HEP C

Question 1

what is Hep C?

Answer 1

Blood borne, single stranded, enveloped RNA
virus

Question 2

how is Hep C transmitted?

Answer 2

IVDU
– How many are chronically infected with HCV?
* Vertical transmission
* Sexual exposure
* Transfusion
* Occupational exposure – needle stick injury
* Tattooing, acupuncture, piercing and dental
work

Question 3

what is the incubation period of Hep C?

Answer 3

– 6-8 weeks
* Acute infection
– Serology can take up to 6 months to become +ve

Question 4

do genotype and viral load affect disease progression?

Answer 4

not usually

Question 5

what influences disease progression?

Answer 5

• Risk Factors
• Alcohol
• Older age at infection
• Infection duration
• Male sex
• Obesity
• Diabetes/insulin resistance
• HIV and/or HBV co infection

Question 6

who do you screen in?

Answer 6

• Unexplained LFTs
• Injected drugs
• Blood transfusion pre-1991
• Children of infected mothers
• Sexual partners of infected people
• Exposure to blood with risk of transmission
• Received tattoos, piercings, or acupuncture
  with poor infection control procedures

Question 7

what are the signs and symptoms of hep C?

Answer 7

• Usually asymptomatic
• Jaundice
• Malaise
• Dark urine
• RUQ pain
• Loss of Appetite, Dec. Weight
• Nausea
• Cirrhosis (Swollen liver, muscle weakness,
  swollen ankles, bloated, itchy skin)

Question 8

how do you diagnose hep C?

Answer 8

• Differential: CHB, ALD, Haemochromatosis
• Risk Factors
• Symptoms
• Blood Tests
• Hepatitis C antibodies
• Serology for Hep C viral RNA
• Liver Biopsy
• Viral Genotyping

Question 9

what are the aims of treatment?

Answer 9

• Primary Aim to achieve viral eradication, or
  sustained viral response (SVR)
• Secondary Aims – Prevent transmission, slow
  progression of liver disease and Inc. QoL
• Response rate: Lower in patients with cirrhosis or fibrosis
• Dependent on treatment history & patient
  parameters

Question 10

what should you do before starting treatment?

Answer 10

• HCV genotype and subtype
• HCV RNA (viral load)
• Treatment naïve or experienced
• Liver disease – Cirrhosis, Staging of hepatic
  fibrosis
• Bloods – FBC, INR, LFTs, Renal function.

Question 11

what are the common side effects/

Answer 11

• Peginterferon
  – Anaemia, flu like symptoms
  – Thrombocytopenia, depression or mood changes
  – ~30% developed major depression (plus increasedrecurrence)
• Ribavirin
  – Haemolytic anaemia, nausea, rash, cough, gout

Question 12

what monitoring needs to be done with the side effects?

Answer 12

– FBC weekly for a month, then monthly.
– Thyroid function – Prior to therapy and then every 3 months

Question 13

what are Daas and what are the different types?

Answer 13

Direct Acting Antivirals
* Types
– NS3/4A Protease Inhibitors (PIs)
– Nucleoside and Nucleotide NS5B Polymerase
Inhibitors
– NS5A Inhibitors
– Non-Nucleoside NS5B Polymerase Inhibitors

Question 14

how do the different types of DAAs work?

Answer 14

• NS3/4A Protease Inhibitors (PIs)
  – Block viral enzyme (protease)
• Nucleoside and Nucleotide NS5B Polymerase
  Inhibitors
  – Directly block HCV RNA preventing replication
• NS5A Inhibitor
  – NS5A HCV protein needed for replication
• Non-nucleoside NS5B Polymerase Inhibitors
  – Insert directly into HCV blocking other parts of HCV
  from binding and replicating

Question 15

what does treatment depend on?

Answer 15

– Genotype
– Naïve or Previous treatment
– Cirrhotic or not.
– Cirrhosis compensated or decompensated
– HCV in pregnancy
– Renal Impairment plus Tx patients
– Coinfection HIV/HCV
– HCV recurrence post liver transplant

Question 16

how do you measure the severity of cirrhosis?

Answer 16

Childs Pugh