Hepatitis C Flashcards
How is hep C most commonly transmitted?
parenteral: IVDU, blood transfusions before 1991
What are the clinical features of hep C?
- malaise
- nausea
- RUQ pain
- jaundice
MOST asymptomatic or not symptomatic enough to seek medical attention
What is the risk of being asymptomatic w hep C?
can go on to chronic HCV
What are the extra-hepatic manifestations of hepatitis C?
- essential mixed cryoglobulinaemia
- membranoproliferative GN
- porphyria cutanea tarda
- autoimmune thyroid disease (women)
How is an acute infection diagnosed?
measure HCV RNA
What marker will still be present even when the virus has been cleared? what should be done if this is +ve ?
anti-HCV abs
Send blood sample for HCV RNA
What is the main complication of hep C?
end stage liver disease
What are the RFs for progression to ESLD
i. coexisting hepatic pathology
ii. HIV
iii. African americans
What is involved in the clinical assessment of a pt w hep C?
- baseline liver fibrosis assessment
- if evidence of fibrosis or cirrhosis - screen for HCC w 6monthly AFP + liver US
- If portal HTN, screen for varices w OGD
What is the aim of treatment?
CURE
When is hep C considered cured?
undetectable HCV RNA in blood 12 weeks after end of treatment
What is the treatment of hep C?
Depends on the HCV genotype and subtype, viral load, severity and persons comorbidities
Combination of :
subcut pegylated interferon alpha + protease inhibitors +/- ribavirin
What are the SE of ribavirin?
haemolytic anaemia
cough
teratogenic
how long after stopping ribavirin should a patient wait until they can become pregnant?
6m
What are the SE of interferon alpha?
flu like sx depression fatigue leukopenia thrombocytopenia
