hepatitis C

Question 1

What is Hep C?

Answer 1

blood borne
single stranded
enveloped
RNA virus

Question 2

declining incidence of Hep C?

Answer 2

• screening of blood and blood products
• safer needle use practice among IVDUs

Question 3

transmission

Answer 3

• IVDU
• Vertical transmission (mother to child)
• Sexual exposure
• Transfusion
• Occupational exposure – needle stick injury
• Tattooing, acupuncture, piercing and dental work

Question 4

after exposure to HCV

Answer 4

• Incubation period – 6-8 weeks
• Acute infection - serology can take up to 6 mths to become +ve
• If not cleared → Chronic HCV
• Genotype and viral load do not usually affect disease progression
• 20% have cirrhosis at 20-30 years after infected
• Liver Failure – 2-5% of patients with cirrhosis/year
• HCC – 1-4% of patients with cirrhosis/year

Question 5

public interventions for HCV

Answer 5

• Prevent new infections
• Inc awareness of infection
• Inc diagnosis
• Treating diagnosed individuals

Question 6

RF for disease progression

Answer 6

• Alcohol (> 6 units/day = progression)
• Older age at infection
• Infection duration
• Male sex
• Obesity
• Diabetes/insulin resistance
• HIV and/or HBV co infection

Question 7

Who should be screened for HCV?

Answer 7

• 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 8

signs and symptoms

Answer 8

• 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 9

diagnosis of HCV

Answer 9

• Differential: CHB, ALD, haemochromatosis
• Risk Factors
• Sx
• Blood Tests
• Hep C antibodies
• Serology for Hep C viral RNA (viral load)
• Liver Biopsy
• Viral Genotyping

Question 10

primary aim of Tx

Answer 10

to achieve viral eradication
OR
sustained viral response (SVR)

Question 11

secondary aim of Tx

Answer 11

prevent transmission

slow progression of liver disease

inc QoL

Question 12

When is response rate to Tx lower?

Answer 12

cirrhosis or fibrosis

Question 13

before starting treatment

Answer 13

• HCV genotype & subtype
• HCV RNA (viral load)
• Tx naïve or experienced
• Liver disease – cirrhosis, staging of hepatic fibrosis
• Bloods – FBC, INR, LFTs, renal fxn

Question 14

DAAs

Answer 14

direct acting antivirals

Question 15

types of DAAs

Answer 15

– NS3/4A protease inhibitors (PIs)
– nucleoside and nucleotide NS5B polymerase iInhibitors
– NS5A inhibitors
– non-nucleoside NS5B polymerase inhibitors

Question 16

How do NS3/4A protease inhibitors work?

Answer 16

block viral enzyme (protease)

Question 17

How do nucleoside and nucleotide NS5B polymerase iInhibitors work?

Answer 17

directly block HCV RNA preventing replication

Question 18

How do NS5A Inhibitors work?

Answer 18

block NS5A HCV protein needed for replication

Question 19

How do non-nucleoside NS5B polymerase inhibitors work?

Answer 19

Insert directly into HCV blocking other parts of HCV from binding and replicating

Question 20

What does Tx depend on?

Answer 20

– Genotype
– Naïve or previous Tx
– Cirrhotic or not
– Cirrhosis compensated or decompensated
– HCV in pregnancy
– Renal impairment plus Tx patients
– Coinfection HIV/HCV
– HCV recurrence post liver transplant

Question 21

What is childs Pugh?

Answer 21

general measure of severity of cirrhosis

grade & score:
A, 5-6 = well functioning
C, 10-15 = decompensated