• Chronic vs. Acute HCV infection
  • liver tests elevated for at least 6 months = chronic HCV
  • HCV Ab negative for the first 4-6 weeks of infection, then becomes positive
  • HCV RNA typically detectable in the first 2 weeks of infection
  
  

  Posted 07/20/16 09:18:54 AM by Anna Krigel

• Patterns seen on liver biopsy
  • Chornic HCV = periportal lymphocytic infiltration
  • Autoimmune hepatitis = portal fibrosis with plasma cell infiltrate
  • ETOH and NASH = central/perisinusoidal injury
  
  

  Posted 07/20/16 09:55:53 AM by Anna Krigel

• IL28B genotype testing
  • SNP that codes for interferon lambda 3
  • predictive of response to interferon-based therapy
    • CC genotype associated with favorable response to treatment with pegylated interferon and ribravirin
    • CT or TT genotypes predict failure to achieve SVR
  • IL28B genotype has also been shown to be predictive of spontaneous clearance of HCV after acute infection
  
  

  Posted 07/20/16 10:04:47 AM by Anna Krigel

• Acute HCV infection
  • majority of patients are asymptomatic
  • symptomatic patients may present with jaundice, nausea, dark urine, and RUQ pain
  • often present with aminotransferases elevated 10 to 20 times above the upper limit of normal
  • recent studies estimate rates of spontaneous clearance of infection at 50% (typically occurs within 12 weeks)
  • newer, direct-acting antiviral regimens have not yet been studied for the treatment of acute HCV
  • risk of waiting to treat the infection until viremia becomes chronic is now minimal with newer agents
  
  

  Posted 07/20/16 10:26:58 AM by Anna Krigel

• For further reading...

  AASLD and IDSA guidelines for diagnosis and management of HCV infection
  Sofosbuvir and Velpatasvir for HCV Genotype 1, 2, 4, 5, and 6 Infection
  
  

  Posted 07/20/16 10:28:21 AM by Anna Krigel

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