HCV Training
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Disease Awareness Detailer: Fatigue, pruritus, jaundice, nausea, right upper-quadrant pain Hepatocellular Carcinoma (HCC) Hepatitis: inflammation of liver, body response to injury/pathogen (release of chemicals, swelling, redness) Chronic hepatitis: low level of inflammation, persistent, preceded by acute hepatitis (less than 6 months) Hep A: more acute, self-limiting, vaccine available Hep B: 5% progress to chronic, vaccine available Hep C: 85% progress to chronic, vaccine not available Hep D: satellite infection; propagate only in presence of Hep B Hep E: not common Chronic infection: typically no symptoms but may have fatigue Acute Infection: most have no discernible symptoms Raised ALT, 2-3x ULN ALT indicate underlying injury Advanced Chronic Infection (ESLD): portal hypertension, ascites, encephalopathy, gastrointestinal bleeding Transmission: IV drug use, transfusion, hemodialysis Asia: HCV prevalence 1-3% Middle East: Genotype 4 Mongolia: 11% Hepacivirus, RNA virus Hep B is DNA virus HCV is a positive sense, single stranded RNA virus
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HCV
Transcript of HCV Training
Disease Awareness Detailer:Fatigue, pruritus, jaundice, nausea, right upper-quadrant painHepatocellular Carcinoma (HCC)Hepatitis: inflammation of liver, body response to injury/pathogen (release of chemicals, swelling, redness)Chronic hepatitis: low level of inflammation, persistent, preceded by acute hepatitis (less than 6 months)Hep A: more acute, self-limiting, vaccine availableHep B: 5% progress to chronic, vaccine availableHep C: 85% progress to chronic, vaccine not availableHep D: satellite infection; propagate only in presence of Hep BHep E: not commonChronic infection: typically no symptoms but may have fatigueAcute Infection: most have no discernible symptomsRaised ALT, 2-3x ULNALT indicate underlying injuryAdvanced Chronic Infection (ESLD): portal hypertension, ascites, encephalopathy, gastrointestinal bleedingTransmission: IV drug use, transfusion, hemodialysisAsia: HCV prevalence 1-3%Middle East: Genotype 4Mongolia: 11%Hepacivirus, RNA virusHep B is DNA virusHCV is a positive sense, single stranded RNA virusNon-structural proteins (NS)NS5A-5B: replication complexNS3/4A: proteaseSerine protease inhibitor: previrNS5A polymerase inhibitor: pasvir, tasvirNS5B polymerase inhibitor: buvirNon-nucleoside analogs: less potent, prone to resistanceDaclatasvir: nucleoside analogSofosbuvir: nucleoside analogViekira: contraindicated in decompensated liver diseaseAnnual physical examination, attempted blood donationHepatocellular, cholestatic (bilirubin), mixed patternALT more specific than ASTCholestatic: Alkaline phosphatase, GGT Anti-HCV negative, HCV RNA positive: acute infection (antibodies not synthesized yet)Liver biopsyF0: no fibrosisF4: cirrhosis, nodulesFibroscan, Fibrotest/FibrosureFIbroscan: transient elastographyRVR: HCV RNA negative
