EXAM #2: HEPATITIS C

Question 1

What type of virus is HCV?

Answer 1

• Flaviviridae

- ssRNA

Question 2

Is Hepatitis C enveloped?

Answer 2

Yes

Question 3

Where is the highest incidence of HCV worldwide?

Answer 3

Egypt

Question 4

What populations is HCV most prevalent in?

Answer 4

1) IVDA
2) Incarcerated
3) HIV
4) Alcoholics
5) Homeless

Question 5

Why is snorting cocaine a risk factor for HCV infection?

Answer 5

• Nosebleeds are associated with cocaine use

- Breach in the mucosa

Question 6

In what age group is there the highest prevalence of HCV?

Answer 6

Baby-boomer (born before 1964)

Question 7

Are tattoo parlors and blood transfusions still considered risk factors for HCV infection?

Answer 7

No

• HCV education in tattoo parlors has lowered risk
• Screening has lowered risk for transfusion

Question 8

When is there a high risk of sexual transmission of HCV?

Answer 8

Woman with HCV and HIV

Monogamous HCV alone is considered low risk for sexual transmission

Question 9

What is unique about HCV and liver enzyme tests?

Answer 9

LTF levels fluctuate

*Patient may have normal ALT and HCV with cirrhosis

Question 10

What percent of patients with HCV will develop HCC per year?

Answer 10

4%

Question 11

What is the worst social behavior associated with HCV infection?

Answer 11

Alcoholism–this is “like throwing gasoline on a fire”

Question 12

What do you need to remember about HCV infection?

Answer 12

This is a SYSTEMIC disease that can have numerous extrahepatic manifestations

Question 13

Who needs to be screened for HCV?

Answer 13

Anyone born between 1940 and 1964

Question 14

How is HCV screened for?

Answer 14

1) HCV antibody screening

2) HCV-RNA confirmation

Question 15

What is the major determinant of HCV therapy/ success with treatment?

Answer 15

Genotype

Question 16

What genotype is most resistant to treatment?

Answer 16

Genotype 1 i.e. what is most prevalent in the US

Question 17

What is the primary goal of HCV therapy?

Answer 17

Eradicate HCV

Question 18

What is the most important secondary goal of HCV therapy?

Answer 18

Reduce HCC incidence

Question 19

What does “sustained viral respose” refer to?

Answer 19

Successful HCV

• Viral load drops
• This is NOT a cure b/c virus will still be detectable

Question 20

What is pegylated interferon?

Answer 20

• Interferon linked to a bulky inert molecule

- Decreases metabolism of interferon

Question 21

What are the adverse effects associated with Interferon?

Answer 21

Interferon is the same cytokine that kills the flu–it is what causes the sx of flu

Thus, the side effects resemble the flu

Question 22

What DAAs?

Answer 22

Direct anti-viral agents

Question 23

What is the standard of care of HCV infection now?

Answer 23

Harvoni–Sofosbuvir + Ledipasvir

Question 24

What is the MOA of Harvoni?

Answer 24

Inhibits HCV at 3 locations:

Question 25

What is the single most common reason for liver transplant?

Answer 25

HCV

Question 26

Outline the high points of the HCV timeline.

Answer 26

``` 1985= nothing known 1987= Chiron patents genome 2012= DAAs 2014= Sofosbavir ```