Viral Hepatitis II Flashcards
What is the family of Hep C? Genetic content? Enveloped?
Flaviviridae
+ssRNA
Enveloped
What country has the highest incidence of Hep C?
Egypt
How fast does Hep C mutate?
Few Years
What disease is very closely associated with Hep C?
HIV
What populations have high rates of Hep C (beside those with HIV)?
IV drug users
Inmates
How does Hep C transmit in cocain?
Blood on straws and nosebleeds
The highest prevalence of Hep C is in what population?
AA males born before 1964
What is the average cost of a liver transplant for HCV?
$430,000/first year
What is the chance of getting HCV from a blood transfusions?
1/10^7
Why are clotting factors more susceptible to HCV? Getting clotting factors before what year should be suspicious for Hep C infection?
Clotting factors are pooled from multiple patients
1987
Blood transfusion or organ transplant before what year have a 5-10% risk for getting Hep C?
1992
What is the chance of getting Hep C from a needle stick? HIV?
HIV = 1/20
Hep C = 1/3
What is the overwhelming cause of getting Hep C?
Injection drug use
What happens to ALT levels in Hep C infections? Which other Hep virus does this?
Oscillation between normal and abnormal
No other Hep virus does this
True or false: despite having normal LFTs, Hep C patients can develop cirrhosis
True
What percent of Hep C patients will die from live cancer each year?
4%
What are the four factors that are associated with fibrosis in Hep C infection?
Duration of infection
EtOH use >50g/day
Age >40
Male gender
What are the ssx of acute infection with Hep C? Chronic? Advanced?
Acute- asymptomatic to jaundiced
Chronic = Fatigue, depression
Advanced = ssx of live rfailure
What are the three major complications of cirrhosis caused by Hep C?
Hepatic encephalopathy
Portal HTN
Hepatorenal syndrome
What are the vascular association with HCV?
Necrotizing vasculitis
Polyarteritis nodosa
What happens with coinfection of Hep C and HIV?
Faster destruction of the liver
What age group should be screened for hep C?
Baby boomers (1940–1964)
Why is it hard to determine if a pt has Hep C?
LFTs can be completely normal
What are the diagnostic tests for HCV?
HCV antibody
Genotyping
Liver biopsy
What genotype is the most common HCV? What is the hardest to treat?
Type I most common
What is the single most important prognostic factor for HCV infection?
Genotype
What is the primary goal of HCV infection?
Eradicate HCV infection
What is a sustained viral response? Is this a cure? How does this occur?
Sustained effect of drug against the virus. Prevents the replication of the virus.
This is not a cure.
What is pegylation? How is this effective?
Add a huge, inert chain of amino acids to the medication that you want.
This increases the time for clearance, meaning lower doses can be used.
What are the side effects of interferon?
ILI
Myalgia/arthralgia
Myelosuppression
N/v, weight loss
What are the two medications that appeared in 2011 that can treat HCV? Are these still used?
DAA (direct antiviral agents)
Telaprevir and Boceprevir
no longer used
What is the MOA of Telaprevir and Boceprevir?
Protease inhibitors
What is the MOA of Sofosbuvir + Ledipasvir? (3)
- Block viral protease
- Block RNA pol
- Block Capping mechanism
What is the treatment for HCV?
Sofosbuvir + Ledipasvir
What are the side effects of Sofosbuvir + Ledipasvir?
Nausea
What is the cure rate with Sofosbuvir + Ledipasvir?
95-99%
HCV accounts for what percent of hepatomas in the US?
1/3
