Hepatitis C virus - Revision history

Aidan: /* Diagnosis */ added info about serology in Ontario

2022-09-15T13:36:29Z

Diagnosis: added info about serology in Ontario

@@ Line 90: / Line 90: @@
 **Viral RNA detectable 2 to 14 days after exposure
 *Anti-HCV antibodies appear to be lifelong but not protective against reinfection, so need to check RNA PCR to rule out reinfection
 ==Management==

Aidan at 14:59, 6 April 2022

2022-04-06T14:59:12Z

@@ Line 54: / Line 54: @@
 *Chronic infection progresses slowly and asymptomatically until they develop liver fibrosis, compensated cirrhosis, and finally decompensated cirrhosis
 **~20-25% progress to end-stage liver disease within 20 years
 ==Diagnosis==

Aidan: /* Diagnosis */

2021-03-30T15:17:47Z

Diagnosis

← Older revision		Revision as of 15:17, 30 March 2021
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	==Clinical Manifestations==		==Clinical Manifestations==

	*After exposure, ~~may~~ ~~clear~~ ~~infection,~~ ~~but~~ ~~70-80%~~ ~~become~~ ~~chronically~~ ~~infected~~		*After exposure, incubation period of [[Usual incubation period::5 to 12 weeks]]
			*Not all have symptoms of primary infection, but if they do they are typically non-specific fatigue and myalgias, and occasionally jaundice
⚫	*~~Progresses~~ slowly and asymptomatically until they develop liver fibrosis, compensated cirrhosis, ~~then~~ decompensated cirrhosis
			**Lasts 2 to 12 weeks
			*About 25% have spontaneous viral clearance within 6 to 12 months, with the rest progressing to chronic infection
		⚫	*Chronic infection progresses slowly and asymptomatically until they develop liver fibrosis, compensated cirrhosis, and finally decompensated cirrhosis
	**~20-25% progress to end-stage liver disease within 20 years		**~20-25% progress to end-stage liver disease within 20 years

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	*Screening with serology for anti-HCV antibodies followed by RNA PCR to confirm ongoing infection		*Screening with serology for anti-HCV antibodies followed by RNA PCR to confirm ongoing infection
	**The window period for serology is about 5 to 10 weeks before antibodies are detectable		**The window period for serology is about 5 to 10 weeks before antibodies are detectable
			**Viral RNA detectable 2 to 14 days after exposure
	*Anti-HCV antibodies appear to be lifelong but not protective against reinfection, so need to check RNA PCR to rule out reinfection		*Anti-HCV antibodies appear to be lifelong but not protective against reinfection, so need to check RNA PCR to rule out reinfection

Aidan: /* Initial Investigations */

2021-02-24T19:18:59Z

Initial Investigations

← Older revision		Revision as of 19:18, 24 February 2021
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	**May need resistance testing		**May need resistance testing
	**Genotype only actually matters for cirrhosis (since we can otherwise pick a pan-genotypic regimen)		**Genotype only actually matters for cirrhosis (since we can otherwise pick a pan-genotypic regimen)
	*Baseline bloodwork, including CBC, liver enzymes, liver function, and creatinine		*Baseline bloodwork, including CBC, liver enzymes (ALT, AST, ALP), liver function (bilirubin, INR, albumin), and creatinine
	*Serology to exclude HIV and HBV (HBsAg, anti-HBs, anti-HBc)		*Serology to exclude HIV and HBV (HBsAg, anti-HBs, anti-HBc)
	*Transferrin saturation to exclude [[hemochromatosis]]		*Transferrin saturation to exclude [[hemochromatosis]]

Aidan: /* Initial Investigations */

2021-02-24T19:18:28Z

Initial Investigations

← Older revision		Revision as of 19:18, 24 February 2021
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	**Genotype only actually matters for cirrhosis (since we can otherwise pick a pan-genotypic regimen)		**Genotype only actually matters for cirrhosis (since we can otherwise pick a pan-genotypic regimen)
	*Baseline bloodwork, including CBC, liver enzymes, liver function, and creatinine		*Baseline bloodwork, including CBC, liver enzymes, liver function, and creatinine
	*Serology to exclude HIV and HBV		*Serology to exclude HIV and HBV (HBsAg, anti-HBs, anti-HBc)
	*Transferrin saturation to exclude [[hemochromatosis~~]], and IgG levels to exclude [[autoimmune hepatitis~~]]		*Transferrin saturation to exclude [[hemochromatosis]]
			*IgG levels, which if elevated can be suggestive of [[cirrhosis]] or possibly [[autoimmune hepatitis]]
	*Baseline liver ultrasound		*Baseline liver ultrasound
	*If not clearly cirrhotic, assess liver fibrosis		*If not clearly cirrhotic, assess liver fibrosis

Aidan at 18:56, 10 September 2020

2020-09-10T18:56:02Z

← Older revision		Revision as of 18:56, 10 September 2020
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	**Harvoni 8 weeks if uncomplicated		**Harvoni 8 weeks if uncomplicated

	=== Treatment-Naive Patients Without Cirrhosis ===		====Treatment-Naive Patients Without Cirrhosis====
	{\| class="wikitable"		{\| class="wikitable"
	! rowspan="2" \|Regimen		! rowspan="2" \|Regimen
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	\|}		\|}

	=== Treatment-Naive Patients With Cirrhosis ===		====Treatment-Naive Patients With Cirrhosis====
	{\| class="wikitable"		{\| class="wikitable"
	! rowspan="2" \|Regimen		! rowspan="2" \|Regimen
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	\|}		\|}

	===Treatment-Experienced Patients===		====Treatment-Experienced Patients====

	*Changes the options, mostly longer courses of treatment		*Changes the options, mostly longer courses of treatment
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	*Counsel to avoid sharing products like needles or razors, safe sex, avoid alcohol		*Counsel to avoid sharing products like needles or razors, safe sex, avoid alcohol
	*Vaccinate for hepatitis A and B		*Vaccinate for [[hepatitis A]] and [[Hepatitis B virus\|B]]

	===Follow-Up===		===Follow-Up===

	*Need to confirm sustained virologic response (SVR)		*Need to confirm sustained virologic response (SVR), defined as negative PCR 12 weeks after completing therapy
			*If they have achieved SVR
			**In patients without cirrhosis, no specific follow-up is necessary
			**In patients with cirrhosis, they should have biannual HCC screening with ultrasound
			**Annual HCV RNA in patients with ongoing risk factors
			*If they have not achieved, then they should be evaluated for salvage therapy

	==Screening==		==Screening==

Aidan: /* Antivirals */

2020-09-10T18:50:18Z

Antivirals

Show changes

Aidan: /* Diagnosis */

2020-08-19T01:45:53Z

Diagnosis

← Older revision		Revision as of 01:45, 19 August 2020
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	*Screening with serology for anti-HCV antibodies followed by RNA PCR to confirm ongoing infection		*Screening with serology for anti-HCV antibodies followed by RNA PCR to confirm ongoing infection
	**The window period for serology is about 5 to 10 weeks before antibodies are detectable		**The window period for serology is about 5 to 10 weeks before antibodies are detectable
			*Anti-HCV antibodies appear to be lifelong but not protective against reinfection, so need to check RNA PCR to rule out reinfection

	==Management==		==Management==

Aidan at 15:20, 13 August 2020

2020-08-13T15:20:36Z

Show changes

Aidan: /* Antivirals */

2020-08-13T15:07:20Z

Antivirals

← Older revision		Revision as of 15:07, 13 August 2020
Line 83:		Line 83:

	*Include nonstructural 3/4A (NS3/4A) serine protease (-previr), the NS5B RNA dependent RNA polymerase (-buvir) and the NS5A protein (-asvir)		*Include nonstructural 3/4A (NS3/4A) serine protease (-previr), the NS5B RNA dependent RNA polymerase (-buvir) and the NS5A protein (-asvir)
	*Assess drug-drug interactions with [[https://www.hepdruginteractions.org/\|www.hepdruginteractions.org]]		*Assess drug-drug interactions with [https://www.hepdruginteractions.org/ www.hepdruginteractions.org]
	**PPI and Epclusa/Harvoni		**PPI and Epclusa/Harvoni
	**Statins require dose reduction; atorvastatin and Maviret is no-no		**Statins require dose reduction; atorvastatin and Maviret is no-no