Hepatitis C

Question 1

Hepatitis C virus:

• type
• incubation period

Answer 1

• hepatitis C is RNA flavivirus
• incubation period: 6-9 weeks

Question 2

Progression of Hepatitis C infection

Answer 2

• some people clear the virus naturally
• those who do not → may: remain free of symptoms; develop liver cirrhosis or cancer

Question 3

Is there a vaccine for Hepatitis C?

Answer 3

No

Question 4

Transmission of Hep C risks for:

• needle stick injury
• vertical transmission
• sexual intercourse

Answer 4

• needle stick injury → about 2% risk
• vertical transmission rate from mother to child → about 6% ( risk is higher if there is coexistent HIV)
• sexual intercourse → less than 5%

Question 5

Is breastfeeding contraindicated in mums with hepatitis C?

Answer 5

Breastfeeding is not contraindicated in mums with hepatitis C

Question 6

What do the majority of Hep C causes come from?

Answer 6

IVDU (90% cases)

Question 7

Structure of Hepatitis C virus

Answer 7

Question 8

Symptoms of acute Hepatitis C infection

Answer 8

After exposure to the hepatitis C virus only around 30% of patients will develop features such as:

• a transient rise in serum aminotransferases / jaundice
• fatigue
• arthralgia

(jaundice + flu-like illness)

Question 9

Investigations for Hepatitis C infection

Answer 9

• HCV RNA → to diagnose acute infection

(HCV RNA can be detected in blood 1-3 weeks after initial exposure)

Question 10

What can be seen in the blood results of a patient infected with Hepatitis C? (2)

Answer 10

• HCV RNA → detected 1-3 weeks after initial exposure (diagnostic of Hep C)
• patients will eventually develop anti-HCV antibodies

* patients who spontaneously clear the virus will continue to have anti-HCV antibodies

Question 11

How many patients will develop chronic Hep C infection?

Answer 11

• around 15-45% of patients will clear the virus after acute infection (depending on their age and underlying health)
• the majority (55-85%) will develop chronic hepatitis C

Question 12

What’s the definition of chronic Hep C (in terms of blood results)?

Answer 12

persistence of HCV RNA in the blood for 6 months

(2 positive PCR HCV 6 months apart)

Question 13

Potential complications of chronic Hep C

Answer 13

• rheumatological problems: arthralgia, arthritis
• eye problems: Sjogren’s syndrome
• cirrhosis (5-20% of those with chronic disease)
• hepatocellular cancer
• cryoglobulinaemia: typically type II (mixed monoclonal and polyclonal)
• porphyria cutanea tarda (PCT): it is increasingly recognised that PCT may develop in patients with hepatitis C, especially if there are other factors such as alcohol abuse
• membranoproliferative glomerulonephritis

Question 15

Management of chronic Hepatitis C

-

• drugs

Answer 15

Drugs: combination of protease inhibitors (e.g. daclatasvir + sofosbuvir or sofosbuvir + simeprevir) with or without ribavirin are used

• treatment depends on the viral genotype - this should be tested prior to treatment
• Treatment success rate 95%

Question 16

What’s the aim of Hepatitis C treatment

Answer 16

Aim of treatment is sustained virological response (SVR) → defined as undetectable serum HCV RNA six months after the end of therapy

Question 17

Side effects of Hepatitis C treatment

• ribavirin
• interferon-alpha

Answer 17

• ribavirin: haemolytic anaemia, cough

*Women should not become pregnant within 6 months of stopping ribavirin as it is teratogenic

• interferon-alpha: flu-like symptoms, depression, fatigue, leukopenia, thrombocytopenia

Question 18

May women on ribavirin become pregnant?

Answer 18

Women should not become pregnant within 6 months of stopping ribavirin as it is teratogenic