Hepatobiliary - Hep C, Hep D

Question 1

Hepatitis C - what is it, how is it spread?

Answer 1

RNA flavivirus

Spread by blood and body fluids

Question 2

Hepatitis C - is there a vaccine available?

Answer 2

No vaccine is available

Question 3

Hepatitis C - incubation period?

Answer 3

6-9 weeks

Question 4

Hep C - disease course?

Answer 4

1 in 4 fights off virus, makes full recovery

3 in 4 it becomes chronic, complications, cirrhosis and hepatocellular carcinoma

Question 5

Hep C - clinical features?

Answer 5

Only around 30% patients will develop features:

Transient rise in jaundice/serum aminotransferases

Fatigue

Arthralgia

Question 6

Hep C - investigations?

Answer 6

Screening - Hep C antibody screening test

Hepatitis C RNA testing to confirm diagnosis of hepatitis C

Calculate viral load (HCV RNA) and assess for specific genotype

Question 7

Hep C - management

Answer 7

• Antiviral treatment with direct acting antivirals (DAAs) is tailored to the specific viral genotype, taken for 8-12 weeks
• Nucleoside analogs are generally preferred e.g. Sofosbuvir and often lead to undetectable viral loads
• Liver transplantation for end-stage liver disease

Question 8

Hep C - Chronic Hep C definition?

Answer 8

Persistence of HCV RNA in blood for 6 months

Question 9

Hep C - chronic Hep C complications?

Answer 9

Potential complications of chronic hepatitis C

• rheumatological problems: arthralgia, arthritis
• eye problems: Sjogren’s syndrome
• cirrhosis (5-20% of those with chronic disease)
• hepatocellular cancer
• membranoproliferative glomerulonephritis

Question 10

Hep C - management of chronic Hep C infection?

Answer 10

Depends on viral genotype - test prior to treatment

Currently combination of protease inhibitors used:

Daclatasvir + sofosbuvir OR sofosbuvir + simeprevir, with or without ribavirin

Question 11

Hep C - complications of chronic hep C treatment?

Answer 11

• ribavirin - side-effects: haemolytic anaemia, cough
  
  • Women should not become pregnant within 6 months of stopping ribavirin as it is teratogenic

Question 12

Hep D - what is it?

Answer 12

Single stranded RNA virus, that is transmitted parenterally, and can only survive in patients who also have a Hep B infection, as it attaches itself to HBsAG to survive, and cannot survive without this protein

Question 13

Hep D - how is it transmitted?

Answer 13

Transmitted parenterally in a similar fashion to Hep B - exchange of bodily fluids

Question 14

Hep D - can patients be infected with Hep B and Hep D at the same time?

Answer 14

Yes they can be infected with both at the same time

Question 15

Hep D - what does co-infection mean?

Answer 15

Hep B and Hep D infection at same time

Question 16

Hep D - what does superinfection mean?

Answer 16

A HBsAg patient subsequently develops a hep D infection

Question 17

Hep D - diganosis?

Answer 17

Reverse polymerase chain reaction of Hep D RNA

Question 18

Hep D - management?

Answer 18

Interferon currently used - poor evidence base