Chronic Hepatitis C
Jane is a 56-year-old lady referred to liver clinic with a positive for hepatitis C virus (HCV) antibody after presenting to her GP with tiredness. She has no active medical history, takes no regular medication and denies any intravenous drug use in the p
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Key Learning Points
• Hepatitis C is blood borne RNA virus that is one of the leading causes of cirrhosis world, especially in patients with other risk factors for liver fibrosis. • The mahjority of case world wide are iatrogenic whilst in the more developed world most are due to intravenous drug use. • Negative viral PCR 12 to 24 weeks after treatment (a sustained viral response) indicates cure of infection. • A proliferation of highly specific antiviral agents is rapidly surpassing interferon as the main mode of therapy for patient with excellent cure rates and tolerability. • Cure of infection massively reduces the risk of serious liver disease, but as immunity isd ineffective reinfection is possible.
V. Athwal University of Manchester and University Hospitals of South Manchester, Manchester, UK M. Prince () The Manchester Royal Infirmary, Manchester, UK e-mail: [email protected] T. Cross (ed.), Liver Disease in Clinical Practice, In Clinical Practice, DOI 10.1007/978-3-319-43126-0_11, © Springer International Publishing Switzerland 2017
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V. Athwal and M. Prince
Case Study Jane is a 56-year-old lady referred to liver clinic with a positive test for hepatitis C virus (HCV) antibody after presenting to her GP with tiredness. She has no active medical history, takes no regular medication and denies any intravenous drug use in the past. She informs you on further questioning that she had a road traffic accident in 1980 and underwent surgery on a left femoral fracture. At this time, she was given blood products. She drinks between two and three bottles of wine per week and works as a teaching assistant. Clinical examination is remarkable for the presence of palmer erythema only. Blood testing reveals: Positive for HCV antibody RNA viral load is log 8.3 IU/ml Genotype 1, subtype A ALT 81 AST 59 Albumin 36 Bilirubin 12 INR 1.1 Platelets 99 Creatinine 71 (eGFR >90)
Questions 1. Which of the choices below is not a method to noninvasively assess liver fibrosis? A. Liver biopsy B. Ultrasound scan the liver with acoustic radiation force impulse (ARFI) imaging C. Shear wave transient elastography (e.g. FibroScan™) D. AST-to-platelets ratio index (APRI) E. FIB-4 index 2. Non-invasive assessment reveals the likelihood of cirrhosis. Which of the choices below would be the best treatment options?
Chapter 11. Chronic Hepatitis C
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A. Advise to wait for newer therapies B. Treat with pegylated interferon-α and ribavirin for 24 weeks. C. Treat with sofosbuvir, ledipasvir and ribavirin for 12 weeks. D. List for liver transplant. E. Check IL28B status and if CC genotype, treat with 12 weeks of telaprevir, pegylated interferon and ribavirin. 3. Treatment is successful at clearing the virus and Jane achieves and SVR at 12 weeks. How would you follow this patient? A. Discharge from liver service B. Yearly repeat HCV RNA PCR to ensure clearance of virus C. Six-monthly ultrasound scan of liver with assessment of synthetic liver function D. Three-monthly alphafetoprotein (AFP) assessment E. Six-monthly LFTs and
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