Hepatitis c

all about hepatitis C

1. Hepatitis C JUN/2017 Elham Soheili .MD

2. Hepatitis C Virus ( HCV) infection is the most common chronic blood born infection in the United States. Most infected persons are younger than 50 years old. Approximately 3.2 million person are chronically infected . HCV is the most common cause of liver transplant in United States ( 30%). Hepatitis C

3. Hepatitis C accounts for 40 % of chronic liver disease. Estimated 8000-10000 death per year in U.S Genotype 1 is the most common world wide. Genotype 1 accounts for 70% cases .( 90% in African American ) in United states Genotype 2 and 3 account for the remaining 30% in the U.S Genotype 4 in Eygept,5 in South Africa 6 Hong Kong Hepatitis C

4. Acute and Chronic Hepatitis Liver failure and Cirrhosis Hepatocellular carcinoma Esophageal and gastric varices Hepatitis C Causes

5. Cryoglobulinemia Sjogen syndrome Low platelet count Lichen Planus Porphyria Cutanea Tarda Insulin resistance DM DM Nephropathy Extrahepatic Complications

6. Porphyria Cutanea Tarda

7. Lichen planus

8. Autoimmune thyroiditis rheumatoid factor in 20-30% of infected patients B-cell lymphoproliferative disorder Increase risk of Pancreatic cancer inflammation of Small and medium size blood vessel( Vasculitis ) Extrahepatic

9. Blood transfusions( Decrease since 1990) Drug abuse – Injections Tattooing Contamination of Medical equipment .(Specially hemodialysis) Hepatitis C Transmission

10. WHO calculates that unsafe health care devices account for 2.3 million new HCV infections per year, and 200 000 HCV related premature deaths, mostly in Developing countries The re-use of injection equipment's without sterilization contributes to major spread. Hepatitis C Transmission

11. Vertical transmission occurs in 3 -10% Mother with higher HCV viral loads or co infection with HIV transmit in higher rates. No risk of transmission is associated with breast feeding. HCV transmission Mother to Child

12. Sexual transmission of HCV can occur, with much lower frequency than that of HIV, and HBV Long term partners of HCV infected patients have higher rates of infection than the general population . May be associated with shared use of Razors and tooth brushes . CDC on the basis of current evidence does not recommend use of barrier precautions among the heterosexual monogamous couples, to prevent HCV transmission . Transmission of Infection in Spouses

13. Person born between 1945 and 1965 Person who ever used injection drug Person with HIV infection Hemophiliacs patient treated with clotting factor prior to 1987. Person who ever undergone long term hemodialysis Person with unexplained elevation of aminotransferase High Risk Population

14. Transfusion or transplantation recipient prior to July 1992 Children born to a mother with Hepatitis C Sexual partner of person with hepatitis C Health care provider after needle injury with infected hepatitis C patient High Risk Population

15. The average incubation period for HCV is 6-7 days The period for exposure to seroconversion is 8-9 weeks. About 90% of the infected are anti HCV positive in 5 months Hepatitis C Infection

16. Hepatitis C

17. Best Initial Test is Hepatitis C antibody (cannot show the level of activity of the virus) Gold Standard and most sensitive is HCV PCR for RNA Assay shows the degree of viral replication, disease activity and determining the response to the therapy Liver Biopsy is the most accurate way to determining the seriousness of the disease. Genotyping predict the response to the treatment Hepatitis C Diagnosis

18. Elevated ALT &AST(dose not correlate to the severity of liver damage) Elevated bilirubin level and Alkaline phosphatase Neutropenia and lymphopenia followed by relative lymphocytosis Measurement of the PT is important in acute hepatitis (it will show sever hepatic synthetic defect and hepatocellular necrosis) Antibody LKM1 Lab Features

19. Hepatitis C infection causes acute symptoms in 15% of cases including: Fever Fatigue Nausea and Vomiting Dark urine and clay color stool Jaundice( usually after prodromal symptoms diminished) Abdominal and joint pain Right upper quadrant pain and tenderness Acute Hepatitis

20. Chronic hepatitis C counts fro 50 to 70% of cases Progression to cirrhosis in about 20-25% 1/3 of patients with chronic hepatitis C have normal transaminase level Chronic hepatitis C intend to slowly progressive and 65% remain asymptomatic ¼ of patient will have end stage liver disease Chronic hepatitis C

21. Older age Longer duration of infection Concomitant liver disease like alcoholic liver, Hep B, hematochoromatosis, Alfa 1 antitrypsin deficiency ,steatoheaptitis . HIV Obesity Progression of liver disease in patient with chronic hepatitis C

22. PEG IFN with Ribavirin with Protease inhibitor to treat Genotype 1 and 4 ( 48 Week ) and genotype 2 ,6 and 5 for( 24 Weeks) hepatitis C Protease inhibitor like Telaprevir –Boceprevir ledipasvir –simeprevir -sofosbuvir Harvoni (ledipasvir and sofosbuvir) use with or with out ribavirin to treat genotype 1-4-5-6 Epclusa (Sofosbuvir and velpatasvir) treat genotype 1-2-3-4-5-6 Treatment