Week 4: Hep C overview

Question 1

acute Hep C

Answer 1

• incubation period is 6-7 weeks
• symptoms develop in fewer than 35% of patients: nonspecific, jaundice is uncommon
• will likely clear if strong immune response
• 75% + develop chronic Hep C
• most common blood borne chronic viral infection in US
• Assoc. IV drug users, blood transfusion before 1992, tattooing, hx of HIV, multiple sex partners
• most common reason for liver transplants in US
• Extrahepatic manifestations: renal disease, porphyria cutanea tarda, diabetes, B cell non hodgkins lymphoma

Question 2

Progression of Chronic Hep C

Answer 2

• progresses slowly
• takes 10-30 years from acute to chronic to cirrhosis, leading to liver failure or HCC
• disease progression assoc. with: alcohol, disease acquisition >40 yo, male, HIV co infection, Hep B confection, immunosuppression, and marijuana use.

Question 3

Treatment for Hep C

Answer 3

• we now have really good drugs for Hep C
• Harvoni: sofosbuvir, ledipasvir
• Viekira Pak: 4 drugs
• sustained virological response
• Hep C has no long term or latent reservoir and can be cured.

Question 4

Hep E

Answer 4

• causes epidemic and self limited hepatitis, genotype 3 in US
• similar to Hepatitis A
• found predominantly in developing world
• incubation 40 days, rarely chronic
• not associated with foreign travel. can be from eating undercooked pork
• can have acute liver failure esp. in pregnant women
• neuro manifestations: guillan-barre, acute neuropathy, ataxia,
• dx: IgM anti-HEV, confirmed with HEV RNA