Hepatitis C - an ever evolving field Flashcards
What is hepatitis C?
blood borne RNA virus
infection is through contaminated blood
one of the most common infectious diseases worldwide
What has caused the rise of hep c in US?
Opioid crisis
Which people are more likely to be exposed to hep c?
intravenous DU people from endemic areas haemophiliacs exposed to lots of blood donors healthcare workers offspring of HCV infected mum sexual partner of HCV infected person
What are the genotypes of HCV?
6 main genotypes
- nucleotide diversity >20%
geographical variation
most important determinant of response to treatment
What is the natural hx of HCV?
acute infection
- > 1% = fulminate hepatitis
- 14-46% spontaneous clearance
- 54% chronic hep c => cirrhosis => hepatocellular carcinoma or hepatic decompensation => death
What factors increase rate of progression to cirrhosis ?
high alcohol intake >50g/day co-infection (HBV/HIV) Age >40 insulin resistance infection with GT3 Steatosis
What factors reduce rate of progression to cirrhosis ?
coffee intake - 2-3 cups a day female young age <30 currentlu no / mild fibrosis african-american normal ALT
What is one of the clinical problems with HCV infection?
asymptomatic for 10-20 yrs - 20% cirrhotic after 20 years
What are the treatments for HCV?
Depends on
- genotype
- amount of fibrosis (determined by fibroscan)W
- presence of co-morbidities = psychiatric and medical
for many yrs relied on interferon and ribavirin
How have the drugs for HCV been developed?
developed to target different parts of the viral life cycle
- many have been developed over recent years and many stopped being used as beter ones have come out
cure rate 97-99%
cure within 8 weeks of treatment
What were the side effects of interferon therapy?
horrible SE and needed to be used for 48 weeks
