Chronic Hepatitis C infection

Incidence

Age

Sex

Geography

Aetiology

Presentation History
- commonly asymptomatic
- some present with symptoms and signs of cirrhosis.

Investigations
- many present with incidental finding of mildly elevated transferases

LFTs

Serum anti-HCV and HCV RNA

Characterise HCV genotype in patients who are given treatment

Liver biopsy
- if treatment is being considered

Macro

Micro - variable - normal with some interface hepatitis - cirrhosis
- chronic inflammatory cell infiltrates comprising lymphocytes, plasma cells ± lymphoid follicles are present in the portal tracts
- there may be interface hepatitis, lobular change, focal lytic necrosis, apoptosis and local inflammation
- fatty change is commonly seen

Staging

Serum markers - many present on screening for HCV antibodies in e.g. blood donors
- Anti-HCV Ab in serum is diagnostic
- HCV RNA

Management
Medical
Indications for treatment
- chronic hepatitis on liver biopsy
- HCV RNA present in serum
- raised serum transferases for > 6 months
- cirrhosis is not a contraindication
- treatment is not indicated in pateints with normal transaminases

- aim is to eliminate HCV RNA from serum -> decreased liver damage, reduced likelihood of HCC

a-interferon
- 3M units 3 times weekly for 12 months
- lower dose than for HBV - hence fewer side-effects
- monitor serum transferases and HCV RNA for three months
- if aminotransferases remain abnormal and HCV RNA is stll present at three months, stop treatment

Ribavirin - in combination with interferon, shows an improvement in long-lerm response

Surgical
- OLT should be considered in patients with decompensated cirrhosis

Prognosis
- after 6 months of a-interferon therapy, 40-50% of patients will have normal aminotransferases
- of these, 50% will relapse after treatment stops
- hence 12 months of therapy is recommended

Good prognostic indicators
- short duration of disease
- absent/minimal cirrhosis
- low HCV RNA levels
- genotype 2 or 3 / little heterogeneity
- low hepatic iron stores
- young age

Complications - HCC

Hepatobiliary medicine

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Incidence
Age
Sex
Geography
Aetiology
Presentation	History - commonly asymptomatic - some present with symptoms and signs of cirrhosis.
Investigations	- many present with incidental finding of mildly elevated transferases LFTs Serum anti-HCV and HCV RNA Characterise HCV genotype in patients who are given treatment Liver biopsy - if treatment is being considered
Macro
Micro	- variable - normal with some interface hepatitis - cirrhosis - chronic inflammatory cell infiltrates comprising lymphocytes, plasma cells ± lymphoid follicles are present in the portal tracts - there may be interface hepatitis, lobular change, focal lytic necrosis, apoptosis and local inflammation - fatty change is commonly seen
Staging
Serum markers	- many present on screening for HCV antibodies in e.g. blood donors - Anti-HCV Ab in serum is diagnostic - HCV RNA
Management	Medical Indications for treatment - chronic hepatitis on liver biopsy - HCV RNA present in serum - raised serum transferases for > 6 months - cirrhosis is not a contraindication - treatment is not indicated in pateints with normal transaminases - aim is to eliminate HCV RNA from serum -> decreased liver damage, reduced likelihood of HCC a-interferon - 3M units 3 times weekly for 12 months - lower dose than for HBV - hence fewer side-effects - monitor serum transferases and HCV RNA for three months - if aminotransferases remain abnormal and HCV RNA is stll present at three months, stop treatment Ribavirin - in combination with interferon, shows an improvement in long-lerm response Surgical - OLT should be considered in patients with decompensated cirrhosis
Prognosis	- after 6 months of a-interferon therapy, 40-50% of patients will have normal aminotransferases - of these, 50% will relapse after treatment stops - hence 12 months of therapy is recommended Good prognostic indicators - short duration of disease - absent/minimal cirrhosis - low HCV RNA levels - genotype 2 or 3 / little heterogeneity - low hepatic iron stores - young age
Complications	- HCC