hepatitis%20c
HEPATITIS C

Hepatitis C can be transmitted through blood transfusions, organ transplants, percutaneous (especially IV drug use), sexual or perinatal route.

It has an incubation period of 14-180 days.

Goal of treatment is to prevent progression to chronic hepatitis C through antiviral treatment of acute hepatitis C. Also, it aims to prevent occurrence of liver-related complications through antiviral treatment of chronic hepatitis C.

Hepatitis%20c Management

General Care

  • Supportive care
    • Consider hospitalization if there is vomiting, dehydration, signs of hepatic decompensation
  • Evaluate for advanced fibrosis or other conditions that may hasten liver fibrosis (eg HBV and HIV infections, genotype 3, nonalcoholic fatty liver disease) to help guide treatment
    • Monitor for HCC with alpha-fetoprotein and liver ultrasound every 6 months in those with advanced fibrosis
  • Screen for other sexually-transmitted diseases in cases of sexually acquired hepatitis or if otherwise appropriate
  • Identify extrahepatic manifestations and treat comorbidities appropriately 
    • Test for HIV infection, past or current HBV infection and for hepatitis A virus immunity and search for other causes of liver comorbidities

Prevention

Primary Prevention

  • At present, there is no available vaccine for HCV
  • The prevention of HCV would depend on the reduction of the risk of exposure especially in patients in healthcare setting and those who are in a high-risk population (eg IV drug use and through sexual contact)
    • HCV RNA should be assessed at 6 or 12 months after SVR to monitor for HCV reinfection in the high-risk population
  • Recommended primary intervention:
    • Hand hygiene should include proper surgical hand preparation, hand washing and use of gloves
    • Appropriate and safe use of healthcare injection
    • Proper handling and disposal of sharp needles and other objects and waste
    • Comprehensive harm-reduction services should be provided to PWID including the use of sterile injecting equipments and treatment of dependence
    • Sterilization of equipments
    • All healthcare personnel should be trained
    • Donated blood should be tested for HBV, HCV, HIV and syphilis
    • Proper and consistent use of condoms should be promoted

Secondary and Tertiary Prevention

  • Recommendations for people who are infected with HCV:
    • Conduct an education and counseling program for patient care and treatment, including risk of reinfection and prevention of HCV transmission
    • Immunization with hepatitis A and B vaccines are recommended to prevent coinfection and provide protection to the liver
    • Early and appropriate medical management including use of antiviral therapy
    • Regular monitoring is the key to early diagnosis of chronic liver disease
      • Continue hepatocellular carcinoma surveillance every 6 months in patients with advanced fibrosis and cirrhosis as an SVR will only reduce but not remove the risk of hepatocellular carcinoma

Follow Up

  • Measure liver function tests and HCV RNA at end of therapy and 12 weeks later  
    • If HCV RNA is undetectable, sustained virologic response (SVR) has been achieved
      • Monitor patient for HCV recurrence  
    • If SVR is not achieved, consider retreatment for chronic HCV  
      • Monitor patient for disease progression: Assess patient every 6-12 months with CBC, liver function tests and INR; ultrasound surveillance with or without alpha-fetoprotein testing every 6 months for hepatocellular carcinoma
Digital Edition
Asia's trusted medical magazine for healthcare professionals. Get your MIMS Gastroenterology - Malaysia digital copy today!
Sign In To Download
Editor's Recommendations
Most Read Articles
4 days ago
While early-phase clinical trials may demonstrate substantial levels of overall response rates in patients with relapsed/refractory multiple myeloma (RRMM), high heterogeneity of evidence prevents the accurate assessment of clinical benefit before patient participation, reports a recent meta-analysis.
Elvira Manzano, 28 Mar 2021
The COVID-19 vaccine AZD1222 by AstraZeneca and the University of Oxford was 79 percent effective overall in preventing symptomatic infections – higher than observed in previous clinical trials of the vaccine – at the interim analysis of a US phase III trial.
4 days ago
The chances of a live birth following either fresh or frozen-thawed embryo transfer cycles cannot be predicted by endometrial thickness alone, according to a study.
01 Apr 2021
Migraine and headache are common ailments of people living in the modern era. Dr Jon Marshall of The Singapore Headache and Migraine Clinic shares his insights with Pearl Toh on how to manage migraine and headache using non-pharmaceutical strategies, with a focus on the manual medicine approach.