Hepatitis C

Question 1

Etiology of Hepatitis C

Answer 1

Hepatitis C virus (RNA virus)- 6 genotypes, reinfection with new genotype is possible

Question 2

Transmission of hepatitis C

Answer 2

1. Perienteral; needle sharing, needle stick injury, blood transfusion, dialysis
2. Organ transplantation
3. Sexually but rare
4. Perinatally

Question 3

Risk groups of heptatitis C

Answer 3

Risk groups
- IV drug users
- HBV/HIV positive individuals
- prison inmates
- people born 1945-1965 (supposedly infected during highest transmission time)
- recipients of blood transfusions or organ transplants before 1992

Question 4

Incubation period Hepatitis C

Answer 4

2 weeks to 6 months

Question 5

Clinical features of hepatitis C

Answer 5

Acute HCV Infection
- HCV infection acquired past 6 months
- Acute HCV infection + Impaired liver function
- Asymptomatic in 80% of cases
Symptoms; Fever, malaise, nausea, vomiting diarrhea, myalgia, arthralgia, Jaundice,
- RUQ pain, Tender hepatomegaly, possible pruritus.
Chronic HCV infection
- Infection persisting >6 months+ impaired liver function + potential extrahepatic manifestations
- Liver cirrhosis (30%) within 20 years of infection.
Extrahepatic Manifestations- Mixed cryoglobulinemia, monoclonal gammopathies, lymphoma,Membranoproliferative glomerulonephritis, polyarteritis nodosa, Sjögren syndrome,Diabetes mellitus, thyroiditis, sialadenitis.

Question 6

Diagnosis of hepatitis C

Answer 6

1. ELISA- standard immunoassay tests for anti-HCV antibodies
2. PCR should be if anti-HCV antibodies is positive.
   Positive PCR indicates active infection
   Negative PCR indicates previous infection.
3. LFT- Increased liver transaminases
4. Decreased total albumin and cholinesterase
5. Increased AP, GGT and bilirubin
6. Liver biopsy may be done if diagnosis is unclear or to evaluated fibrosis
7. USG- to detect cirrhosis and hepatocellular carcinoma.
8. She wanted to hear about FIBROSCAN AND ELASTOGRAPHY

Question 7

Treatment of hepatitis C

Answer 7

Acute and chronic has same treatment.
● Interferons are no longer used.
● Direct-acting Antiviral agents
● NS3/4a protease inhibitors- high potency but limited genotypic coverage.
Lower barrier to resistance (Paritaprevir, Asunaprevir, Grazoprevir)
● Nonstrucutral protein 5A inhibitors- high potency with multigenotypic coverage. Low barrier to resistance (Ombitasvier, Ledipasvir, Daclatasvier, Elbasvir, Velpatasvir)
● NS5B Nucleoside Polymerase Inhibitors- Intermediate potency with
pangenotypic coverage. High barrier to resistance (Sofosbuvir, Dasabuvir)
● NS5B Nonnucleoside inhibitor- Intermediated potency with limited genotypic coverage. Low barrier to resistance.
● Current oral therapy; Sofosbuvier+Ribavirin, Sofosbuvir+Ledipasvir,
Daclatasvir+Asunaprevir, Elbasvier+Grazoprevir, Dasabuvir + ritonavir/ Ombitasvir/Paritaprevir

Question 8

Hepatitis C complications

Answer 8

Fulminant Hepatitis (although rare), Liver cirrhosis, hepatocellular carcinoma, secondary hemochromatosis, esophageal varices.

Question 9

Hepatitis C prophylaxis

Answer 9

Prophylaxis
● No vaccine is available
● All individuals 18-79 years of age should be screened at least once in their life.
● Women should be screened when pregnant
● - Regular testing in high-risk individuals
● - Infants of HCV positive mothers
● - Health care personnel who have been exposed to blood by HCV positive or patient with unknown HCV status
● - Anti-HCV antibody test + confirmatory PCR for HCV RNA if antibody test is positive

Question 10

How to check liver stiffness?

Answer 10

Transient elastography, or FibroScan® (EchoSens, Paris), measures liver stiffness and is the most common method used for diagnosing cirrhosis