Hepatitis C

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  • Created by: z
  • Created on: 20-02-16 15:22

Epidemiology and transmission

  • IVDU (most common- 80-90%, THINK- past users)
  • Recurrent blood donation receivers (e.g. haemophiliacs, esp before 1991)
  • health care workers
  • migrants/travellers
  • offspring of HCV mother
  • sexual partner of HCV pt (MSM)

therefore prevention:

  • education of IVDU
  • needle exchange
  • good sharps managment
  • blood donor screening

Contaminated healthcare injections WHO, 200):

  • reusing euiqpment for injections, esp SE asia and middle east
  • cause 2 million HCV infecctions (40% of all new)
  • also 21 mil HBV 
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Virology

  • single stranded RNA virus 
  • infection through contaminated blood
  • discovered 1989
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Worldwide prevalence

  • highest in north africa
  • high in asia
  • high in sub-saharan africa
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HCV genotypes

  • 6 main genotypes
  • detemine reponse to treatment (GN3 hardest to treat ATM)
  • geographical variation 
    • GN1 and 3 in UK 
    • GN1 in US
    • GN3 in Indo-Pakistani pts
  • little effect on natural history
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Natural history

 (http://www.natap.org/2005/images/110305/natural-1.gif)

  • 20% initial clearence
  • if not= chronic hepatitis
    • 20% cirrhosis at 20 years
    • 50% cirrhosis at 30 years
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Factors affecting rate of progression to cirrhosis

Increase

  • hIgh alcohol intake
  • co-infections (HBV/HIV)
  • age of infection >40
  • insulin restistance 
  • GT3 infection
  • steatosis

Decrease

  • coffee intake(>3  cups/day)
  • female
  • age of infection <30
  • black ethnicity
  • normal ALT

NB HCV also increases risk of CV death

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Treatment 1

Depends on:

  • genotype
  • amount of fibrosis (use fibroscan to assess)
  • presence of co-mrobidities

Previously:

  • interferon and ribavirin
  • triple therapy
    • telaprevir or boeprevir with interferon and ribavirin for 24-48 wks
  • interferon associated with s/e
    • "flu"
    • exacerbated psych conditions
    • not safe for pt w/ cirrhosis
    • some pt not sensitive 
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Treatment 2

STR (single tablet regimen)

  • Ledipasvir/Sofosbuvir 90/400mg
    • once daily, oral
    • 12 week treatment (compliance)
    • 90% cure at 12 weeks

Ledipasvir

  • NS5A inhibitor
  • effective against GN1a and GN1n

Sofosbuvir

  • NS5B nucleotide polymerase inhibitor
  • effective against GN1-6
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