Viral Hepatitis C

Question 1

Describe hepatitis C

Answer 1

Small, enveloped, ss-RNA virus

Poor fidelity of replication + high mutation rates- lots of HCV genotypes (can co-exist in a single pt)

Question 2

How is hepatitis C transmitted?

Answer 2

PARENTERAL
Sexual
Vertical

Question 3

List 6 risk factors for hepatitis C

Answer 3

Recipients of blood + blood products  
IVDU
Non-sterile acupuncture  
Tattooing  
Haemodialysis  
HCPs

Question 4

Describe the pathogenesis of hepatitis C

Answer 4

Virus NOT thought to be directly hepatotoxic

Humoral + cell-mediated responses to viral infection leads to hepatic inflammation + necrosis

Question 5

Describe the epidemiology of hepatitis C

Answer 5

COMMON

Different genotypes have different geographical prevalence

Question 6

How does hepatitis C usually present?

Answer 6

90% of acute infections are ASYMPTOMATIC
May be diagnosed after incidental abnormal LFT or in older pts with complications of cirrhosis
May be NO SIGNS

Question 7

List symptoms of hepatitis C

Answer 7

10% become jaundiced with mild flu-like illness

Question 8

List 3 categories of signs of hepatitis C

Answer 8

1. Signs of chronic liver disease (long-standing HCV) e.g. jaundice, ascites
2. Signs of hepatic encephalopathy if advanced CLD
3. Extra-hepatic manifestations (rare): Skin rash + Renal dysfunction (due to glomerulonephritis)

Question 9

Describe the serology of hepatitis C

Answer 9

Anti-HCV antibodies: IgM (acute) or IgG (past exposure or chronic)

Question 10

Describe LFTs seen in hepatitis C

Answer 10

Acute: High ALT, AST + BR
Chronic: 2-8 x elevation of AST + ALT (often fluctuates over time)
Transaminase (AST + ALT) levels bear little correlation to histological changes

Question 11

Why may you perform a liver biopsy in hepatitis C?

Answer 11

Assess degree of inflammation + liver damage (NOT for dx)

Useful for diagnosing cirrhosis

Question 12

List 3 preventative measures against hepatitis C?

Answer 12

Screen blood, blood products + organ donors
Needle exchange schemes for IVDU
Instrument sterilisation

Question 13

Can you be completely protected from hepatitis C?

Answer 13

NO VACCINE AVAILABLE

Question 14

Describe management of acute hepatitis C

Answer 14

Mainly supportive (antipyretics, antiemetics, cholestyramine)

Question 15

Describe medical management of chronic hepatitis C

Answer 15

Antivirals are now curative: NS5A inhibitors
Pegylated interferon-a
+
Ribavarin

Question 16

List 3 complications of hepatitis C

Answer 16

Fulminant hepatic failure
Chronic carriage of HCV
Hepatocellular carcinoma

Question 17

List 3 rarer complications of hepatitis C

Answer 17

Porphyria cutanea tarda
Cryoglobulinaemia
Glomerulonephritis

Question 18

What is the prognosis of hepatitis C?

Answer 18

80% progress to chronic carriage

Of these, 20-30% will develop cirrhosis over 10-20 years

Question 19

What may be seen on liver biopsy in chronic hepatitis C?

Answer 19

Lymphoid follicles in portal tracts
Fatty change
Cirrhosis may be present

Question 20

Why is reverse transcriptase PCR used in hepatitis C?

Answer 20

Allows detection + genotyping of HCV

Used to confirm antibody testing or if suspected in pt but serology negative

Question 21

Describe the long term management in chronic hepatitis C

Answer 21

Monitor HCV viral load after 12 weeks to determine tx efficacy
HCV RNA level measured by PCR on EDTA blood sample is used to monitor response to tx.
Regular US of the liver may be needed if pt has cirrhosis

Question 22

What defines cure of chronic hepatitis C?

Answer 22

Undetectable HCV RNA at 48 weeks after completion of tx (AKA ‘sustained virological response’ or SVR)