Viral Hepatitis C

Question 1

What is hepatitis C?

Answer 1

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

Question 2

Describe hepatitis C

Answer 2

Small, enveloped, ss-RNA virus
RNA viruses have poor fidelity of replication + mutation rates are high - so, there are lots of HCV genotypes (which can co-exist in a single pt)

Question 3

How is hepatitis C transmitted?

Answer 3

PARENTERAL
Sexual transmission
Vertical transmission

Question 4

List 6 risk factors for hepatitis C

Answer 4

Recipients of blood + blood products  
IV drug users  
Non-sterile acupuncture  
Tattooing  
Haemodialysis  
HCPs

Question 5

Describe the pathogenesis of hepatitis C

Answer 5

Virus NOT thought to be directly hepatotoxic

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

Question 6

Describe the epidemiology of hepatitis C

Answer 6

COMMON

Different genotypes of HCV have different geographical prevalence

Question 7

How does hepatitis C usually present?

Answer 7

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

Question 8

List symptoms of hepatitis C

Answer 8

10% become jaundiced with mild flu-like illness

Question 9

List 3 categories of signs of hepatitis C

Answer 9

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

Question 10

Describe the serology of hepatitis C

Answer 10

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

Question 11

Describe LFTs seen in hepatitis C

Answer 11

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 12

Why may you perform a liver biopsy in hepatitis C?

Answer 12

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

Useful for diagnosing cirrhosis

Question 13

List 3 preventative measures against hepatitis C?

Answer 13

Screen blood, blood products + organ donors
Needle exchange schemes for IV drug users
Instrument sterilisation

Question 14

Can you be completely protected from hepatitis C?

Answer 14

NO VACCINE AVAILABLE

Question 15

Describe management of acute hepatitis C

Answer 15

Mainly supportive (antipyretics, antiemetics, cholestyramine)

Question 16

Describe medical management of chronic hepatitis C

Answer 16

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

Question 17

List 3 complications of hepatitis C

Answer 17

Fulminant hepatic failure
Chronic carriage of HCV
Hepatocellular carcinoma

Question 18

List 3 rarer complications of hepatitis C

Answer 18

Porphyria cutanea tarda
Cryoglobulinaemia
Glomerulonephritis

Question 19

What is the prognosis of hepatitis C?

Answer 19

80% of exposed progress to chronic carriage

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

Question 20

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

Answer 20

Lymphoid follicles in portal tracts
Fatty change
Cirrhosis may be present

Question 21

Why is reverse transcriptase PCR used in hepatitis C?

Answer 21

Allows detection + genotyping of HCV

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

Question 22

Describe the long term management in chronic hepatitis C

Answer 22

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 the patient has cirrhosis

Question 23

What defines cure of chronic hepatitis C?

Answer 23

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