hepatitis C Flashcards
What is Hep C?
blood borne
single stranded
enveloped
RNA virus
declining incidence of Hep C?
- screening of blood and blood products
- safer needle use practice among IVDUs
transmission
- IVDU
- Vertical transmission (mother to child)
- Sexual exposure
- Transfusion
- Occupational exposure – needle stick injury
- Tattooing, acupuncture, piercing and dental work
after exposure to HCV
- Incubation period – 6-8 weeks
- Acute infection - serology can take up to 6 mths to become +ve
- If not cleared → Chronic HCV
- Genotype and viral load do not usually affect disease progression
- 20% have cirrhosis at 20-30 years after infected
- Liver Failure – 2-5% of patients with cirrhosis/year
- HCC – 1-4% of patients with cirrhosis/year
public interventions for HCV
- Prevent new infections
- Inc awareness of infection
- Inc diagnosis
- Treating diagnosed individuals
RF for disease progression
- Alcohol (> 6 units/day = progression)
- Older age at infection
- Infection duration
- Male sex
- Obesity
- Diabetes/insulin resistance
- HIV and/or HBV co infection
Who should be screened for HCV?
- Unexplained LFTs
- Injected drugs
- Blood transfusion pre-1991
- Children of infected mothers
- Sexual partners of infected people
- Exposure to blood with risk of transmission
- Received tattoos, piercings, or acupuncture with poor infection control procedures
signs and symptoms
- Usually asymptomatic
- Jaundice
- Malaise
- Dark urine
- RUQ pain
- Loss of appetite, dec weight
- Nausea
- Cirrhosis (swollen liver, muscle weakness, swollen ankles, bloated, itchy skin)
diagnosis of HCV
- Differential: CHB, ALD, haemochromatosis
- Risk Factors
- Sx
- Blood Tests
- Hep C antibodies
- Serology for Hep C viral RNA (viral load)
- Liver Biopsy
- Viral Genotyping
primary aim of Tx
to achieve viral eradication
OR
sustained viral response (SVR)
secondary aim of Tx
prevent transmission
slow progression of liver disease
inc QoL
When is response rate to Tx lower?
cirrhosis or fibrosis
before starting treatment
- HCV genotype & subtype
- HCV RNA (viral load)
- Tx naïve or experienced
- Liver disease – cirrhosis, staging of hepatic fibrosis
- Bloods – FBC, INR, LFTs, renal fxn
DAAs
direct acting antivirals
types of DAAs
– NS3/4A protease inhibitors (PIs)
– nucleoside and nucleotide NS5B polymerase iInhibitors
– NS5A inhibitors
– non-nucleoside NS5B polymerase inhibitors
How do NS3/4A protease inhibitors work?
block viral enzyme (protease)
How do nucleoside and nucleotide NS5B polymerase iInhibitors work?
directly block HCV RNA preventing replication
How do NS5A Inhibitors work?
block NS5A HCV protein needed for replication
How do non-nucleoside NS5B polymerase inhibitors work?
Insert directly into HCV blocking other parts of HCV from binding and replicating
What does Tx depend on?
– Genotype
– Naïve or previous Tx
– Cirrhotic or not
– Cirrhosis compensated or decompensated
– HCV in pregnancy
– Renal impairment plus Tx patients
– Coinfection HIV/HCV
– HCV recurrence post liver transplant
What is childs Pugh?
general measure of severity of cirrhosis
grade & score:
A, 5-6 = well functioning
C, 10-15 = decompensated
