HCV
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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?

    <p>Low grade fever</p> Signup and view all the answers

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

    <p>They can be undetectable during early acute infection.</p> Signup and view all the answers

    What is the primary component of the HCV particle?

    <p>RNA genome</p> Signup and view all the answers

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

    <p>Lichen planus</p> Signup and view all the answers

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

    <p>NS2 protein</p> Signup and view all the answers

    Which hepatitis C genotype is most prevalent in Egypt?

    <p>Genotype 4</p> Signup and view all the answers

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

    <p>Most patients are asymptomatic.</p> Signup and view all the answers

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

    <p>Within 8-10 weeks</p> Signup and view all the answers

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

    <p>Breastfeeding</p> Signup and view all the answers

    What is the typical incubation period for HCV infection?

    <p>2 to 12 weeks</p> Signup and view all the answers

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

    <p>NS5B protein</p> Signup and view all the answers

    How does the innate immune response deal with HCV infection?

    <p>Through secretion of Type I and Type III interferons</p> Signup and view all the answers

    Which of the following statements about HCV is incorrect?

    <p>HCV can integrate into the host genome</p> Signup and view all the answers

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

    <p>It differentiates between ongoing and prior infections.</p> Signup and view all the answers

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

    <p>It can identify patients with active infections.</p> Signup and view all the answers

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

    <p>More than 6 months</p> Signup and view all the answers

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

    <p>They eliminate the need for HCV genotyping before treatment.</p> Signup and view all the answers

    Which patient population is recommended for routine HCV screening?

    <p>All individuals aged 18 years and older</p> Signup and view all the answers

    What characterizes occult HCV infection (OCI)?

    <p>It can be classified as seropositive or seronegative.</p> Signup and view all the answers

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

    <p>40% to 60%</p> Signup and view all the answers

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

    <p>Early treatment to prevent chronicity.</p> Signup and view all the answers

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

    <p>Hemolytic anemia</p> Signup and view all the answers

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

    <p>To halt inflammation and prevent liver related complications.</p> Signup and view all the answers

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

    <p>8 to 12 weeks</p> Signup and view all the answers

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

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

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

    <p>NS3/4 protease inhibitors</p> Signup and view all the answers

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

    <p>Increased risk of adverse effects</p> Signup and view all the answers

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

    <p>Elbasvir / grazoprevir</p> Signup and view all the answers

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

    <p>Resistance-associated substitutions (RASs)</p> Signup and view all the answers

    Which treatment regimen is recommended for patients with decompensated cirrhosis?

    <p>Sofosbuvir-based regimens with ribavirin</p> Signup and view all the answers

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

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

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

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

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

    <p>No specific follow-up is required</p> Signup and view all the answers

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

    <p>No dose adjustments are needed for standard regimens</p> Signup and view all the answers

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

    <p>It does not influence cure rates</p> Signup and view all the answers

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

    <p>Increased risk of calcineurin toxicity</p> 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?

    <p>600 mg</p> 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.

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