Hepatitis C

Question 1

What is the epidemiology for Hep C?

Answer 1

· Endemic in most parts of the world.
· IVDU is the most important risk factor.
· Prevalence is higher in those who are institutionalised.

Question 2

Is Hep C more common in males or females?

Answer 2

Males.

Question 3

What is the pathophysiology of Hep C?

Answer 3

· Following acute infection, up to 45% of young healthy patients may develop a vigorous antibody and cell-mediated immune response, leading to the spontaneous eradication of the virus.
· But the majority of infected patients fail to clear the virus. This results in chronic infection and progressive liver damage.

Question 4

What is the prognosis for Hep C?

Answer 4

· 5 year survival is 91% in those with HCV and compensated cirrhosis.
· 5 year survival is 50% in those with decompensated cirrhosis.
· Mortality rate is higher in males.

Question 5

What is the aetiology of Hep C?

Answer 5

· Belongs to the Flavivirus family and is a RNA virus.
· Transmitted by percutaneous blood exposure.
· Causes:
- Unsafe healthcare procedures.
- IVDU’s.
- Sexual activity.
- Accidental blood contact.

Question 6

Suggest some risk factors which can cause Hep C?

Answer 6

· Unsafe medical practices. 
· IV or intranasal drug use. 
· Blood transfusion or organ transplant. 
· Birth between 1945 - 1965. 
· Heavy alcohol use. 
· HIV.
· Incarceration/Institutionalisation. 
· Multiple sexual partners.

Question 7

What are the typical signs and symptoms of Hep C?

Answer 7

· Usually asymptomatic but may have the following:

• Constitutional symptoms - fatigue, myalgia and arthralgia.
• Jaundice.
• Ascites.
• Hepatic encephalopathy.

Question 8

What investigations should be done if you suspect a patient has Hep C?

Answer 8

· Hepatitis C antibodies.

· Serum aminotransaminases.

Question 9

Suggest some differential diagnoses.

Answer 9

· Chronic HBV infection.
· Alcoholic liver disease.
· Steatohepatitis.

Question 10

What treatment options are available for Hep C patients?

Answer 10

· Recent infection:
- Monitor patient and start treatment.

· Chronic infection:

• Antiviral therapy.
• Treated using direct acting antiviral (DAA) tablets - taken for 8-12 weeks. E.g. ribavirin.

Question 11

What complications can arise?

Answer 11

· Interferon-related major depression.
· Cirrhosis.
· HCC.
· Rheumatological complications - myalgia, fatigue, arthralgia, arthritis, Sjogren’s syndrome.