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home - Liver - Hepatitis C - Hepatitis C Diagnosis Written by Dr Sebastian Zeki
Knowledge


Understands the serological interpretation categorisation and
investigation of patients with chronic hepatitis B and/or C with
particular emphasis on the need for treatment and surveillance

Recognises the particular populations at risk
Aware of national and international agreed guidelines on viral
hepatitis management and use of interferon and antiviral drugs

Aware of hepatitis B reactivation in the context of immunosuppression
Skills
Uses appropriate diagnostic modalities including serology
genotyping viral load measurements liver biopsy and related
investigations

Monitors anti-viral and immunomodulatory therapies with appropriate
investigations

Behaviours
Communicates effectively with patients and relatives in the context of
viral liver disease and underlying social and psychological risk factors

Marshals multi-disciplinary support networks and in particular
recognise the crucial role of nurse practitioners in disease
management

Also..

Hepatitis C Diagnosis

The roles of a liver biopsy: Staging and prognosis of the disease.Determination of threshold for treatment changes.Diagnosis of other diseases. Groups in whom the need for testing is uncertain:Recipients of transplanted tissue.Intranasal cocaine or other non-injecting illegal drug users.Those with a history of tattooing, body piercing.Those with a history of sexually transmitted diseases or multiple sex partners.Long-term steady sex partners of HCV-positive persons. Diagnosis:+ve anti-HCV ELISA does not distinguish those who cleared the infection from those who are chronically infected.Distinction from chronic infection — Both may have detectable HCV RNA, antibodies against HCV, and elevated serum aminotransferases.May have to rely on evidence such as new symptoms, exposure timing Development of chronic infection —Occurs in 80%May be lower in children and needls stick injury and with symptomatic acute Hep CTreatment:Assess HCV RNA status 3 months after symptom onset before beginning therapy.If cleared HCV RNA should have subsequent determinations at three-month intervals for one year to assure that clearance was sustained.Treatment with pegylated interferon-alfa for 6m or standard interferon for 24 weeks (as per chronic HCV)- gives good SVR rates Anti-HCV ELISA 3 Reactive Nonreactive Confirm with RIBA 2 or 3 if low risk HCV RNA Do HCV RNA anyway if high risk No further HCV evaluation HCV genotypingQuantitative HCV RNA -Anti-HCV ELISA tests become positive as early as eight weeks after exposure-50% have ELISA positive HCV antibodies when first presenting. -HCV RNA positivity is the first biochem-cal evidence of HCV infection- appears days to 8 weeks post exposure 1.Testing for HCV RNA by PCR immediately and at weeks 4 and 12 2. Antibody testing using an ELISA immediately and at week 12 3. Serum aminotransferases (ALT and AST) immediately and at weeks 4 and 12 Hepatitis C Diagnosis People who should be screened:Those who ever injected illegal drugs.Those who received clotting factors made before 1987.Those who received blood/organs before July 1992.Those who were ever on chronic hemodialysis.Those who have evidence of liver disease. Indication for testing based upon the need for exposure management:Healthcare, emergency, and public safety workers after needle stick/mucosal exposure to HCV-positive blood Children born to HCV-positive women Those in whom routine testing is not recommended (unless an additional risk factor is identified):Healthcare, emergency medical, and public safety workers.Pregnant women.Household (non-sexual) contacts of HCV-positive persons.The general population. Liver biopsy may not be required prior to treatment of patients with genotype 2 or 3 (80% virologic response rate)Most places do a liver biopsy unless SVR, and then repeat at 2 years. Following known exposure patients should undergo: Diagnosis and treatment of acute hepatitis C in adults Written by Dr Sebastian Zeki

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