Hepatitis C Flashcards
What is hepatitis C?
An infectious disease caused by the hepatitis C virus that primarily affects the liver
Describe the initial infection of hepatitis C?
People often have mild or no symptoms
In what % of people does hepatitis C persist after initial infection?
75-85%
How can hepatitis C be transmitted?
- IV drug use
- Blood transfusions or organ transplantations
- Skin piercings or tattoos
- Mother to infant
- Sexual intercourse
What increases the risk of hepatitis C transmission with sexual intercourse?
Concurrent HIV infection
In what % of cases does hepatitis C cause acute symptoms?
15%
What are the symptoms of acute hepatitis C infection?
- Decreased appetite
- Fatigue
- Nausea
- Muscle or joint pains
- Weight loss
What happens in the first few decades of chronic hepatitis C infection?
Most experience minimal or no symptoms, however may be associated with fatigue and mild cognitive problems
What are the risk factors for progression of chronic hepatitis C infection?
- High circulating virus levels
- Long duration of disease
- Male gender
- Older age at acquisition
- Alcohol excess
- Co-infection with HIV/hepatitis B
What are the extra-hepatic manifestations of hepatitis C?
- Cryoglobulinaemia
- Membranous glomerulonephritis
- Sjorgen’s sndrome
- Lichen planus
- Autoimmune hepatitis
- Thyroiditis
- Polyarteritis nodosum
- Polymyositis
How is a diagnosis of HCV made?
- Anti-HCV antibody
- HCV RNA by PCR
What does a positive anti-HCV antibody show?
Confirms exposure to HCV (but not persistent infection)
What does positive HCV RNA by PCR show?
Confirms ongoing infection
What initial investigations should be done in HCV?
- HCV genotyping
- Bloods
- Look for signs of hep B infection
- HIV testing
- Screening for other STIs
What bloods should be done in HCV?
- FBC
- U&Es
- LFTs
- Clotting screen
- HbA1c
- TFTs
Why is FBC required in HCV?
- Anaemia
- Neutropenia
- Thrombocytopenia
Why are TFTs required in HCV?
Need to establish baseline as anti-virals can cause thyroid dysfunction
What specialist investigations may be done in HCV?
- Viral load
- Autoantibodies
- Liver ultrasound
- Liver biopsy
Why might viral load be done in HCV?
To assess response to treatment
When is liver ultrasound used in HCV?
In patients with advanced fibrosis or cirrhosis, to screen for hepatocellular cancer
What is the role of liver biopsy in HCV?
To assess extent of damage caused by inflammation, fibrosis, cirrhosis, and exclude other causes of liver damage
Why might autoantibodies be checked in HCV?
Because autoimmune hepatitis may be exacerbated by anti-viral therapy
How does chronic hep C present?
Chronic HCV is indicated by persistently elevated or fluctuating liver enzyme levels.
It can go undetected for ages until incidental liver testing or tries to donate blood
What is involved in the management of hepatitis C?
- Education
- Lifestyle advice
- Antiviral therapy
- Liver transplantation
- Vaccination against hepatitis A and B
What education is required in hepatitis C?
- Ensure patient is aware of natural history of disease
- Advise not to donate blood
- Avoid sharing razors and needles
- Condoms for sexual contacts
- Provide patient with sources of support and information about hepatitis C
What lifestyle advice can be given in hepatitis C?
- Stop drinking alcohol, or reduce alcohol consumption if this is not possible
- Stop smoking
- Maintain a healthy body weight and diet
What should all patients with chronic hepatitis C be considered for?
Anti-viral therapy
What does the treatment regime, duration of treatment, and effectiveness depend on in HCV?
- HCV genotype and subtype
- Viral load
- Severity of liver disease
- Co-morbidities
- Ability to tolerate treatment
What regime is usually used in HCV?
Combination dual drug therapy
What does combination of dual drug therapy usually consist of in HCV?
Weekly self-administered SC injections of interferon-alpha, and daily doses of oral ribavirin
What is added in triple therapy for HCV?
A protease inhibitor
In what % of people with a sustained viral response can HCV be cured?
More than 99%
Why is regular clinical and blood monitoring required in HCV?
To check for adverse effects and response to treatment
What are the adverse effects of anti-viral therapy in HCV?
- Flu like symptoms
- Haemolytic anaemia
- Depression
- Dry skin, eczema, and itchiness
- Hypothyroidism or hyperthyroidism
- Insomnia
- Weight loss
- Fatigue
- Alopecia
What is the treatment of choice for people with end stage liver disease in HCV?
Liver transplantation
What is the problem with liver transplantation in HCV?
HCV recurrence due to graft infection is common, and the course of HCV-related liver disease is accelerated in transplant recipients
What proportion of patients who have a liver transplant for HCV will develop cirrhosis within 5 years of liver transplantation?
1/3
What are the complications of HCV? -
- Cirrhosis
- Liver failure
- Hepatocellular carcinoma
What clerical thing should be done for HCV?
All suspected cases of acute viral hepatitis are reported to the local Health Protection Team - inform patient that this is being done
