We'll move on to our next case.
A 37-year-old woman is seen in clinic after a
recent diagnosis of hepatitis C infection.
She has a history of injection
drug use 15 years ago.
She feels well and
takes no medications.
Vitals and physical exam are normal.
Lab studies show the following:
Her hepatitis C antibody is positive.
Her RNA, PCR is also positive
with 1.2 million copies.
She has a positive
hepatitis B surface antibody.
And her surface antigen and core
antibody are both negative.
What is the best next
step in management?
So let's go through
some key features here.
She has a known history of hepatitis C infection
from her exposure to intravenous drug use.
She has a positive hepatitis C
antibody and a positive viral load
which indicates that she
has an active infection.
She also has an isolated
positive hep B surface antibody.
We will talk about what that means.
So, let's talk now about hepatitis C.
Hepatitis C begins with
an acute infection.
A majority of patients will then go
on to develop chronic inflammation
and only a small proportion of patients
will develop spontaneous cure,
so this is in contrast to hepatitis B where
most patients develop spontaneous cure.
Then, after chronic inflammation, a small
minority will then go on to develop fibrosis
and eventually, cirrhosis of the liver.
After patients have developed
advanced fibrosis or cirrhosis,
they are then at risk for cancer of
the liver or hepatocellular cancer.
So hepatitis C is the most common
blood-borne infections in the United States.
You should remember to always screen
individuals born between 1945 and 1965.
And patients are usually asymptomatic
carriers of this infection.
So the treatment for hepatitis C has actually
evolved quite a bit in the last 10 years.
We now have new therapies
that are over 95% effective
in allowing treatment for all
individuals with hepatitis C.
The goal really is to stop disease
progression, prevent cirrhosis
and prevent the end-stage complications
that occur with cirrhosis.
The type of direct antiviral agents that we use
depends on the person's hepatitis C genotype.
One example that you may hear about is this
combination of sofosbuvir and ledipasvir.
So now let's return to our case.
Our 37-year-old woman with a known
hepatitis C infection from her IV drug use.
She has a positive antibody to hepatitis C and a
positive viral load which indicate an active infection.
And we review now her positive hepatitis B
surface antibody, because it's an isolation,
indicates that she has had prior
vaccine and immunity to hep B.
So, what is the best
next step in management?
We know that she has an active hepatitis C
infection, so she should be treated for hepatitis C.
You would first start with
checking her hepatitis C genotype
which will guide you in what
drugs to use for her treatment.
And as part of the screening, you
should obtain an abdominal ultrasound
or transient elastography
to screen for fibrosis.