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GIHEP Micro - Viral Hep (iii) Hep C (Transmission (perinatal, sexual,…
GIHEP Micro - Viral Hep (iii) Hep C
Intro
RNA virus (flavivirus)
@ least 6 distinct genotypes (1-6)
no cross protection (i.e. can get reinfected with another genotype)
can't be cultured yet, hence no vaccine
incubation period = 8 wks on average
outbreaks have ocurred in Ire among IVDUs + people given contaminated blood products
factors increasing rate of disease progression + severity
alcohol
high BMI
insulin resistance
steatohepatitis
older age
HIV/hep B co-infection
factors decreasing rate of disease progression + severity
antivirals
OTL
Transmission
perinatal
sexual
parenteral ('blood borne virus')
IVDUs sharing needles
haemodialysis
non-sterile glucometer
sharing personal care items (razor, toothbrush)
needle stick injuries
piercing, tattooing, acupuncture
Acute infection
most asymp
rarely acute hep
can be followed by clearance (in 25% Hep C RNA no longer detectable)
Chronic infection
in 75%
85% asymp
rarely dxed/txed early
@ risk of fibrosis, cirrhosis (advanced fibrosis - 10-30% @ 40 yrs of infection), HCC, liver failure
fatigue, nausea, anorexia, myalgia, arthralgia, signs of chronic liver disease
extra hep features
common
haematological
endocrine (diabetes, thyroiditis)
rheumatological (membranoproliferative glomerulonephritis, sjogrens)
dermatological (rashes)
Serology
Anti HCV Ab
+ve 2-6 months after exposure (HENCE NOT ALWAYS +VE IN ACUTE)
will remain +ve even if patient has cleared infection
HCV Ag
+ve in acute + chronic infection
HCV RNA
+ve in acute + chronic infection
-ve if infection has been cleared
Tx
acute
no post exposure prophylaxis
goal = prevent chronic infections
IFN
chronic
goal = eradicate RNA in serum
Tx regimens depends on genotype, other co-infections (e.g. HIV), past hx of antiviral tx + degree of fibrosis
DAAs/IFN
also give hep A + B vaccine
Prevention
standard precautions
screen blood products
clean/disposable needles
hand hygiene
PPE - gloves, goggles, aprons etc
safe disposal of sharps
avoid risk factors: safe sex
no vaccine/Ig available