Hepatitis C Infection with Case

00:01 We'll move on to our next case.

00:04 A 37-year-old woman is seen in clinic after a recent diagnosis of hepatitis C infection.

00:10 She has a history of injection drug use 15 years ago.

00:13 She feels well and takes no medications.

00:16 Vitals and physical exam are normal.

00:19 Lab studies show the following: Her hepatitis C antibody is positive.

00:23 Her RNA, PCR is also positive with 1.2 million copies.

00:29 She has a positive hepatitis B surface antibody.

00:33 And her surface antigen and core antibody are both negative.

00:37 What is the best next step in management? So let's go through some key features here.

00:43 She has a known history of hepatitis C infection from her exposure to intravenous drug use.

00:50 She has a positive hepatitis C antibody and a positive viral load which indicates that she has an active infection.

00:59 She also has an isolated positive hep B surface antibody.

01:04 We will talk about what that means.

01:08 So, let's talk now about hepatitis C.

01:12 Hepatitis C begins with an acute infection.

01:15 A majority of patients will then go on to develop chronic inflammation and only a small proportion of patients will develop spontaneous cure, so this is in contrast to hepatitis B where most patients develop spontaneous cure.

01:31 Then, after chronic inflammation, a small minority will then go on to develop fibrosis and eventually, cirrhosis of the liver.

01:39 After patients have developed advanced fibrosis or cirrhosis, they are then at risk for cancer of the liver or hepatocellular cancer.

01:50 So hepatitis C is the most common blood-borne infections in the United States.

01:55 You should remember to always screen individuals born between 1945 and 1965.

02:01 And patients are usually asymptomatic carriers of this infection.

02:08 So the treatment for hepatitis C has actually evolved quite a bit in the last 10 years.

02:13 We now have new therapies that are over 95% effective in allowing treatment for all individuals with hepatitis C.

02:22 The goal really is to stop disease progression, prevent cirrhosis and prevent the end-stage complications that occur with cirrhosis.

02:32 The type of direct antiviral agents that we use depends on the person's hepatitis C genotype.

02:40 One example that you may hear about is this combination of sofosbuvir and ledipasvir.

02:49 So now let's return to our case.

02:51 Our 37-year-old woman with a known hepatitis C infection from her IV drug use.

02:58 She has a positive antibody to hepatitis C and a positive viral load which indicate an active infection.

03:05 And we review now her positive hepatitis B surface antibody, because it's an isolation, indicates that she has had prior vaccine and immunity to hep B.

03:16 So, what is the best next step in management? We know that she has an active hepatitis C infection, so she should be treated for hepatitis C.

03:26 You would first start with checking her hepatitis C genotype which will guide you in what drugs to use for her treatment.

03:32 And as part of the screening, you should obtain an abdominal ultrasound or transient elastography to screen for fibrosis.