Hepatitis C

Question 1

Definition of chronic HCV infection

Answer 1

HCV IgG+ with detectable HCV RNA

Question 2

Definition of chronic active HCV infection

Answer 2

Chronic HCV infxn + abnl LFTs

Question 3

Diagnosis of mother-to-infant transmission of HCV

Answer 3

Positive neonatal serum HCV RNA on 2 occasions, 3-4 mos apart, after the infant is 2 mos old, and/or
Anti-HCV detected after 18 mos of age

Question 4

Risk factors for vertical transmission of HCV

Answer 4

Coinfection with HIV, high maternal viral load

Question 5

Evaluation of HCV positive pregnant women

Answer 5

HCV RNA viral load
HBsAg
Hepatitis A antibody
LFTs
HIV
GI referral
STD screening

Question 6

Which vaccines should be given to pts with HCV infection?

Answer 6

HAV, HBV, if nonimmune - coinfection has additive morbidity

Question 7

Treatment of HCV in nonpregnant adults

Answer 7

Combo antiviral therapy - alpha interferon, ribavirin. Cannot be used during or immed prior to pregnancy, bc ribavirin is teratogenic. Should be started postpartum for same indications as other nonpregnant adults.

Question 8

Delivery mode in HCV+ women

Answer 8

C/S should be reserved for obstetrical indications in HCV+ but HIV- women

Question 9

Is breastfeeding contraindicated in women with HCV?

Answer 9

Only if coinfected with HIV

Question 10

Symptoms of HCV infection

Answer 10

75% asymptomatic. Symptoms = malaise, fever, abd pain, jaundice.

Question 11

HCV incubation time

Answer 11

30-60 days

Question 12

Natural history of HCV infaction

Answer 12

Chronic HCV (+RNA) develops in 50-75% of adult/pediatric pts. Chronic active disease (abnl LFTs) develops in at least 20% of chronic HCV infection.

Question 13

Risk factors for HCV infection

Answer 13

Screening only recommended in women with risk factors:
History of intravenous drug abuse
History of blood transfusion or exposure to blood products
History of multiple STDs
HIV infection
Hepatitis B viral infection
Sexual partner who abuses intravenous drugs or has HIV, HBV, or HCV infection
Three or more lifetime sexual partners
Incarceration
History of body piercing and tattooing
Recipient of organ transplants before 1992
Unexplained elevated transaminases
Patient or staff members involved in chronic dialysis programs
Participant in in vitro fertilization programs from anonymous donors

Question 14

Complications of chronic HCV

Answer 14

Cirrhosis (10-20%)
Hepatocellular carcinoma (1-5%)

Question 15

How does HIV-HCV coinfection affect vertical transmission?

Answer 15

• Greatly increases vertical transmission
• HAART has been shown to decrease HCV transmission in coinfected women
• HIV coinfected women delivered by C/S were 60% less likely to have an HCV-infected child than those delivered vaginally

Question 16

Does vertical transmission of HCV correlate with mode of delivery?

Answer 16

• No, not in HIV negative women

- Use of scalp electrode is discouraged

Question 17

CVS, amniocentesis & HCV infection

Answer 17

Amniocentesis does not appear to significantly increase the risk (8), but very few studies have addressed this. If amniocentesis is requested, transplacental needle insertion should be avoided. There are no data regarding CVS and in utero transmission: appropriate counseling should be undertaken if an HCV-infected woman requests CVS, and the availability of amniocentesis should be discussed as a potentially less-invasive and vasodisruptive procedure.

Question 18

Effect of chronic active hepatitis in pregnancy

Answer 18

Increased incidence of preterm delivery, intrauterine growth restriction, small for gestational age, and NICU admission

Question 19

Work-up of pregnant woman with +HCV IgG

Answer 19

HCV RNA viral load
Hepatitis B surface antigen
Hepatitis A antibody
Liver function testing
HIV screening
Gastroenterology referral
STD screening
Vaccination against HAV and/or HBV should be administered if the woman is nonimmune for either or both, to avoid the comorbidities of superimposed hepatitis viral infections, which can be substantial.

Question 20

Diagnosis of HCV infection

Answer 20

The diagnosis is best confirmed by serologic testing. The initial screening test should be an EIA. The confirmatory test is a recombinant immunoblot assay (RIBA ). Seroconversion may not occur for up to 16 weeks after infection. In addition, although these immunologic tests have been available for many years, they still do not consistently and precisely distinguish between IgM and IgG antibody.

Question 21

Risk of perinatal transmission of HCV

Answer 21

Per Creasy: If low serum concentration of HCV RNA and HIV-, risk is < 5%. If RNA concentration high or HIV+, rate may approach 25%.

EB MFM:
Anti-HCV only (RNA negative) 1–2% 
Viremic (HCV RNA positive) 4–6% 
HIV positive 19–40% 
HIV negative 3–5% 
Anti-HCV and injection drug use 9%

Question 22

What is hepatitis G?

Answer 22

Caused by an RNA virus that is related to the hepatitis C virus.
Hepatitis G is more prevalent, but less virulent, than hepatitis C.
Many patients who have hepatitis G are coinfected with hepatitis A, B, C, and/or HIV. Coinfection with hepatitis G does not adversely affect the prognosis of these other infections.

Question 23

Symptoms of hepatitis G

Answer 23

Most pts are asymptomatic.

Question 24

Diagnosis of hepatitis G

Answer 24

PCR for virus, ELISA for antibody

Question 25

Does hepatitis G cause a carrier state? Is it perinatally transmitted?

Answer 25

Hepatitis G can cause a chronic carrier state, and perinatal transmission has been documented. However, the clinical effects
of infection in both mother and baby appear to be minimal.
Patients should not routinely be screened for this infection, and no special treatment is indicated even if infection is confirmed.