It's an a RNA virus. Incubation period:
These are the type of viral
in which you worry about chronicity.
40-80% of your cases, whenever you
have hepatitis c ocurring
and it going to chronicity,
what are you worried about?
back in the 70's and 80's was an
Since then, things have
subsided quite a bit.
And in pharmacology management,
you should definitely know about
hepatitis C, genotype 1.
You focus on genotype 1.
Because we can now treat
hepatitis C. Not just treat
cure a patient between 8-12 weeks
with genotype 1.
This is new information.
This is research that is now thrown into
and translating into
patients that are completely cured.
Some of the prognosis
you should know of,
the combination of the two without
Most common reason for liver
transplantation because of chronicity.
Your liver dies... 4 million cases still
in the U.S.
Alcohol abuse accelerates the disease
progression as you could imagine.
Transfusions prior to 1990.
At this point, we're good.
I mean to say we have enough check
You walk in and there is transfusion
that is required.
There is going to be a nurse
that is always there with you
to check things off.
to make sure that
you are not passing hepatitis c
into your patient.
Avid drug users, intranasal
High risk sexual behavior
Keep in mind with tattoos.
That you may then pass
on hepatitis c.
Acute disease usually asymptomatic.
At some point, they may
then show jaundice.
Incidental findings on routine
Meaning to say, the patient is seem
they might feel a little bit
of fatigue and such but
often times in clinical practice,
it's an incidental finding.
What about extra hepatic manifestations?
This, you want to know as being
Hepatitis B can also result in
cryoglobulinemia but hepatitis C
essential mixed cryoglobulinemia.
What does that mean to you?
Upon exposure to cold,
the immunoglobulins will then aggregiate
and causing more or less
throughout the entire body.
Porphyria cutanea tarda
could be an extra hepatic manifestation.
What does Porphyria cutanea tarda
mean to you?
Your focus should be on cutanea
And upon exposure to UV rays,
there will be blistering pain.
That you want to focus upon.
let's say that your patient
and you see a little bit of redness
in the front of your leg.
And then upon palpation
you feel it,
patient says: "Ow, stop hurting me, doc."
I'm sorry, I don't mean to do this but
what is this that you are causing?
Why is the patient feeling pain?
And what is the redness that you are
seeing on the sheen?
Or the anterior aspect of the leg.
There is a huge list in
dermatology for erethyma nodosum.
But keep in mind,
that whenever there is an infection,
many types including,
coccidioides immitis such as...
I mean the list is quite large.
You might find Erythema nodosum
already find this.
The redness in the front of the leg.
could be associated with B cell lymphoma
as could be Hepatitis C.
We have another graph here for
specifically hepatitis C.
With hepatitis c, you may or may
not find symptoms
and definitely not as complicated
as what we dealt with with hepatitis B.
And everything that I have broken
down for you in Hepatitis B,
in terms of the markers,
Know them well.
Know that table of interpretation.
That is money.
In every possible respect.
This is hepatitis c.
The graph here is the following:
It is an RNA virus.
What type of transaminase that you
will find elevated?
You focus on ALT,
And then Anti HCV kicks in.
Approximately six months later,
you're on your way to recovery.
As I told you earlier, new information
on your boards that you make sure
that you are familiar with, please
will be the interferon free therapy
that I am not going to cover here.
but with interferon free therapy with
drugs such as Sofosbuvir
Serologic Pattern of Acute
Hepatitis C infection
with recovery continues and this time
We have HCV. You'll notice then that
ALT can then flactuate
depending on as to whether
is on the road to recovery or not.
Diagnosis: Anti-HCV Antibody by ELISA
viral application is measured
by HCV. That is important.
The replication becomes important
because one of the objectives
that you will be using clinically,
is seeing what the right of the
sustained viral replication will be.
And obviously, the less that you find
the better of you and your practice and
the patient is going to be.
So, viral replication measured by
RNA by PCR testing
and indicates chronic infection.
ALT does not indicate degree of
liver damage but it is important for you to know.
ALT will tell you: "Oh, yes."
The patient may be suffering from
viral hepatitis but it will not
be translated into
the severity of.
And that is a discussion we had
many a time.
Liver biopsy used for staging.
Especially if you are worried about your
patients chronicity going into
Hepato cellular carcinoma.
Four major genotypes that you want to
be very responsible for.
We have Genotype 1, which is
the most important one
that you are paying attention to
on your boards.
USA and Europe, you are looking
at well, greater than 50%
Take a look at the Mediterranean population.
That is where
you will be for that.
Would be the Indian sub-continent
and that will be a major type
of hepatitis C.
And hepatitis C
in Egypt and North Africa.
In other words, the northern regions.
If you are thinking Egypt,
Libya and so on, and so forth.
and they will be genotype 4.
spend a little bit of time.
that you know what genotype
is dealing with which population.
And what the different genotypes
you focus upon the new management
therapy and regimen that we have
that we have for genotype 1, please.
What about the remainder,
well I'll give you a brief
overview for that coming up.
Management of Hepatitis C standard care.
is still pegylated interferon
for periods of almost 24-48 weeks.
So, you are looking close to a year of
Once again, let me mention here,
that you want to make sure that you find
The new information for genotype1.
Multiple side effects of limited
therapy is the following.
With interferon therapy,
this is what you are worried about:
fatigue, low grade fever,
to the point where now,
the patient might have a decrease
of RBC count
resulting in susceptibility to
or they might be bleeding involved-
Hair loss and hyperthyroidism
are also incredibly important
that you are worried about
So imagine if you are able to find
an alternate form of therapy,
where you might not need to give
You avoid all of this and you cure
If HCV goes into chronicity,
two major things that you
are worried about,
complete death of the liver-
And if cirrhosis has kicked in,
You need to make sure that you then,
check up for,
hepato cellular carcinoma.
What more you could know of that
perhaps indicate that your patient
has go on to a HCC.
Increase in? ( which marker please?)