Internal Medicine

0521779407-09 CUNY1086/Karliner 0 521 77940 7 June 4, 2007 21:12

690 Hepatitis C

■advanced disease: small shrunken cirrhotic liver, collaterals sugges-

tive of portal hypertension

Liver Biopsy

■usually performed before therapy to assess severity of liver disease,

although not a prerequisite for treatment

■particularly useful in patients without clinical evidence of cirrho-

sis/advanced liver disease

■early disease: variable inflammation and stage 1–2 fibrosis

■advanced disease: stage 3 (bridging) fibrosis, stage 4 fibrosis (cirrho-

sis)

differential diagnosis

■HCV-specific lab tests will confirm HCV infection

■fatigue, malaise, other subjective Sx may be due to many causes (e.g.,

EBV infection, depression)

■chronic liver disease may result from alcohol, other infections(e.g.,

HBV), other disorders (e.g., hemochromatosis), or a

■combination of factors (e.g., HCV plus alcohol)

management

What to Do First

■assess severity of liver disease, candidacy for therapy

General Measures

■adjust or avoid potentially hepatotoxic medications

■assess for immunity to hepatitis A and B; immunize those without

protection

■history, physical, LFTs, consider liver biopsy, ultrasound to assess

liver disease

■check HCV genotype: predicts chance of successful therapy, defined

as sustained virological response (SVR); i.e., loss of circulating HCV

RNA by PCR or TMA assay 24 weeks after stopping therapy

➣1a, 1b: 70% of U.S. infections

➣2a, 2b, 3: 25% of U.S. infections

➣4 (Egypt and Middle East), 5 (Africa), and 6 (Vietnam) uncommon

specific therapy

■indicated for adult patients with chronic infection and liver injury,

but not with severe, decompensated liver disease