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Thayer, FNP, BC
Gastro/Hepatology NP
James H. Quillen, VAMC
OBJECTIVES
PREVALENCE
IDENTIFY RISK FACTORS
TREATMENT OPTIONS
COMMON SIDE EFFECTS OF
ANTIVIRAL THERAPY
APPROPRIATE CODING
FACES OF THE DISEASE
PREVALENCE
NHANES IV (1999-2002)1
1.6% anti-HCV positive (95% CI 1.3-1.9%) =
4.1 million persons (95% CI 3.4-4.9 million)
1.3% chronic infection = 3.2 million persons
Peak prevalence age 40-49 (4.3%)
Three characteristics identified 85.1% all
infections: abnormal serum ALT, ever IVDU,
transfusion <1992
Most persons born 1945-1964
Armstrong GL, Wasley A, Simard E, et al. Ann Intern Med 2006; 144: 705-14.
TESTING FOR HCV AB
Recent/past injection drug Recipients of transfusion
userseven if only used or transplantation before
once July 1992
Groups with high HCV Children born to women
prevalence infected with HCV
HIV-infected individuals Healthcare, public safety,
and emergency medical
Hemophiliacs treated personnel following needle
with clotting factor injury or mucosal exposure
concentrates before to HCV-infected blood
1987
Current sexual partners of
Hemodialysis recipients individuals infected with
HCV
Patients with
unexplained Persons who have used
aminotransferase illicit drugs by noninjection
abnormalities routes
DIAGNOSIS
Positive Hepatitis C antibody-exposure
Positive Hepatitis C RNA (PCR)
RIBA
Generally asymptomatic
Acute Hepatitis C
PROGRESSION
ACUTE HEPATITIS C
15-40% will spontaneously resolve, generally
within the first 6-18 months after acute onset.
60-85% will progress to chronic infection
CHRONIC
85-90% stable
10-15% progress to cirrhosis
PROGRESSION
CIRRHOSIS
75% slowly progressive
25% progress to HCC
2-4% liver failure
HCC
Risk increases for every year for a patient
with chronic hepatitis C.
Patients without signs of cirrhosis can
develop HCC
PREDICTIONS BY 2019
193,000 HCV deaths
720,700 million years of advanced liver disease
1.83 million years of life lost
http://www.mayoclinic.org/meld/mayomo
del6.html
survival probability of a patient with end-
stage liver disease is estimated based
on the following variables.
INR, Bilirubin, Creatinine, on dialysis
twice per week
Score greater 11
GENOTYPES
Genotype 1
Treatment nave
Relapse, partial response, null responder
Genotype 2 & 3
Treatment nave, usually 24 weeks
Relapse, partial response, null response
Genotype 4
Treatment nave, 48 weeks
Relapse, partial response, null responder