

Enzyme immunoassay - tested for anti-HCV
Best approach is to testy for HCV RNA using sensitive assay such as PCR test - indicates an active infection if positive

Question 8

What are the biochemical indicators of HPV infection?

Answer 8

In chronic HCV - increases in the ALT/AST range from 1-20 times the upper limit
Alkaline phosphatase and gamma glutamyl transportable normal. If elevated, indicates cirrhosis
LH and CK normal
Albumin, bilirubin and prothrombin normal until late stage
Iron and ferritin levels may be slightly elevated

Question 9

Which invasive test is helpful in grading the severity of disease and staging the degree of fibrosis?

Answer 9

Liver biopsy

Question 10

What is the d/d for HCV?

Answer 10

Autoimmune hepatitis
Cholangitis
Chronic HDV and HBD
Drug induced liver disease

Question 11

What are the 2 goals of HCV treatment?

Answer 11

1. Achieve sustained eradication of HCV
2. Prevent progression to cirrhosis, HCC and decompensated liver disease

Question 12

What is the treatment for HCV

Answer 12

Antiviral therapy in a multi drug approach

Question 13

What is the purpose of direct acting antivirals?

Answer 13

Targets and inhibit HCV encoded proteins that are essential for HCV replication

Question 14

What are some examples of multi drug therapies for HCV?

Answer 14

Glecaprevir and Pibrentasvir
Sofosbuvir and Velpatasvir
Lerdipasvir and Sofosbuvir

Question 15

What are some complications of HCV?

Answer 15

Rarely fulminant hepatitis (liver failure)
Liver cirrhosis
Hepatocellular carcinoma
Secondary hemochromatosis