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home - Liver - Hepatitis C - Hepatitis C Treatment Overview 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 Treatment Overview

HCV RNA levels increase after HIV seroconversion and continue to increase over timeProgression to cirrhosis and HCC is faster if co-infected Risks for anti-HCV antibodies:Non-Hispanic black and Mexican American peopleLow family incomeThose with a lifetime history of =20 sexual partners.HCV RNA positive risk factors (identifies 85%of positives):MaleAbnormal serum ALT Report heavier alcohol intake Factors Associated With Disease Progression:In the host, the acquisition of HCV infection after the age of 40-55 may be associated with a more rapid progression of liver injury.Children-appear to have a relatively decreased risk of disease progression.HIV- progression is accelerated.EtOH and high BMI- more likely to get fibrosis.African Americans- progression may be slower and histology less severe.Marijuana- daily use gives more rapid fibrosis.Coinfection with different hep C genotypes or hep B and C. HCV accounts for 30% of HCCRisk genotype1b > genotype 2a/cOnly occurs in patients with cirrhosis 30% Chronic hepatitis without cirrhosis Poor correlation between ALT and histology25% have ALT >2x normal30% have normal ALT NauseaAnorexiaMyalgiaArthralgiaWeaknessWeight loss.Associated with cogni-tive impairment.No correlation of symptoms and disease activity Host factors associated with Clearance:The presence of specific HLA-DRB1 and DQB1 alleles.High titers of neutralizing antibodies against HCV structural proteins.Host neutralizing responses that target viral entry after HCV binding.The persistence of an HCV-specific CD4 T-cell response.White patients with relatively low peak levels of HCV viremia during acute infection.Children. Spontaneous clearance very rare if HCV persistence for >6 months Acute hepatitis CMost patients are asymptomatic.Jaundice occur in< 25 %.Some get malaise, nausea, and right upper quadrant pain for 2 to 12 weeks.Fulminant hepatic failure is very rare (more common if Hep B co-infected). 20% of all hepatitis 20 to 30 % after 20y 60 to 80 % Chronic hepatitis C Natural History HCC Cirrhosis- 4% risk of decompensation per year Hepatitis C Natural History Written by Dr Sebastian Zeki

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