Hepatitis C

Question 1

Hepatitis C - Diagnosis

Answer 1

ELISA: detect HCV antibodies. Detectable in acute disease between 6-12 weeks after infection.
If ELISA antibody test is positive: PCR; detects presence of viral RNA (viral load) in serum –> determine whether active disease exists.

Chronic infection:
Elevated transaminase levels, positive ELISA, detectable viral RNA for at least 6 months. Liver biopsy to evaluate extent of liver damage and guide treatment; staging.

Genotyping: important for therapy

Liver damage:
Magnetic resonance elastography: check liver stiffness
Biopsy
CT/MRI

Test for HBV and HIV

Lab findings:
Increased AST and ALT
Increased bilirubin and urobilinogen
Lymphocytosis
Prolonged PT
Increased gamma globulin fraction
Increased IgG and IgM

Question 2

Acute Hep. C - Treatment

Answer 2

Spontaneous resolution may occur, observe for 6 months before starting therapy

Sofosbuvir - 400 mg PO + Ledipasvir - 90 mg PO once daily for 6 weeks

Question 3

Sofosbuvir - MoA

Answer 3

RNA polymerase inhibitor

Question 4

Sofosbuvir and Ledipasvir - Adverse effects

Answer 4

fatigue, headache, nausea, weakness

Question 5

Sofosbuvir and Ledipasvir - Interactions

Answer 5

Barbiturates: decreases concentration via P-glycoprotein

Question 6

Sofosbuvir and Ledipasvir - Contraindications

Answer 6

Pregnancy

Renal failure

Question 7

Chronic Hep C - Treatment

Answer 7

Sofosbuvir - 400 mg PO + Velpatasvir (100 mg) for 12 weeks

Question 8

Velpatasavir - MoA

Answer 8

NS5A inhibitor

Question 9

Velpatasavir - Adverse effects

Answer 9

Headache, weakness, nausea

Question 10

Velpatasavir - Interaction

Answer 10

Barbiturates induces metabolism via CYP3a4

Question 11

Velpatasavir - Contraindication

Answer 11

Drugs that induces cyp3a4 such as barbiturates.