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Source: Deming, P. Viral Hepatitis. In: DiPiro, JT, Talbert RL, Yee GC, Matzke GR, Wells BG, Posey LM. Pharmacotherapy: A Pathophysiologic Approach. 8th ed. http://accesspharmacy.com/content.aspx?aid=7979809. Accessed May 31, 2012.

  • Acute or chronic viral infection of liver

  • RNA virus, Flaviviridae family

  • Chronic infection develops in majority of cases.
    • Immune response insufficient to eradicate rapidly diversifying virus.
    • Infected hepatocytes undergo apoptosis.
      • Extent of hepatocyte apoptosis may correlate with extent of disease.
      • Liver damage and hepatocellular carcinoma (HCC) associated with high levels of apoptosis
      • Viral persistence associated with low levels of apoptosis

  • Most common blood-borne pathogen
  • Infection transmission routes
    • Parenterally
      • Injection-drug use
      • Other illicit-drug use
    • Sexual contact
      • Multiple sexual partners
      • Coinfection with sexually transmitted infections (STIs)
    • Household exposure
    • Occupational exposure

  • Screening recommended in high-risk groups (Table 1)
  • No vaccine available

Table 1. Recommendations for Hepatitis C Virus (HCV) Screening

  • Sexual contact
  • Injection-drug users
  • Household contact with HCV-positive person
  • Blood transfusion or transplant before 1992
  • Clotting factors administered before 1987
  • Chronic hemodialysis

  • Acute HCV infection
    • Most patients asymptomatic and undiagnosed.
    • Symptoms occur in one-third of adults 7 weeks after infection (range 3–12 weeks)
  • Chronic HCV infection
    • Defined as persistently detectable HCV RNA for 6 months or more.
    • Develops in majority of patients (85%).

Signs and Symptoms

  • Acute HCV infection
    • Fatigue
    • Anorexia
    • Weakness
    • Jaundice
    • Abdominal pain
    • Dark urine
    • Rarely progresses to fulminant hepatitis.
  • Chronic HCV infection
    • Persistent fatigue most common symptom.
    • Additional symptoms
      • Right upper quadrant pain
      • Nausea
      • Poor appetite
  • Physical exam
    • Hepatomegaly
    • Stigmata of liver disease in advanced disease
      • Spider nevi
      • Splenomegaly
      • Palmar erythema
      • Testicular atrophy
      • Caput medusae
    • Necroinflammatory disease on liver biopsy
      • Fibrosis
      • 20% develop cirrhosis
      • From cirrhosis, 50% progress to:
        • Decompensated cirrhosis
        • Hepatocellular carcinoma

Laboratory Tests

  • Hepatic transaminases
  • Reactive enzyme immunoassay for anti-HCV diagnostic for chronic HCV.
  • Quantitative HCV assay
  • Genotyping

Diagnostic Procedures

  • Liver biopsy

  • Eradication of HCV infection

  • Treatment indicated in patients with:
    • Previously untreated HCV who have chronic HCV
    • Circulating HCV RNA
    • Increased ALT levels
    • Evidence on biopsy of moderate to severe hepatic grade and stage
    • Compensated liver disease

  • Vaccinate patients with chronic HCV against hepatitides A and B.
  • Lifestyle changes
    • Stop alcohol consumption.
    • Maintain normal weight.
    • Stop smoking.
    • Stop illicit drugs.
  • Minimize prescription-drug use.

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