Hepatitis C

Hepatitis C

key features:

1. Hepatitis C virus is responsible for most cases of viral hepatitis in Australia. 
2. there are at least 6 major genotypes of HCV and treatment decisions are based n the genotype
3. Diagnosis and progress:
1. HCV Ab (Anti HCV) +ve = exposure (current or past)
2. HCV RNA + ve = chronic viraemia, -ve spontaneous clearance
3. HCV/CD4= Viral load
4. ALTs on LFTs indicate disease activity (tested 3 times over 6 months)
5. ALTs persistently normal = good prognosis
6. ALT increases = referral for treatment
7. If PCR +ve + significant viral load + ALT increases perform HCV genotype - determines treatment
4. current treatment is ribavirin orally daily and pegylated alpha-interferon. At present the determination of the genotype and the viral load will identify those groups most likely to respond to therapy. e.g. genotype 1 will have a good response, genotype 2 and 3 have excellent response
5. Patients with hepatitis c should be tested for hepatitis A and B 
6. They should avoid ETOH
7. Factors associated with faster disease progression include significant ETOH ingestion, co-infection with hepatitis B or HIV, age over 40 years at acquisition, marijuana use and obesity
8. Those at increased risk of having hepatitis c
1. Blood transfusion recipients (prior to HBV and HCV)
2. Intravenous drug users 
3. Male homosexuals who have practised unsafe sex
4. kidney dialysis patients
5. sex industry workers
6. those with abnormal LFTs with no obvious cause
7. Tattooed people/body piercing
9. Advice to those who are positive for HCV
1. Do not donate blood or any body organs or tissues
2. Do not share needles
3. Advise health care workers, including your dentist
4. Do not share intimate equipment such as tooth brushes, razors, nail files and nail scissors
5. Wipe up blood spills in the home with household bleach
6. Cover up cuts or wounds with an adequate dressing
7. Dispose of blood stained tissue, sanitary napkins and other dressings safely
8. Use safe sex practices such as condoms 
9. Avoid tattooing

References:

1. John Murtagh
2. http://www.racgp.org.au/afp/2013/july/hepatitis-c/