Hepatitis C - Diagnosis and Management Summary
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Hepatitis C - Diagnosis and Management Summary

 • Screening: Screen high-risk patients (see below) and all patients born 1945-1965 (“Baby Boomers”)

 • Risk Factors: Blood products before 1992 or from infected individual, MSM, HIV, chronic HD, incarceration, immigration from high prevalence area, birth to HCV infected mother, sex with HCV partner

 • Diagnosis and Clinical Course: Most common cause of acute viral hepatitis (8% of all cases) (CDC). Onset is 9 weeks after initial infxn; fatigue, abdominal pain, jaundice. However, more commonly asymptomatic. Fulminant hepatic failure rare. 20% resolve acute infection; more likely to resolve spontaneously if female, acute sxs, G1 80% chronic infxnliver disease/periodic ALT elevations in 60-70% of those, 20% progress to cirrhosis, ~5% incidence of HCC, reduced to 1% with SVR 

 • Extrahepatic: Porphyria cutanea tarda, mixed cryo, MPGN, lichen planus, necrolytic acral erythema, Sjogren’s sxs, ITP

 • Treatment: Treat with ID and/or Hepatology input. Varies based on genotype (1-6), comorbidities (cirrhosis, CKD, HIV), Rx failures. DAAs x 12 weeks. Requires labs and assessment for fibrosis/cirrhosis. If acute infxn, wait 16 weeks to initiate Rx as pt may clear. Recheck HCV RNA 12 weeks after therapy to ensure SVR. See hcvguidelines.org

Seromarkers

 • HCV Ab reactive - Current infxn, past resolved infxn, or false +. Check HCV RNA

 • HCV Ab reactive, HCV RNA detected - Check HCV genotype and treat

 • HCV Ab reactive, HCV RNA not detected - Past exposure/treatment. No active infxn. (spontaneous clearance)



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