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ACUTE HEPATITIS C

ACUTE HEPATITIS C. Curtis Barry, MD ECHO December 30, 2016. Disclosure Statement. I have no potential conflicts of interests to report. Case. 43 year old female presents to ED with jaundice Sent from Spectrum Recent IVDU, sharing needles with BF who was recently diagnosed with HCV

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ACUTE HEPATITIS C

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  1. ACUTE HEPATITIS C Curtis Barry, MD ECHO December 30, 2016

  2. Disclosure Statement I have no potential conflicts of interests to report

  3. Case • 43 year old female presents to ED with jaundice • Sent from Spectrum • Recent IVDU, sharing needles with BF who was recently diagnosed with HCV • TB-9.4, ALT-807, AST-795, alk phos-102 • US normal • HCV ab positive and HCV RNA 434,699 IU/ml

  4. Acute HCV • Acute HCV- defined as presenting within 6 months of exposure

  5. LABS • 1. + HCV RNA with negative HCV ab test (seronegative “window” period) • 2. + HCV ab test after prior negative (termed seroconversion) in appropriate setting

  6. From AASLD HCV guidelines 2016

  7. ? Postexposure prophylaxis • No data on efficacy or cost-effectiveness of antiviral therapy pre or postexposure prophylaxis of HCV • Older studies showed postexposure tx with interferon regimens did not prevent infection

  8. ? Treatment • In interferon era there was data to suggest tx of acute hcv (particularly genotype 1) was superior to waiting • ?emerging data for treatment of acute HCV with shortened course of DAA regimens in HCV mono and HCV/HIV. Not enough data to support regimen or duration

  9. Monitoring • <1% chance of acute liver failure • Hepatic profile (TB, ALT, AST) and INR (in setting of elevated TB) every 2-4 weeks until ALT normalizes and HCV RNA repeatedly undetectable suggesting spontaneous resolution

  10. Predictors of Spontaneous Clearance • Jaundice • Elevated ALT • Female • Younger age • HCV genotype 1

  11. Counseling • Addiction specialist if related to substance use • Risk of transmission thought to be higher in acute phase. Consider using barrier precautions even in stable monogamous relationships

  12. Recommendation • Monitoring for spontaneous clearance for minimum of 6 months before initial treatment is recommended.

  13. Case • Admitted to hospital • INR1.1 and LFTs trending down. Discharged back to rehab • Canceled 1st follow-up visit • Present to clinic (4 months after initial presentation)

  14. Had completed rehab and living in sober house • ALT normal and HCV RNA undetectable

  15. QUESTIONS?

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