Questions and Answers
What is the percentage range of patients with HCV who develop persistent infection?
Which symptom is least likely to be associated with acute hepatitis C?
What is the annual rate of hepatic decompensation in patients with established cirrhosis from HCV?
Which of the following is NOT a clinical manifestation of portal hypertension in chronic hepatitis C?
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Which of the following statements about anti-HCV antibodies is correct?
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What is the primary component of the HCV particle?
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Which extrahapatitic condition is most closely associated with chronic hepatitis C infection?
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Which protein is NOT classified as a structural protein of HCV?
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Which hepatitis C genotype is most prevalent in Egypt?
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Which statement about the clinical presentation of chronic hepatitis C is true?
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What is the typical time frame for anti-HCV antibodies to become detectable post-exposure?
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What is the method of HCV transmission that does NOT pose a risk?
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What is the typical incubation period for HCV infection?
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Which of the following proteins is responsible for the high level of virion turnover in HCV?
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How does the innate immune response deal with HCV infection?
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Which of the following statements about HCV is incorrect?
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What is the significance of HCV RNA detection in patients with positive HCV antibodies?
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Which statement accurately describes HCVcAg testing in the context of acute HCV infection?
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How long must HCV RNA be present in serum to diagnose chronic hepatitis C?
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What is the role of pangenotypic regimens in the treatment of chronic hepatitis C?
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Which patient population is recommended for routine HCV screening?
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What characterizes occult HCV infection (OCI)?
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What is the cure rate for the combination treatment of PEG-IFN alpha and ribavirin?
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What is the priority in the management of acute hepatitis C?
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Which of the following is a side effect associated with ribavirin treatment?
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What is the primary goal of treating chronic hepatitis C infection?
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What is the recommended duration of treatment with direct acting antivirals (DAAs) for HCV?
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What defines a sustained virological response (SVR) in HCV treatment?
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Which direct acting antiviral class includes drugs ending with the suffix '-previr'?
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What is the effect of ribavirin in patients with a creatinine clearance less than 50 ml/min?
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Which of the following combinations is recommended for genotype 1 and 4 HCV treatment?
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What is commonly associated with resistance to direct acting antivirals (DAAs) in HCV treatment?
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Which treatment regimen is recommended for patients with decompensated cirrhosis?
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What is the recommended action for treating patients with HCV who also have hepatocellular carcinoma?
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How should the treatment regimen be adjusted for patients whose prior DAA therapy has failed?
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What follow-up is recommended for noncirrhotic patients after achieving a sustained viral response (SVR)?
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For patients with renal impairment, what is true regarding the use of direct-acting antivirals (DAAs)?
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What is the impact of the timing of DAA therapy before and after liver transplantation on cure rates?
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What is a common drug-drug interaction concern when using DAAs with calcineurin inhibitors?
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What is the recommended initial dose of ribavirin for patients with chronic kidney disease before increasing to the weight-based dose?
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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.