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.