Hepatitis C

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Infection with HCV causes acute and chronic hepatitis.

HCV can also cause extra-hepatic diseases.

 

Transmission

Transmission- direct contact with blood and blood products (after needle stick injuries (3%).

Mother to child during delivery (<5%)

Transplanted organ

Sexual transmission can occur but plays a minor role.

Incubation period

Incubation period- 1 to 2 months.

 

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Clinical features

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Asymptomatic infection is common in infants and children.

Acute infection

Acute infection occur in 25% of patients infected with hepatitis C virus.

The common symptoms are nausea and abdominal discomfort.

Jaundice

Skin rash and arthralgia

Significant number of symptomatic patients may clear the virus (20-50%) permanently.

 

Chronic infection

Most patient with hepatitis C virus infection progress to chronic infection.

Some prospective studies have shown that infants and children are more likely to clear the virus.

Most patients remain asymptomatic for several years.

Some may present with chronic liver disease

Ø      Arthritis

Ø      Urticaria

Ø      Skin rash

Ø      Jaundice

Ø      Hepatomegaly

Ø      Splenomegaly

 

Other complications include

ü      Glomerulonepheritis

ü      Cryoglobulinemia

ü      Cirrhosis

ü      Hepatocellular carcinoma

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 Investigation

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LFT- increase transaminase level

 

Diagnostic test

Serum- Hepatitis C antibody

EDTA blood  should be send HCV RNA PCR for patients with cryoglobulinemia as the HCV antibody test could be false negative.

All HCV antibody positive patient should be tested for HCV RNA by PCR to determine the status.

 

Hepatitis C

 

Current infection                         +                                    +

 

Screening

Serum should be send for HCV antibody

HCV antibody screening should be carried out for patients

         -before transplants

         -before dialysis

         -patients with history of intravenous drug use

         -healthcare worker (carrying out exposure prone procedures)

         - and after needle stick injury

All transfusing centre in the UK uses HCV RNA PCR testing for screening of all blood and blood products before transfusion.

 

HCV Qualitative PCR are used for testing patients

 -after needle stick injury at 3 and 6 months

 -infants borne to HCV infected mother at 3 and 6 months

 

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Management

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Acute infection- conservative

Interferon monotherapy may be used to treat patient with acute HCV infection. Some experts may advise delaying therapy for 6-9 month after acquiring infection.

 

Chronic infection

Patient with moderate and severe liver disease should be treated with Ribavirin and Pegylated interferon.

Treatment for HCV genotype 2 and 3 can be started even if the liver disease is mild as the response rate is high.

Transplant is the other method of managing patients with decompensted liver cirrhosis however recurrent infection with hepatitis C virus is high.

 Management of HCV infected patients (PDF)

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Prevention

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Screening before transplant and transfusion can prevent transmission.

There is no vaccine or post exposure prophylaxis.

 

 

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