2024 08 VH-HIV C.pdf

‫دوره ﺗﺪرﻳﺒﻴﻪ ﻋﻦ‪) :‬اﻟﻮﻗﺎﻳﺔ ﻣﻦ‬ ‫اﻟﺘﻬﺎب اﻟﻜﺒﺪ اﻟﻔﺎﻳﺮوﺳﻲ وﻓﺎﻳﺮوس‬ ‫ﻧﻘﺺ اﻟﻤﻨﺎﻋﺔ ﻓﻲ ﻃﺐ اﻻﺳﻨﺎن(‬ ‫اﻟﻤﺪرب ‪ :‬د‪.‬ﺣﯿﺪر ھﺸﺎم ﻣﺤﻤﺪ‪ -‬ﻣﺪرب ﻣﻌﺘﻤﺪ‪ -‬ﻣﺪﯾﺮاﻟﻘﺴﻢ اﻟﻔﻨﻲ‪/‬‬ ‫م‪.‬اﻻﻣﺎم ﻋﻠﻲ )ع( اﻟﻌﺎم‪ /‬د‪.‬ص‪.‬ﺑﻐﺪاد اﻟﺮﺻﺎﻓﺔ‬ ‫اﻟﻔﺌﺔ اﻟﻤﺴﺘﮭﺪﻓﮫ‪ :‬اﻃﺒﺎء اﻻﺳﻨﺎن‬ ‫ﻋﻠﻰ ﻗﺎﻋﺔ...

‫دوره ﺗﺪرﻳﺒﻴﻪ ﻋﻦ‪) :‬اﻟﻮﻗﺎﻳﺔ ﻣﻦ‬ ‫اﻟﺘﻬﺎب اﻟﻜﺒﺪ اﻟﻔﺎﻳﺮوﺳﻲ وﻓﺎﻳﺮوس‬ ‫ﻧﻘﺺ اﻟﻤﻨﺎﻋﺔ ﻓﻲ ﻃﺐ اﻻﺳﻨﺎن(‬ ‫اﻟﻤﺪرب ‪ :‬د‪.‬ﺣﯿﺪر ھﺸﺎم ﻣﺤﻤﺪ‪ -‬ﻣﺪرب ﻣﻌﺘﻤﺪ‪ -‬ﻣﺪﯾﺮاﻟﻘﺴﻢ اﻟﻔﻨﻲ‪/‬‬ ‫م‪.‬اﻻﻣﺎم ﻋﻠﻲ )ع( اﻟﻌﺎم‪ /‬د‪.‬ص‪.‬ﺑﻐﺪاد اﻟﺮﺻﺎﻓﺔ‬ ‫اﻟﻔﺌﺔ اﻟﻤﺴﺘﮭﺪﻓﮫ‪ :‬اﻃﺒﺎء اﻻﺳﻨﺎن‬ ‫ﻋﻠﻰ ﻗﺎﻋﺔ ﻣﺴﺘﺸﻔﻰ اﺑﻦ رﺷﺪ اﻟﺘﺪرﯾﺒﻲ ‪٢٠٢٤ /٨ /٨-٤‬‬ ‫‪4-8 /8 /2024‬‬ ‫‪Dr.Haidar Husham - VH HIV‬‬ ‫‪1‬‬ Hepatitis C virus  Objectives of this module By the end of the module you should be able to : – Describe Hepatitis C virus clinical picture, epidemiology, mode of transmission, and prevention. 4-8 /8 /2024 Dr.Haidar Husham - VH HIV ٣  Hepatitis C Virus 4-8 /8 /2024 Dr.Haidar Husham - VH HIV 4  WESTERN FAR EAST/ASIA EUROPE EASTERN 60 M USA 9M MEDITERRANEAN 20M 4M SOUTH EAST ASIA 30 M AFRICA 32 M SOUTH AMERICA 10 M AUSTRALIA 0.2 M 170 Million Hepatitis C virus (HCV) carriers WHO, 1999 3-4 MM new cases / year 4-8 /8 /2024 Dr.Haidar Husham - VH HIV 5 4-8 /8 /2024 Dr.Haidar Husham - VH HIV 6  Hepatitis C Virus Genotypes 11( 6 major) with many subtypes and quasispecies The predominate genotype in Saudi is Genotype 4 (62.9% ) Europe & America Genotype 1 75 (24.8) % severe disease Genotype 2 = 10.8 (7.4) % Genotype 3 = 5.8 (5.9) % Genotype 1 & 4 Poor response to therapy 4-8 /8 /2024 Dr.Haidar Husham - VH HIV 7  Natural History of HCV Infection Exposure (Acute phase) 15% (15) 85% (85) HIV and Resolved Chronic Alcohol 80% (68) 20% (17) Stable Cirrhosis 75% (13) 25% (4) Slowly HCC Progressive Transplant Death MJ Semin Liver Dis 1995; 15: Management of Hepatitis C NIH Consensus Statement 1997; March 24-26:15(3). 4-8 /8 /2024 Dr.Haidar Husham - VH HIV 8 4-8 /8 /2024 Dr.Haidar Husham - VH HIV 9 HCV Counseling Other Transmission Issues HCV not spread by kissing, hugging, sneezing, coughing, food or water, sharing eating utensils or drinking glasses, or casual contact Do not exclude from work, school, play, child- care or other settings based on HCV infection status 4-8 /8 /2024 Dr.Haidar Husham - VH HIV 10  Features of Hepatitis C Virus Infection Incubation periodAverage 6-7 weeks Range 2-26 weeks Acute illness (jaundice) Mild (< (50% after 5 years Four times more common than HIV 4-8 /8 /2024 Dr.Haidar Husham - VH HIV 16  Occupational Transmission of HCV Average incidence 1.8% following needle stick from HCV-positive source – Associated with hollow-bore needles Prevalence 1-2% among health care workers – Lower than adults in the general population – 10 times lower than for HBV infection 4-8 /8 /2024 Dr.Haidar Husham - VH HIV 17  HCV Related to Health Care Procedures Recognized primarily in context of outbreaks – Chronic hemodialysis – Hospital inpatient setting – Private practice setting – Home therapy Unsafe injection practices – Reuse of syringes and needles – Contaminated multiple dose medication vials 4-8 /8 /2024 Dr.Haidar Husham - VH HIV 18  HCW to Patient Transmission of HCV Rare – In U.S., none related to performing invasive procedures Most appear related to HCW substance abuse – Reuse of needles or sharing narcotics used for self- injection No restrictions routinely recommended for HCV- infected HCWs 4-8 /8 /2024 Dr.Haidar Husham - VH HIV 19  Perinatal Transmission of HCV Transmission only from women HCV-RNA positive at delivery – Average rate of infection 6% – Higher (17%) if woman co-infected with HIV – Role of viral titer unclear No association with – Delivery method – Breastfeeding Infected infants do well – Severe hepatitis is rare 4-8 /8 /2024 Dr.Haidar Husham - VH HIV 20  Sexual Transmission of HCV Case-control, cross sectional studies – Infected partner, multiple partners, early sex, non-use of condoms, other STDs, sex with trauma, Partner studies – Low prevalence (1.5%) among long-term partners infections might be due to common percutaneous exposures (e.g., drug use), BUT – Male to female transmission more efficient more indicative of sexual transmission 4-8 /8 /2024 Dr.Haidar Husham - VH HIV 21  Household Transmission of HCV Rare but not absent Could occur through percutaneous/mucosal exposures to blood – Contaminated equipment used for home therapies IV therapy, injections – Theoretically through sharing of contaminated personal articles (razors, toothbrushes) 4-8 /8 /2024 Dr.Haidar Husham - VH HIV 22  Reduce or Eliminate Risks for Acquiring HCV Infection Screen and test donors Virus inactivation of plasma-derived products Risk-reduction counseling and services – Obtain history of high-risk drug and sex behaviors – Provide information on minimizing risky behavior, including referral to other services – Vaccinate against hepatitis A and/or hepatitis B Safe injection and infection control practices 4-8 /8 /2024 Dr.Haidar Husham - VH HIV 23  Reduce Risks for Disease Progression and Further Transmission Identify persons at risk for HCV and test to determine infection status – Routinely identify at risk persons through history, record review Provide HCV-positive persons – Medical evaluation and management – Counseling Prevent further liver damage Prevent transmission to others MMWR 1998;47 (No. RR-19) 4-8 /8 /2024 Dr.Haidar Husham - VH HIV 24  HCV Prevalence by Selected Groups United States Hemophilia Injecting drug users Hemodialysis STD clients Gen population adults Surgeons, PSWs Pregnant women Military personnel 0 10 20 30 40 50 60 70 80 90 Average Percent Anti-HCV Positive  Postexposure Management for HCV IG, antivirals not recommended for prophylaxis Follow-up after needlesticks, sharps, or mucosal exposures to HCV-positive blood – Test source for anti-HCV – Test worker if source anti-HCV positive Anti-HCV and ALT at baseline and 4-6 months later For earlier diagnosis, HCV RNA at 4-6 weeks – Confirm all anti-HCV results with RIBA Refer infected worker to specialist for medical evaluation and management 4-8 /8 /2024 Dr.Haidar Husham - VH HIV 26  THANK YOU for your attention 4-8 /8 /2024 Dr.Haidar Husham - VH HIV 27