hepatitis c.pptx

It's presentation on hepatitis c infection and it's management

1. HEPATITIS C Dr.HARDIK (R1 GENERAL MEDICINE DEPARTMENT ) PDU MEDICAL COLLEGE RAJKOT

2. DEFINITION Hepatitis c is contagious liver disease caused by hepatitis c virus. It accounts for 3% global population involved It can range in severity from mild illness lasting for few weeks to serve life threatening illness

3. INTRODUCTION Labelled as a "non-A, non-B hepatitis,“ Member of hepacivirus c. It is a linear, single-stranded enveloped RNA virus belonging to the flavivirus family.

4. VIRAL PROTEIN

5. VIRAL PROTEINS STRUCTURAL: 1) C: core protein nucleocapsid 2) E1, E2: envelope Glycoprotein 3) P7: ion channel for viral release NON STRUCTURAL:1) NS3: serine proteas 2) NS5A: RNA binding site within replication complex 3) NS5B: RNA dependent RNA polymerase DIRECTLY ACTING ANTIVIRAL ACT ON:NS5A,NS5B NS5A(-) : declatasavir Velpatasavir NS5B: Sofosbuvir

6. TRANSMISSION

7. INCUBATION PERIOD 15days to 160 days

8. VIRAL CYCLE

9. PATHOGENESIS

10. COURSE OF ILLNESS

11. SYMPTOMS-ACUTE

12. CHRONIC

13. EXTRAHEPATIC MENIFESTATION

14. WHOM TO TEST 1. People who inject drugs ( PWID) 2. Men who have sex with men 3. Female sex workers 4. People who received blood transfusion before routine testing for hepatitis C 5. People who need frequent blood transfusion, such as, thalessemic and dialysis patients 6. People living with HIV 7. Inmates of prisons and other closed setting s

15. LAB DIAGNOSIS > As illustrated in figure,following an initial eclipse phase of 1–2 weeks when no virological or serological markers of infection may be detected, the natural course of HCV infection is characterized by the appearance of HCV RNA, then HCV core p22 Ag in the absence of an antibody response for a further 6–10 weeks. >after that ANTI-HCVantibody appears in blood

16. DIAGNOSIS IN CHILDREN anti-HCV antibodies from an infected mother may persist in children <18 months of age, HCV RNA detection is also used to diagnose HCV infection in this age group (after 2 months of age)

17. LAB INVESTIGATION Complete blood cell (CBC) count with differential
International normalized ratio (INR) Liver function tests, including levels of ALT and AST, alkaline phosphatase, albumin, and total and direct bilirubin
Calculated glomerular filtration rate (eGFR
Screening tests for coinfection with human immunodeficiency virus (HIV) or hepatitis B virus (HBV)

18. Serum pregnancy testing in women of childbearing age before initiating a treatment regimen that includes ribavirin or that includes direct-acting antiviral agents (DAAs) without ribavirin The World Health Organization (WHO) recommends nucleic acid testing for qualitative or quantitative HCV RNA detection as well as for test of cure at 12 or 24 weeks following antiviral treatment completion.[50]In areas with limited resources, the WHO suggests using the aminotransferase/platelet ratio index (APRI) or the fibrosis-4 (FIB-4) score for evaluating hepatic fibrosis rather than other noninvasive tests that require more resources (eg, elastography, FibroTest), as follows[50]:

19. >APRI = [(AST (IU/L)/AST_ULN (IU/L))×100]/platelet count (109 /L)

>FIB-4= age (years) × AST (IU/L)/platelet count (109)/L × [ALT (IU/L)1/2 APRI>0.2 FIB-4>3.2 are suggestive of hepatic fibrosis

20. TREATMENT Whom To Treat Any individual diagnosed to have infection with hepatitis C virus (viremia +) needs treatment. The duration of treatment will depend on the several situations such as, cirrhosis versus non-cirrhosis, presence of decompensation (ascites, variceal bleeding, hepatic encephalopathy, or infection(s), treatment naïve versus treatment experienced (to peg IFN, DAAs, etc).

21. WHAT REGIME TO USE

22. DOSAGE RECOMMENDED DAA

23. DOSE ADJUSTMENT FOR RIBAVIRIN ANEMIA: IF 1) HB<10: 600mg 2) HB<8.5 : discontinue RENAL FAILURE: patients with an eGFR <50 mL/ min/1.73 m2 should not be treated with ribavirin and those on haemodialysis must have the dose lowered to 200 mg per day or take it three times per week.

24. Management of treatment experienced

25. CONTRAINDICATIONS