Hep C diagnosis and management for doctors, medical students, finals and MRCP PACES
Definition of Hepatitis C
- Infection of hepatocytes caused by hepatitis C virus
Epidemiology of Hepatitis C
- Incidence 0.5% in UK
- Much higher in Africa, and IV drug users.
Causes of Hepatitis C
- Hepatitis C virus – an RNA virus
- Predominantly blood-borne transmission but sexual and vertical transmission can occur.
Presentations of Hepatitis C
- Rarely presents acutely and then only as a mild flu-like illness
- 85% develop chronic infection
- Presents as chronic liver disease (see CLD page)
Differential diagnosis of Hepatitis C
- Any cause of chronic liver disease (see CLD page)
Genotypes of Hepatitis C
- There are 11 distinct genotypes of hepatitis C virus and many different subtypes
- Genotypes 1-3 are the most common and have worldwide distribution
- Genotypes 1a and 1b account for 60% of all disease and traditionally were the most difficult subtypes to treat. This is now changing with the development of new direct acting antiviral agents.
Initial management of Hepatitis C
- Investigations as per any other cause of chronic liver disease (see CLD page)
- HCV RNA levels
- Anti-HCV IgM
- Ultrasound liver and alphafetoprotein
- Every 6 months in those patients with cirrhosis to monitor for HCC
- Liver biopsy
Treatment of Hepatitis C
- The development of highly effective protease inhibitors which have been available since 2011 has significantly altered the landscape of hepatitis C treatment.
- The aim of chronic hepatitis C treatment is now full viral load suppression with the intent to cure patients of this disease.
- Several new drugs have been approved in the last few years and many more are on the way.
- This information is correct at the time of publication but is likely to change as well as be subject to national and local policies with regard to funding and availability.
- The AASLD and EASL guidelines can provide thorough up to date information on which drugs are currently available for treatment.
- Treatment should be prioritised for those:
- With significant fibrosis or cirrhosis
- With HIV/HBV coinfection
- Pre/post liver transplantation
- At high risk of transmitting the virus
- There are a number of treatment regime options and the choice will be determined by the patient genotype, possible drug interactions and previous drug treatment.
- Genotype 1 treatment
- Traditionally the most difficult genotype to treat – this has now changed with the advent of direct-acting antiviral agents.
- Sofusbovir plus ribavirin and peg-interferon
- Sustained viral response >90% cases
- An 8-12 week course gives a sustained viral response (SVR) in >94% cases
- Simeprevir plus sofusbovir
- This is given for 12-24 weeks
- Peg-interferon and ribavirin
- The traditional agents used in genotype 1 which give viral suppression in only 40-50% cases
- Genotypes 2 & 3
- Ribavirin + sofusbovir +/- peg-interferon
Complications of Hepatitis C
- Chronic infection which can lead to chronic liver disease, cirrhosis and its complications including HCC (see decompensated CLD page)
Prognosis of Hepatitis C
- It is estimated that approximately 350 million people die every year from hepatitis C and its complications
- With new treatments however, improved prognosis for chronic hepatitis C and potentially a cure looks very promising.
- However, these new drugs are currently prohibitively expensive and not therefore available to the vast majority of people in the world who are living with chronic hepatitis C.
Common Hepatitis C exam questions for medical students, finals, OSCEs and MRCP PACES
Click here to download free teaching notes on hepatitis C: Hepatitis C
Perfect revision for medical students, finals, OSCEs and MRCP PACES