• HCV is an enveloped virus with a positive-sense RNA genome.

  •  

  • Although most acute infections are asymptomatic, HCV produces high rates of chronic infection and mortality.

  • Treatment of HCV infection includes recombinant interferon-α.

  • No vaccine is available for HCV.

 

 

HVC is parenterally transmitted by blood transfusions or intravenous drug use and, rarely, by sexual contact.

 

On initial infection, approximately 15% of persons will develop an acute hepatitis syndrome and completely recover.

However, most infected individuals will appear asymptomatic yet progress to chronic infection.

 

 

 

 

 

 

 

It is uncommonly diagnosed as a cause of acute hepatitis, often producing subclinical infection, but it is frequently diagnosed later as a cause of chronic hepatitis. The natural history of infection is not completely understood, but 50% to 85% of patients with hepatitis C will develop chronic infection.

On initial infection, approximately 15% of persons will develop

  • nausea
  • vomiting
  • loss of appetite
  • fever
  • fatigue
  • abdominal pain
  • joint pain
  • dark urine
  • light, clay-colored bowel movements
  • jaundice, or yellowing of the skin and eyes

 

and completely recover.

However, most infected individuals will appear asymptomatic yet progress to chronic infection. This chronic infection may progress to cirrhosis, liver failure, or hepatocellular carcinoma. HCV is transmitted from person to person, primarily via contact with infected blood or sexual contact. Routine screening of the donated blood supply for HCV was started in 1992. Prior to this, HCV was the primary cause of posttransfusion hepatitis. The high percentage of infections that are asymptomatic contributes to the spread of the virus in the population.

 

http://hepc.liverfoundation.org/diagnosis/sex-and-hep-c/

 

 

HVC is parenterally transmitted by blood transfusions or intravenous drug use and, rarely, by sexual contact. It is uncommonly diagnosed as a cause of acute hepatitis, often producing subclinical infection, but it is frequently diagnosed later as a cause of chronic hepatitis. The natural history of infection is not completely understood, but 50% to 85% of patients with hepatitis C will develop chronic infection.

Mavyret

https://www.mavyret.com/hcp/about?cid=ppc_ppd_mavyret_ggl_bv_2396

    for evidence of current or prior hepatitis B virus (HBV) infection before initiating treatment with MAVYRET. HBV reactivation has been reported in HCV/HBV coinfected patients who were undergoing or had completed treatment with HCV direct-acting antivirals and were not receiving HBV antiviral therapy. Some cases have resulted in fulminant hepatitis, hepatic failure, and death. Monitor HCV/HBV coinfected patients for hepatitis flare or HBV reactivation during HCV treatment and post-treatment follow-up. Initiate appropriate patient management for HBV infection as clinically indicated.

    CONTRAINDICATIONS

    MAVYRET is contraindicated:

    • In patients with severe hepatic impairment (Child-Pugh C)
    • With the following drugs: atazanavir or rifampin

    WARNINGS AND PRECAUTIONS

    Risk of Reduced Therapeutic Effect Due to Concomitant Use of MAVYRET with Carbamazepine, Efavirenz-containing Regimens, or St. John's Wort

    • Carbamazepine, efavirenz, and St. John's Wort may significantly decrease plasma concentrations of glecaprevir and pibrentasvir, leading to reduced therapeutic effect of MAVYRET. The use of these agents with MAVYRET is not recommended.

    ADVERSE REACTIONS

    Most common adverse reactions observed with MAVYRET:

    • >10% of subjects: headache and fatigue
    • ≥5% of subjects: headache, fatigue, and nausea

    INDICATION

    Treatment of HCV infection includes recombinant interferon-α.]

    MAVYRET™ (glecaprevir and pibrentasvir)

    [
  • No vaccine is available for HCV.

 

The diagnosis of chronic HCV infection

Following a positive HCV virus serological test another test (NAT for the detection of HCV RNA) be performed to diagnose chronic infection. NAT for HCV RNA should also be performed to assess whether to start treatment for hepatitis C.

 

. HCV–polymerase chain reaction (PCR) to measure of disease activity and as a monitor of response to therapy.

Recombinant interferon, which induces host antiviral and antiproliferative activity, is the most widely used therapy for HCV.

 

 

Reduce moderate and high levels of alcohol intake

An alcohol intake assessment is recommended for all persons with HCV virus infection followed by the offer of a behavioural alcohol reduction intervention for persons with moderate-to-high alcohol intake.

4. Assessing degree of liver fibrosis and cirrhosis

In resource-limited settings, the aminotransferase/platelet ratio index (APRI) or FIB4 tests should be used for the assessment of hepatic fibrosis rather than other non-invasive tests that require more resources such as elastography or fibrotest.

Treatment with direct-acting antivirals (DAAs)

WHO recommends that all patients with hepatitis C be treated with DAA-based regimens, except for a few specific groups of people in whom interferon-based regimens can still be used (as an alternative regimen for patients with genotype 5 or 6 infection and those with genotype 3 HCV infection who also have cirrhosis).

7. Telaprevir and boceprevir should no longer be used

These 2 first-generation DAAs, which are administered with pegylated interferon and ribavirin, were recommended in the 2014 guidelines. Evidence now shows that they result in more frequent adverse effects and less frequent cures compared with newer DAA-based regimens. Thus, these 2 medicines are no longer recommended by WHO.

8. WHO recommends preferred and alternative DAA regimens based on genotype and cirrhosis status

 

 

HCV–polymerase chain reaction (PCR) is also used to quantitate the amount of circulating virus present in an infected person. This serves as a measure of disease activity and as a monitor of response to therapy. Recombinant interferon, which induces host antiviral and antiproliferative activity, is the most widely used therapy for HCV.

 

 

 

 

  •  

  • On initial infection, approximately 15% of persons will develop an acute hepatitis syndrome and completely recover. However, most infected individuals will appear asymptomatic yet progress to chronic infection.
  • This chronic infection may progress to cirrhosis, liver failure, or hepatocellular carcinoma. HCV is transmitted from person to person, primarily via contact with infected blood or sexual contact. Routine screening of the donated blood supply for HCV was started in 1992. Prior to this, HCV was the primary cause of posttransfusion hepatitis. The high percentage of infections that are asymptomatic contributes to the spread of the virus in the population.

 

50% to 85% of patients with hepatitis C will develop chronic infection.

  • HCV produces high rates of chronic infection and mortality. No more with Hepatitis Drug

 

Content 13

A 62-year-old man presents to your office for follow-up of some abnormal blood test results. You saw him 2 weeks ago as a new patient for a routine physical examination. You ordered blood tests and found that his liver enzymes were elevated by approximately three times the upper limits of normal. The patient says that to his knowledge he's never had abnormal liver tests before, although he has not been to a doctor in several years. He denies alcohol or drug use and is not taking any medications. He gives no history of jaundice. His past medical history is significant only for hospitalization at the age of 45 for a bleeding stomach ulcer. He required surgery and had transfusion of 4 units of blood. He recovered from this episode without further complication and has had no recurrences. Your complete physical examination 2 weeks ago was normal, and a focused physical examination today shows no signs of jaundice, no hepatosplenomegaly, and no physical examination findings suggestive of portal hypertension. You diagnose an infectious etiology for the laboratory findings (elevated liver enzymes).

Questions

What is the most likely infectious cause of his abnormal liver function tests?

How did he most likely acquire this infection?

 

Summary: A 62-year-old man who had a blood transfusion previously has abnormal liver function tests, which are likely caused by an infectious etiology.

  • Most likely infectious etiology: Hepatitis C virus (HCV).

  • Most likely route of transmission: Blood transfusion.

Clinical Correlation

 

On initial infection, approximately 15% of persons will develop an acute hepatitis syndrome and completely recover. However, most infected individuals will appear asymptomatic yet progress to chronic infection. This chronic infection may progress to cirrhosis, liver failure, or hepatocellular carcinoma. HCV is transmitted from person to person, primarily via contact with infected blood or sexual contact. Routine screening of the donated blood supply for HCV was started in 1992. Prior to this, HCV was the primary cause of posttransfusion hepatitis. The high percentage of infections that are asymptomatic contributes to the spread of the virus in the population. Diagnosis is made by the presence of circulating antibody to HCV. HCV–polymerase chain reaction (PCR) is also used to quantitate the amount of circulating virus present in an infected person. This serves as a measure of disease activity and as a monitor of response to therapy. Recombinant interferon, which induces host antiviral and antiproliferative activity, is the most widely used therapy for HCV.

 

A 62-year-old man presents to your office for follow-up of some abnormal blood test results. You saw him 2 weeks ago as a new patient for a routine physical examination. You ordered blood tests and found that his liver enzymes were elevated by approximately three times the upper limits of normal. The patient says that to his knowledge he's never had abnormal liver tests before, although he has not been to a doctor in several years. He denies alcohol or drug use and is not taking any medications. He gives no history of jaundice. His past medical history is significant only for hospitalization at the age of 45 for a bleeding stomach ulcer. He required surgery and had transfusion of 4 units of blood. He recovered from this episode without further complication and has had no recurrences. Your complete physical examination 2 weeks ago was normal, and a focused physical examination today shows no signs of jaundice, no hepatosplenomegaly, and no physical examination findings suggestive of portal hypertension. You diagnose an infectious etiology for the laboratory findings (elevated liver enzymes).

 

What is the most likely infectious cause of his abnormal liver function tests?

How did he most likely acquire this infection?

Summary: A 62-year-old man who had a blood transfusion previously has abnormal liver function tests, which are likely caused by an infectious etiology.

  • Most likely infectious etiology: Hepatitis C virus (HCV).

  • Most likely route of transmission: Blood transfusion.

Clinical Correlation

HVC is parenterally transmitted by blood transfusions or intravenous drug use and, rarely, by sexual contact. It is uncommonly diagnosed as a cause of acute hepatitis, often producing subclinical infection, but it is frequently diagnosed later as a cause of chronic hepatitis. The natural history of infection is not completely understood, but 50% to 85% of patients with hepatitis C will develop chronic infection.

On initial infection, approximately 15% of persons will develop an acute hepatitis syndrome and completely recover. However, most infected individuals will appear asymptomatic yet progress to chronic infection. This chronic infection may progress to cirrhosis, liver failure, or hepatocellular carcinoma. HCV is transmitted from person to person, primarily via contact with infected blood or sexual contact. Routine screening of the donated blood supply for HCV was started in 1992. Prior to this, HCV was the primary cause of posttransfusion hepatitis. The high percentage of infections that are asymptomatic contributes to the spread of the virus in the population. Diagnosis is made by the presence of circulating antibody to HCV. HCV–polymerase chain reaction (PCR) is also used to quantitate the amount of circulating virus present in an infected person. This serves as a measure of disease activity and as a monitor of response to therapy. Recombinant interferon, which induces host antiviral and antiproliferative activity, is the most widely used therapy for HCV.

Regarding the treatment of hepatitis C for genotype 1 patients, which of the following therapies has the highest cure rate?

The correct answer is "A." Of the options available, ledipasvir/sofosbuvir(Harvoni) has the highest rate of sustained virologic response, with rates of 93% or better for genotype 1. 

 


 

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