Hepatitis C Flashcards
What kind of virus?
Positive stranded RNA virus of the Flaviviridae family
Genotypes in Australia
G1 = 50%
G3 = 40%
All others =10%
Egypt = G4
Why treat?
Improves all cause mortality
Decreases liver related mortality and need for liver transplant
Reduces HCC rates
Reduces liver failure rates
Extra hepatic manifestations of HCV
Mixed cyroglobulinemia --> vasculitis and renal disease Lymphoproliferative disorders Porphyria cutanea tarda Lichen planus Thyroid dysfunction DM Sjorgens syndrome Polyarthritis
HCV direct acting antibody targets
Translation and polyprotein processing = NS3-NS4A protease inhibitors
HCV RNA replication = NS5B polymerase and NS5A inhibitors
Assembly and virion morphogenesis = NS5A inhibitors
What treatment for HCV genotype 1a and 1b
Sofosbuvir + Ledipasvir
= NS5B nucleoside inhibitor + NS5A inhibitor
No cirrhosis = 8-12 weeks
Cirrhosis = 12-24 weeks
What treatment for HCV genotype 3
Sofosbuvir + daclatasvir
= NS5B nucleoside inhibitor + NS5B non-nucleoside inhibitor
No cirrhosis = 12 weeks
Cirrhosis = 12 weeks + ribavirin or 24weeks alone
Important drug interactions?
Contraindicated = carbamazepine and amiodarone
Sofosbuvir + Ledipasvir = statins contraindicated
Rafampicin –> decreased drug levels
What other information is important for follow up?
Must know patients cirrhosis status
If cirrhotic needs ongoing HCC surveillance
Which co-morbidities contradict therapy?
Renal Failure
EGFR <30
