Question

The prevalence of Hepatitis C virus (HCV) infection is increasing throughout the world. Clinically, acute infections are infrequently recognized because most patients experience minimal symptoms or are often asymptomatic. However, the vast majority of HCV- infected individuals become chronically infected. Advanced Practice Nurses must be able to identify patients at risk for HCV.

a. Explain the pathophysiologic processes involved in this disorder and explain how this infection may go undetected for many years.

b. Describe the laboratory tests (including test results interpretation) used to diagnose and differentiate acute versus chronic infection. Include what tests are needed (and why) to manage a patient receiving treatment. Make sure to include the molecular and genotyping testing.

c. Using current pathophysiological knowledge regarding HCV, explain how the current treatments for this viral infection eliminate the infection. Include cure rates for the various treatment modalities.

Answer 1

a-Pathophysiology of Hepatitis C

HCV is a non-cytopathic virus ,when it enters the body,the liver cell and undergoes replication ,at the same time it cause tissue necrosis by different methods including immune mediated cytolysis in addition to various other phenomena such as hepatic steatosis ,oxidative stress and insulin resistance.

• Viruses cause inflammation of the liver.
• Microscopically spotted parenchymal cell degenration.
• Necrosis of hepatocytes.
• Causes diffuse lobular inflammatory reaction.
• Distruption of liver cell cords.
• Accumulation of macrophages near degenerating hepatocytes.

People with HCV infection commonly go without noticible symptoms for as many as 20-30 yeras.Those who are infected experinces no significant symptoms when they first acquire the infection,and then they can remain symptomless for years even while the infection is causing damage to their liver and other organs.They feel perfectly healthy until severe inflammation and scarring occurs.Even when tested in more than half of all infected people elevated enzymes or an abnormality in the liver only appears once serious damge has occured.

b-Clinical presentaion.

• `The incubation period varies from 15-150 days.
• Acute hepatitis - can be silent,especially in children and young adults.Symptoms may also vary from mild illness to ALF .Malise ,fatigue ,pruritis, ,headache,abdominal pain,arthalgias,nausea ,anorexia and fever are common but nonspecific symptoms.
• Chronic hepatitis.- Runs an indolent course,sometime for decades.Fatigue is a common symptom. The disesae may only become clinically apparent late in the natural coursse.
• Diganostic testing-
• Antibodies aganist HCV
• HCV RNA HCV GENOTYPE AND SUBTYPES
• LIVER BIOPSY.

c- HCV management depends on

• Readication of the virus.
• Decrease disease progression.
• Histologic improvement.
• Decreasse HCC frequency.

Acute infection.

• IFN ( standard or pegylated ) for 6 months has been assosiated with a high rate of sustained HCV RNA clearence

Chronic infection.

• In patients with genotype 1 tha standered of care is to use triple therapy including pIFN ,ribavirin,and a direct antiviral agent (DAA ) DAAs currently approved are boceprevir and telaprevir.

HCC develops in approximately 1% to 2% of patients per year.