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Hepatitis C Clinical Guidelines of Management

Dr. Haseeb Noor


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INTRODUCTION

HEPATITIS C VIRUS IS A RNA VIRUS OF THE FLAVIVIRIDAE FAMILY 6 HCV GENOTYPE AND MORE THAN 50 SUBTYPE. THE EXTENSIVE GENETIC HETEROGENICITY OF HCV, PERHAPS EXPLAINS DIFFICULTIES IN VACCINE DEVELOPMENT AND THE LACK OF RESPONSE TO THERAPY.
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EPIDEMIOLOGY PAKISTAN

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No nation wide data Healthy blood donors screening data. Hafizabad Study Population 12500 Houses selected 504 Serum sample 313 HCV antibody 6%

SpreadParenteral

Body Fluids -Blood :- Screening- 1991. Needling :- injections,infusions Pricks:-Ears,tattooing,acupuncture, neurological exam and docus. Cuts:Surgeons,dentists,barbers,manicur e, *vertical transmission
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NATURAL HISTORY

VARIABLE

DEPENDS UPON SEVETITYY OF DIEASE. ASSOCIATED CO MORBIDS (CONCOMIITTANT HBV,ALCOHOL,HIV,

MALE SEX,IRON AND FAT INFILTRATION IN LIVER,GENOTYPE OF HCV,DRUGS)


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ACUTE HEPATITIS C

POST EXPOSERHCV RNA DETECTED IN BLOOD IN 1-3 WEEKS HCV ANTIBODY INITAILLY 50 70 %,IN 3

MONTH POSITIVE IN 90 %. ALT INCREASE IN 2-8 WEEKS NON SPECIFIC/ASYMPTOMATIC NEEDLE PRICK 2-10% (FOR HBV AND HIV IT IS 1/250)
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CHRONIC HEPATITIS C

ELEVATED ALT / +VE HCV RNA IN BLOOD FOR MORE THAN 6 MONTHS 8O % OF ACUTE HEPATITIS C PROGRESS TO CHRONIC HEPATITIS FACTOR ASSOCIATED WITH EARLY CLEARENCE ( FEMALE SEX, YOUNG AGE, CERTAIN MAJOR HLA COMPLEX GENES.)

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CHRONIC HEPATITIS C SEQULAE

CAH---PROGRESSIVE LIVER FIBROSIS --CIRRHOSIS---ESLD---HCC INITIAL INFECTION 20 YEARS --CIRRHOSIS.

IN USA
DEATH ASSOCIATED HCV=4000 ESDL/HCC TREATMENT OF ESLD IS LIVER TRANSPLANTATION
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ALANINE TRANSAMINASE ALT (SGPT)


ASSESSING disease activity poor ASSOCIATION B/W degree OF ALT ELEVATION AND severity OF THE DISEASE ON LIVER BIOPSY GOOD FOR monitoring response TO TREATMENT. USUALLALY normal IN cirhosis AND ESLD,BUT ELEVATED IN HCC
SADIK
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2002
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HCV RNA BY POLYMERASE CHAIN REACTION


ALL HCV ANTIBODY +VE , SHOULD CONFIRMED WITH HCV RNA. Qualitative ASSAY CAN DETECT AS LOW AS 50 COPIES/ML Single positive assay CONFIRMs THE replication but single ve assay doesnt rule out the patient as being viremic quantitative ASSAY (VIRAL LOAD) PROVIDE INFORMATION IN ASSESING responseTO TREATMENT
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LIVER BIOPSY

Iinfo regarding inflammation(grade) and fibrosis(stage)

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HBV SEROLOGY

OTHER LABORATORY TESTS

FERRITIN LEVEL AND % SATURATION OF TRANSFERRIN ULTRASOUND ABDOMEN PROTHROMBIN TIME,T.BILIRUBIN, S.ALBUMIN.

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INDICATION OF TREATMENT

PREVIUOSLY untreated PATIENTS WITH NO CONTAINDICATION(NAVE) PATIENTS WITH HCV & HIV Relapse CASE OF INTERFERONE MONOTHERAPY Non responsive TO IFN MONOTHERAPY

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TREATMENT

STANDARD TREATMENT :-INTERFERON ALPHA 2a & 2b 3 MILLION UNITS SQ THRICE A WEEK PLUS RIBAVIRIN 800-1200 mg/day DURATION 48 WEEKS IN GENOTYPE 1,4,5&6 24 WEEKS FOR OTHER ,SPECIALLY GENOTYPE 2&3 RESPONSE
SVR = 60-66 % FOR GENOTYPE 2 & 3 SVR = 27-33 % FOR GENOTYPE 1
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TREATMENT

PEGYLATED INTERFERON HIGHEST RESPONSE RATE WITH PEGINTERFERON IN COMBINATION WITH RIBAVIRIN GENOTYPE 2 & 3 76- 82 % GENOTYPE 1 (48 WEEKS) 42- 46%

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PREVENTION

SAFE SEX USE OWN SHAVING/HAIR DRESSING KIT. AVOID SHARING OF COMMON HOUSE ITEMS (RAZORS,TOOTHBRUSH) AVOID BODY PIERCING AND TATOOING

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Conclusion

Hepatitis C Black Jaundice is the AIDS of the Third World and only effective treatment is Prevention.

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