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