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home - Liver - Hepatitis C - Hepatitis C Epidemiology and Virology Written by Dr Sebastian Zeki

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
Uses appropriate diagnostic modalities including serology
genotyping viral load measurements liver biopsy and related

Monitors anti-viral and immunomodulatory therapies with appropriate

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


Hepatitis C Epidemiology and Virology

Written by Dr Sebastian Zeki HIV coinfection increases risk to 19%High HCV viral load increases risk Breast feeding safe unless HIV coinfectedScreening not recommended as no intervention availableChildren of HCV mothers need test at 2-6m and anti-HCV after 15m Increased risk in promiscuous heterosexuals and male homo-sexuals and in HIV positive patientsLow risk in monogomous stable sexual partners- in US dont even recommend condoms Overall risk isapproximately 0.1 % annually Hepatitis C Epidemiology and Virology Related to flaviviruses and pestiviruses Open Reading Frame: 9000 nucleotides encode a 3000 amino acid polypro- Posttransla-tional Modific-tion results in all struc-tural and non-structural proteins 5’ untranslated region essential for replication RNA Virus RNA virus have no error correction ability Therefore get a lot of viral heteroogeneity (Quasispecies)- allows immune avoidance and viral persistence GenotypesIn US and Europe 1>2 and 3> 4,5,6.Genotype 3 is most common in Africa and the Middle East and Europe.In IVDU and MSM: Genotype 4 most common.In South Africa: Genotype 5 most commonHong Kong, Vietnam, and Australia: Geno-type 6 most common. Routes of transmission:i.v. drug use (=60% new Hep C infections).Cocaine snorting.Blood transfusion (prev 10% of Hep C- now rare esp.since nucleic acid testing (NAT) ).Sex with an intravenous drug user.Religious scarification.Having been struck or cut with a bloody object.Pierced ears or body parts.Immunoglobulin injection.Organ transplantation — HCV infected donor will result in 30-75% recipients getting HCV infection.Sexual or household contact — The efficiency of HCV transmission by sexual or household contact is low.Hemodialysis — Some risk but other than universal precautions, no special things to be done and no need for dedicated machines.Tattooing- Alone this is an equivocal risk factor for HCV.Perinatal transmission - Vertical HCV transmission rate of 3%. EpidemiologyThe incidence is 19,000 cases/year.The anti-HCV antibody prevalence: 1.6 % (equating to about 4.1 million anti-HCV positive persons).The prevalence of positive HCV RNA is about 1.3 % (or about 3.2 million persons who are HCV RNA-positive).Peak age prevalence is 40 to 49 years old. Characteristics of the hepatitis C virus

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