Causes of Acute Hepatitis Viral Hepatitis A BD
Causes of Acute Hepatitis Viral Hepatitis A, B/D, C, E EBV CMV & HSV Drugs Ethanol Tylenol Halothane Toxins Jamaica Bush Tea Mushrooms Vascular Hypotension Budd-Chiari Autoimmune Hepatitis Metabolic Wilson's Disease A 1 AT
Causes of Chronic Hepatitis Viral Hepatitis Hep B Hep C Drugs MTX INH Amiodarone Alcohol NAFLD Autoimmune AIH PBC PSC Metabolic A 1 AT HHC Wilson's Abbreviations: NAFLD: nonalcoholic fatty liver disease; AIH: autoimmune hepatitis; PBC: primary biliary cirrhosis mary sclerosing cholangitis, A 1 AT: alpha-1 antitrypsin deficiency, HHC: hereditary hemochromotosis
Symptoms, or Lack of, in Chronic HCV Infection 100 Patients (%) Cirrhosis 7% Symptomatic 37% 80 80 60 40 20 0 56% Asymptomatic Fatigue
Patients* With HCV infection (%) ALT Elevations Are Not Indicative of Chronic HCV Infection 100 80 60 42 43 40 15 20 0 Persistently Normal ALT Intermittently Elevated ALT Persistently Elevated ALT Inglesby TV, et al. Hepatology. 1999; 29: 590 -596.
Diagnostic Tests for HCV Infection Diagnostic Test Type Serologic Virologic Antibodies Virus > 95% > 98% Variable > 98% Specifications Mode of detection Sensitivity Specificity Detection 2 -6 mos 2 -6 wks postexposure Use CDC Morbidity Mortality Weekly Report. 1998; 16(RR-19): 1 -33. Screening NIH Confirmation Management of Hepatitis C Consensus Conference Statement. June 10 -12, 2002. Available at: http: //consensus. nih. gov/2002 Hepatitis. C 2002116 html. Accessed April 10, 2007.
Clinical Significance of HCV Genotypes Great genetic diversity: 2 genotypes (1 through 6) • Multiple subtypes: a, b, c, etc – Genotype is best pretreatment predictor of response • Genotype 1: least responsive to therapy – Determines dose and duration of therapy • Genotype 1: 48 weeks of peg-IFN alfa + RBV 1000 -1200 – mg Genotype 2/3: 24 weeks of peg-IFN alfa + RBV 800 mg – All patients should have genotype determined prior to • initiating therapy Choo QL, et al. Science. 1989; 244: 359 -62. NIH Consensus Development Conference Statement. Bethesda, Md: National Institutes of Health; June 10 -12, 2002. Hadziyannis SJ. Ann Intern Med. 2004; 140: 346 -355.
Prevalence of HCV Dependant on Risk Factors Hemophilia 74 -90% • IVDA 72 -89% • Prison 40% • HIV 30 -40% • Blood transfusion prior to 90 5 -9% • Infants to HCV+ Mothers 5% • Sexual Partner 0. 5 -3% • % General Population 1. 8 • Adapted from MMWR. 1998; 47: 5.
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