Hepatitis C Flashcards
References: EB MFM, Creasy & Resnik
Definition of chronic HCV infection
HCV IgG+ with detectable HCV RNA
Definition of chronic active HCV infection
Chronic HCV infxn + abnl LFTs
Diagnosis of mother-to-infant transmission of HCV
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
Risk factors for vertical transmission of HCV
Coinfection with HIV, high maternal viral load
Evaluation of HCV positive pregnant women
HCV RNA viral load HBsAg Hepatitis A antibody LFTs HIV GI referral STD screening
Which vaccines should be given to pts with HCV infection?
HAV, HBV, if nonimmune - coinfection has additive morbidity
Treatment of HCV in nonpregnant adults
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.
Delivery mode in HCV+ women
C/S should be reserved for obstetrical indications in HCV+ but HIV- women
Is breastfeeding contraindicated in women with HCV?
Only if coinfected with HIV
Symptoms of HCV infection
75% asymptomatic. Symptoms = malaise, fever, abd pain, jaundice.
HCV incubation time
30-60 days
Natural history of HCV infaction
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.
Risk factors for HCV infection
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
Complications of chronic HCV
Cirrhosis (10-20%) Hepatocellular carcinoma (1-5%)
How does HIV-HCV coinfection affect vertical transmission?
- 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
Does vertical transmission of HCV correlate with mode of delivery?
- No, not in HIV negative women
- Use of scalp electrode is discouraged
CVS, amniocentesis & HCV infection
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.
Effect of chronic active hepatitis in pregnancy
Increased incidence of preterm delivery, intrauterine growth restriction, small for gestational age, and NICU admission
Work-up of pregnant woman with +HCV IgG
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.
Diagnosis of HCV infection
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.
Risk of perinatal transmission of HCV
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%
What is hepatitis G?
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.
Symptoms of hepatitis G
Most pts are asymptomatic.
Diagnosis of hepatitis G
PCR for virus, ELISA for antibody
Does hepatitis G cause a carrier state? Is it perinatally transmitted?
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.
