HCV
A+E (200M WW carriers)
HCV infection (ssRNA). 250,000 UK cases. 85% related to IVDU (50% IVDU incidence)
Carrier rates:
0.1% Europe, 3% S.Europe, 5% Africa, 20% Egypt (parenteral Schisto antimony Tx)
P+P
Pathology:
HIV Co-infection causes a rapid decline in condition. HIV +ve have 10% transmission risk
If mother infected in pregnancy transmission rate is 5% if not HIV +ve
Fibrotic risks:
♂, alcohol, DM, fatty liver (not viral load or genotype)
Transmission:
20% undetermined. Related to needles -  in haemophiliacs
IVDU + Blood:
Highly effective (85% related to IVDU)
Vertical:
Poorly effective. 5% if RNA +ve. 40% if HIV+ve
Sexual:
Rare (low rates in prosies / STD clinics but ↑ in HIV+ve + Homos
Genotypes:
 UK Genotypes 1 + 3. 90% asymptomatic pts develop chronic liver disease.
Prognosis:
50% symptomatic pts clear the virus
30% develop cirrhosis in 10 – 30Y
15% develop HCC
Complications: Arthritis, GN + porphyria Cutanea Tarda (PCT)
IRIS:
When HIV + HCV +ve IRIS occurs
S+S
Asymptomatic(90%):
Fatigue:
Anorexia:
Complications:
PCT:
Acute infections asymptomatic. 10% have mild flu like illness + jaundice
Weight ↓ + N which doesn’t correlate with disease activity
Joint pain + oedema etc
Photosensitive blister eruption with hyperpigmentation + hypertrichosis (esp. malar)
Iϕ
Hx:
LFTs:
HCV Serology:
HCV RNA:
Liver biopsy:
CATOPTAN + WANDPUBSTIMI + A NIMS GROVA PT + IBDIFMAG
Bad at predicting disease severity
Anti HCV Ab detected from 3M post infection with ELISA +/or RIBA-2(Recombinant
immunoblot assay)
Mild (no scarring yet occurred), Moderate (mild fibrosis has occurred), severe (bridging
fibrosis occurs connecting areas of fibrosis)
Tx
Peg IFN A2a:
Ribavirin:
General:
Pegylated cytokine with a range of activities to ↑ immune response to virally infected
cells eg ↑ MHC I + II expression + activate NK cells. Dose depends on formulation
Pegasys™ at 180microg SC Once/W
400mg PO OD, 600mg PO ON (depending on preparation)
↓ HCC rates. Success rate depends on genotype;
1 + 4 = 48W success 50%, 2-3 + 24W success rate. 75%
TxSE
All:
Peg IFN Alpha:
Ribavirin:
Not well tolerated or particularly effective. HIV + HCV responds less well to Tx
Flu like S+S(50%) varying from mild to severe.  ↓ with repeat injections
Dose dependent haemolytic anaemia, Teratogenic (up to 6M as stays in RBCs),
headache, irritability + mood change