HCV

Questions and Answers

What is the percentage range of patients with HCV who develop persistent infection?

15-45%

20-30%

55-85% (correct)

40-55%

Which symptom is least likely to be associated with acute hepatitis C?

Fulminant hepatitis (correct)

Anorexia

Intermittent abdominal pain

Fatigue

What is the annual rate of hepatic decompensation in patients with established cirrhosis from HCV?

2-5% (correct)

1-2%

10-15%

5-10%

Which of the following is NOT a clinical manifestation of portal hypertension in chronic hepatitis C?

Low grade fever Signup and view all the answers

Which of the following statements about anti-HCV antibodies is correct?

They can be undetectable during early acute infection. Signup and view all the answers

What is the primary component of the HCV particle?

RNA genome Signup and view all the answers

Which extrahapatitic condition is most closely associated with chronic hepatitis C infection?

Lichen planus Signup and view all the answers

Which protein is NOT classified as a structural protein of HCV?

NS2 protein Signup and view all the answers

Which hepatitis C genotype is most prevalent in Egypt?

Genotype 4 Signup and view all the answers

Which statement about the clinical presentation of chronic hepatitis C is true?

Most patients are asymptomatic. Signup and view all the answers

What is the typical time frame for anti-HCV antibodies to become detectable post-exposure?

Within 8-10 weeks Signup and view all the answers

What is the method of HCV transmission that does NOT pose a risk?

Breastfeeding Signup and view all the answers

What is the typical incubation period for HCV infection?

2 to 12 weeks Signup and view all the answers

Which of the following proteins is responsible for the high level of virion turnover in HCV?

NS5B protein Signup and view all the answers

How does the innate immune response deal with HCV infection?

Through secretion of Type I and Type III interferons Signup and view all the answers

Which of the following statements about HCV is incorrect?

HCV can integrate into the host genome Signup and view all the answers

What is the significance of HCV RNA detection in patients with positive HCV antibodies?

It differentiates between ongoing and prior infections. Signup and view all the answers

Which statement accurately describes HCVcAg testing in the context of acute HCV infection?

It can identify patients with active infections. Signup and view all the answers

How long must HCV RNA be present in serum to diagnose chronic hepatitis C?

More than 6 months Signup and view all the answers

What is the role of pangenotypic regimens in the treatment of chronic hepatitis C?

They eliminate the need for HCV genotyping before treatment. Signup and view all the answers

Which patient population is recommended for routine HCV screening?

All individuals aged 18 years and older Signup and view all the answers

What characterizes occult HCV infection (OCI)?

It can be classified as seropositive or seronegative. Signup and view all the answers

What is the cure rate for the combination treatment of PEG-IFN alpha and ribavirin?

40% to 60% Signup and view all the answers

What is the priority in the management of acute hepatitis C?

Early treatment to prevent chronicity. Signup and view all the answers

Which of the following is a side effect associated with ribavirin treatment?

Hemolytic anemia Signup and view all the answers

What is the primary goal of treating chronic hepatitis C infection?

To halt inflammation and prevent liver related complications. Signup and view all the answers

What is the recommended duration of treatment with direct acting antivirals (DAAs) for HCV?

8 to 12 weeks Signup and view all the answers

What defines a sustained virological response (SVR) in HCV treatment?

Absence of HCV RNA in serum after 12 weeks post-treatment Signup and view all the answers

Which direct acting antiviral class includes drugs ending with the suffix '-previr'?

NS3/4 protease inhibitors Signup and view all the answers

What is the effect of ribavirin in patients with a creatinine clearance less than 50 ml/min?

Increased risk of adverse effects Signup and view all the answers

Which of the following combinations is recommended for genotype 1 and 4 HCV treatment?

Elbasvir / grazoprevir Signup and view all the answers

What is commonly associated with resistance to direct acting antivirals (DAAs) in HCV treatment?

Resistance-associated substitutions (RASs) Signup and view all the answers

Which treatment regimen is recommended for patients with decompensated cirrhosis?

Sofosbuvir-based regimens with ribavirin Signup and view all the answers

What is the recommended action for treating patients with HCV who also have hepatocellular carcinoma?

Delay treatment until 3-6 months post complete HCC treatment Signup and view all the answers

How should the treatment regimen be adjusted for patients whose prior DAA therapy has failed?

Switch to a regimen with unique mechanisms or prolong therapy Signup and view all the answers

What follow-up is recommended for noncirrhotic patients after achieving a sustained viral response (SVR)?

No specific follow-up is required Signup and view all the answers

For patients with renal impairment, what is true regarding the use of direct-acting antivirals (DAAs)?

No dose adjustments are needed for standard regimens Signup and view all the answers

What is the impact of the timing of DAA therapy before and after liver transplantation on cure rates?

It does not influence cure rates Signup and view all the answers

What is a common drug-drug interaction concern when using DAAs with calcineurin inhibitors?

Increased risk of calcineurin toxicity Signup and view all the answers

What is the recommended initial dose of ribavirin for patients with chronic kidney disease before increasing to the weight-based dose?

600 mg Signup and view all the answers

Study Notes

Hepatitis C Virus (HCV) Overview

HCV is a small, single-stranded positive-sense enveloped RNA virus from the Hepacivirus genus, within the Flaviviridae family.
HCV particles consist of an envelope (E1 and E2 glycoproteins), a lipid membrane, a nucleocapsid, and an RNA genome.
The RNA genome encodes a polyprotein (3010–3033 amino acids) cleaved into structural and non-structural proteins, including NS3 (protease/helicase) and NS5B (RNA-dependent RNA polymerase).
There are seven HCV genotypes; genotype 4 is the most prevalent in Egypt.
HCV has a high mutation rate due to NS5B RNA polymerase activity, leading to the presence of viral quasispecies.

Transmission and Incubation

Primary transmission routes include parenteral (IV drug use, blood transfusion), tattooing, sharing razors, acupuncture, and less commonly, sexual and perinatal transmission.
The incubation period for HCV is typically 2 to 12 weeks, with an average of 7 weeks.
Breastfeeding is not associated with HCV transmission.

Pathogenesis

HCV is not directly cytopathic to hepatocytes.
The immune response is pivotal in controlling the virus; failure leads to chronic infection.
Chronic infection can result in liver fibrosis, cirrhosis, and increased hepatocellular carcinoma (HCC) risk.

Histopathology

Key features include lymphoid aggregates in portal tracts and macrovesicular steatosis.
Acute and chronic hepatitis C morphologically resemble other forms of hepatitis.

Infection Outcomes

Only 15-45% of infected individuals achieve spontaneous viral clearance; 55-85% develop chronic hepatitis.
20-30% of chronic HCV patients may develop cirrhosis in 20-30 years.
Established cirrhosis carries a 2-5% annual risk of hepatic decompensation and 1-4% annual risk of HCC.

Clinical Presentation

Acute Hepatitis C: Often asymptomatic; 25% may present with jaundice.
Chronic Hepatitis C: Symptoms are non-specific (fatigue, malaise, abdominal pain, etc.), accompanied by signs of portal hypertension and hepatic decompensation.

Diagnosis

Diagnosis relies on serological markers, primarily detecting anti-HCV antibodies and HCV RNA.
Anti-HCV antibodies can exist without current infection and may not distinguish past from current infections.
HCV RNA is detectable within 2 weeks of exposure, critical for diagnosing active infections.
HCV genotyping assists in treatment planning; baseline NS5A RAS testing is required for genotype 3.
Imaging and liver biopsy can assess disease severity.

Prevention

No vaccine exists; screening is crucial for early intervention.
Routine one-time testing recommended for all individuals aged 18 and older, with prenatal screening encouraged.

Treatment

Acute HCV: Direct-acting antivirals (DAAs) are prescribed immediately upon diagnosis to prevent chronic progression.
Chronic HCV: Treatment aims to eradicate the virus, with DAAs providing curative rates of 90-97% over 8-12 weeks, significantly reducing complications.
Traditional therapies (PEG-IFN and ribavirin) offer lower success rates (40-60%) and more side effects.

DAA Classes

DAAs include NS3/4 protease inhibitors (names end in “-previr”), NS5A inhibitors (“-asvir”), and NS5B polymerase inhibitors (“-buvir”).
Resistance-associated substitutions (RASs) can occur with DAA exposure, impacting efficacy.

DAA Treatment Strategies

Treatment regimens vary based on patient conditions (compensated vs. decompensated cirrhosis).
Specific protocols exist for patients with HCC, renal impairment, or prior DAA treatment failures.

Post-Treatment Assessment

HCV RNA should be measured 12 weeks post-therapy to confirm viral clearance (SVR).
Continued monitoring is recommended for patients with cirrhosis for potential HCC and varices.

Liver Transplantation

Referral for transplantation is advised for patients with decompensated cirrhosis.
Pre- and post-transplant treatment with DAAs is equally effective in achieving viral cure.

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Description

Test your knowledge on the structure and functions of HCV, a small, single-stranded RNA virus. This quiz covers vital components such as envelope proteins, genome structure, and protein encoding. Discover the intricacies of HCV and enhance your understanding of virology.

HCV