Viral Hepatitis: C

Question 1

Define Viral Hepatitis?

Answer 1

Hepatitis caused by infection with hepatitis C virus (HCV), often following a chronic course (in 80% of cases)

Question 2

What is the aetiology of HCV?

Answer 2

HCV is a small, enveloped, single-stranded RNA virus
RNA viruses have poor fidelity of replication and mutation rates are high
So there are lots of HCV genotypes (which can co-exist in a single patient)

Question 3

What is the transmission of HCV?

Answer 3

Parenteral:
Sexual Transmission
Vertical Transmission

Question 4

What patients are at risk of HCV?

Answer 4

Recipients of blood and blood products 
IV drug users 
Non-sterile acupuncture 
Tattooing 
Haemodialysis 
Health care workers

Question 5

What is the pathology of HCV?

Answer 5

The virus is not thought to be directly hepatotoxic

It is the humoural and cell-mediated responses to the viral infection that leads to hepatic inflammation and necrosis

Question 6

What might you see on a Liver Biopsy for HCV?

Answer 6

Chronic Hepatitis
Lymphoid follicles in portal tracts
Fatty change
Cirrhosis may be present

Question 7

What is the epidemiology of HCV?

Answer 7

COMMON

Different genotypes of HCV have different geographical prevalence

Question 8

What are the presenting symptoms of HCV?

Answer 8

90% of acute infections are ASYMPTOMATIC
10% become jaundiced with mild flu-like illness
May be diagnosed after incidental abnormal LFT

Question 9

What are the signs of HCV on physical examination?

Answer 9

May be NO SIGNS

There may be signs of chronic liver disease (if long-standing HCV infection)

Question 10

What are the extra-hepatic manifestations of HCV?

Answer 10

Skin rash
Renal dysfunction (due to glomerulonephritis)

Question 11

What bloods do you do for HCV?

Answer 11

HCV Serology
Reverse-transcriptase PCR
LFT

Question 12

What is the HCV Serology of HCV?

Answer 12

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

Question 13

Why do we do Reverse-transcriptase PCR for HCV?

Answer 13

Allows detection and genotyping of HCV

Question 14

What do we look for on LFTs for Acute infection of HCV?

Answer 14

High ALT, AST and bilirubin

Question 15

What do we look for on LFTs for Chronic Infection of HCV?

Answer 15

2-8x elevation of AST + ALT (often fluctuates over time)

Question 16

Why do we do a Liver Biopsy for HCV?

Answer 16

Assess the degree of inflammation and liver damage
Transaminase (AST and ALT) levels bear little correlation to histological chnages
Useful for diagnosing cirrhosis

Question 17

What do we do to prevent HCV?

Answer 17

Screen blood, blood products and organ donors
Needle exchange schemes for IV drug users
Instrument sterilisation
NO VACCINE AVAILABLE

Question 18

What is the Acute Medical management plan for HCV?

Answer 18

Mainly supportive (antipyretics, antiemetics, cholestyramine)

Question 19

What is the medical management plan for Chronic HCV?

Answer 19

Pegylated interferon-a
Ribavirin (guanosine nucletide analogue)
Duration:
HCV Genotype 1 or 4: 24-48 weeks
HCV Genotype 2 or 3: 12-24 weeks

Question 20

When do we do Regular US of the liver for HCV?

Answer 20

May be needed if the patient has cirrhosis

Question 21

What are the possible complications of HCV?

Answer 21

Fulminant hepatic failure
Chronic carriage of HCV
Hepatocellular carcinoma

Question 22

What are the less possible complications of HCV?

Answer 22

Porphyria cutanea tarda
Cryoglobulinaemia
Glomerulonephritis

Question 23

What is the prognosis for patients with HCV?

Answer 23

80% of exposed will progress to chronic carriage

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