This document provides information on managing hepatitis C in primary care. It discusses gaps in the hepatitis C care continuum, with up to 90-95% of individuals living with hepatitis C being unaware of their infection. Screening for hepatitis C is important for improving detection and treatment. The natural history of hepatitis C infection is described, showing how timely treatment can arrest disease progression and prevent death. Groups at risk for hepatitis C infection are identified. Guidelines for pre-treatment assessment and approved direct-acting antiviral treatment regimens are presented, along with considerations for special patient groups such as those with HIV, hepatitis B, or kidney disease coinfection. Monitoring during and after treatment is also covered.
This document discusses hepatitis C virus (HCV) and current treatment options. It provides the following key points:
- HCV is the most common blood-borne pathogen in the US, with around 3.2 million people chronically infected. Chronic infections often progress to cirrhosis over 20-30 years.
- New all-oral treatment regimens that do not require interferon are highly effective. Sofosbuvir-based combinations can achieve over 90% sustained virologic response rates.
- Treatment is now recommended for most patients with chronic HCV to prevent long-term complications like cirrhosis and liver cancer. However, costs remain very high, with prices over $80,000 for a
Hepatitis C is a global health problem affecting over 170 million people worldwide. It is transmitted through blood and body fluids. In Pakistan, studies have found hepatitis C in 18-60% of patients with liver disease. Major risk factors for hepatitis C in Pakistan include unsafe injections, which have been found to transmit hepatitis C due to widespread reusing of needles and syringes. Tattooing and body piercing have also been associated with hepatitis C transmission in Pakistan. Diagnosis involves testing for hepatitis C antibodies and RNA. Treatment involves pegylated interferon and ribavirin combination therapy. Prevention strategies in Pakistan should focus on needle exchange programs, education on safe injection practices, and ensuring access to sterile syringes.
A 45-year-old woman presented with fatigue, weakness, and loss of appetite. Laboratory tests found elevated liver enzymes and HCV RNA. A liver biopsy showed severe inflammation and fibrosis. She was diagnosed with chronic hepatitis C based on her history of blood transfusion, laboratory results, and biopsy findings. The best course of action would be to treat her hepatitis C with pegylated interferon and ribavirin therapy to reduce liver damage and prevent progression to cirrhosis.
Midterm Outcome Evaluation of Government-Led Endeavors to Eliminate Hepatitis C as a Public Health Threat by 2030 in Malaysia
Presentation Slides by Mr Chan Huan Keat, presented on the 14th National Conference for Clinical Research (NCCR) 2021 Dr Wu Lien Teh Youth Investigator Awards (YIA) on 19th August 2021
Following are the links for this presentation on Zenodo Repository:
Presentation Slides: https://zenodo.org/record/5348475
E-Poster: https://zenodo.org/record/5348564
Hepatitis C virus (HCV) was identified in the 1970s and can lead to chronic liver disease. Globally, an estimated 71 million people have chronic HCV infection. In India, the prevalence is estimated between 0.5-1.5% with genotype 3 being most common. HCV is transmitted through blood and blood products, unsafe medical injections, and from mother to child. Most infections become chronic, potentially leading to cirrhosis or liver cancer over time. Screening and treatment have advanced significantly in recent decades to help eliminate HCV transmission through blood and cure chronic infections.
1. The document discusses managing Hepatitis C infection in unique populations such as children, pregnant women, and those with comorbidities. It provides guidelines for testing, monitoring, and treatment of acute and chronic HCV infection in these groups.
2. Rates of mother-to-child transmission of HCV are approximately 5% but can be higher in women with HIV coinfection or higher viral loads. Children born to HCV-infected mothers should be tested after 18 months of age.
3. For children under 12, the only approved treatment is 24-48 weeks of pegylated interferon and ribavirin depending on genotype. For adolescents 12 and older, direct-acting antiviral regimens are
Chronic hepatits c guidelines for screening and treatment lisa glassSyed Ali
This document provides guidelines for screening and treatment of chronic hepatitis C virus (HCV) infection. It discusses the virology of HCV and epidemiology of infection in the United States. Risk-based screening was found to miss over 50% of cases, so birth-cohort screening for those born between 1945-1965 was recommended. New direct-acting antiviral regimens have high cure rates over 12 weeks for most genotypes and disease stages. Treatment is recommended for those with significant fibrosis to reduce complications of cirrhosis like liver failure and cancer.
This document discusses hepatitis C virus (HCV) and current treatment options. It provides the following key points:
- HCV is the most common blood-borne pathogen in the US, with around 3.2 million people chronically infected. Chronic infections often progress to cirrhosis over 20-30 years.
- New all-oral treatment regimens that do not require interferon are highly effective. Sofosbuvir-based combinations can achieve over 90% sustained virologic response rates.
- Treatment is now recommended for most patients with chronic HCV to prevent long-term complications like cirrhosis and liver cancer. However, costs remain very high, with prices over $80,000 for a
Hepatitis C is a global health problem affecting over 170 million people worldwide. It is transmitted through blood and body fluids. In Pakistan, studies have found hepatitis C in 18-60% of patients with liver disease. Major risk factors for hepatitis C in Pakistan include unsafe injections, which have been found to transmit hepatitis C due to widespread reusing of needles and syringes. Tattooing and body piercing have also been associated with hepatitis C transmission in Pakistan. Diagnosis involves testing for hepatitis C antibodies and RNA. Treatment involves pegylated interferon and ribavirin combination therapy. Prevention strategies in Pakistan should focus on needle exchange programs, education on safe injection practices, and ensuring access to sterile syringes.
A 45-year-old woman presented with fatigue, weakness, and loss of appetite. Laboratory tests found elevated liver enzymes and HCV RNA. A liver biopsy showed severe inflammation and fibrosis. She was diagnosed with chronic hepatitis C based on her history of blood transfusion, laboratory results, and biopsy findings. The best course of action would be to treat her hepatitis C with pegylated interferon and ribavirin therapy to reduce liver damage and prevent progression to cirrhosis.
Midterm Outcome Evaluation of Government-Led Endeavors to Eliminate Hepatitis C as a Public Health Threat by 2030 in Malaysia
Presentation Slides by Mr Chan Huan Keat, presented on the 14th National Conference for Clinical Research (NCCR) 2021 Dr Wu Lien Teh Youth Investigator Awards (YIA) on 19th August 2021
Following are the links for this presentation on Zenodo Repository:
Presentation Slides: https://zenodo.org/record/5348475
E-Poster: https://zenodo.org/record/5348564
Hepatitis C virus (HCV) was identified in the 1970s and can lead to chronic liver disease. Globally, an estimated 71 million people have chronic HCV infection. In India, the prevalence is estimated between 0.5-1.5% with genotype 3 being most common. HCV is transmitted through blood and blood products, unsafe medical injections, and from mother to child. Most infections become chronic, potentially leading to cirrhosis or liver cancer over time. Screening and treatment have advanced significantly in recent decades to help eliminate HCV transmission through blood and cure chronic infections.
1. The document discusses managing Hepatitis C infection in unique populations such as children, pregnant women, and those with comorbidities. It provides guidelines for testing, monitoring, and treatment of acute and chronic HCV infection in these groups.
2. Rates of mother-to-child transmission of HCV are approximately 5% but can be higher in women with HIV coinfection or higher viral loads. Children born to HCV-infected mothers should be tested after 18 months of age.
3. For children under 12, the only approved treatment is 24-48 weeks of pegylated interferon and ribavirin depending on genotype. For adolescents 12 and older, direct-acting antiviral regimens are
Chronic hepatits c guidelines for screening and treatment lisa glassSyed Ali
This document provides guidelines for screening and treatment of chronic hepatitis C virus (HCV) infection. It discusses the virology of HCV and epidemiology of infection in the United States. Risk-based screening was found to miss over 50% of cases, so birth-cohort screening for those born between 1945-1965 was recommended. New direct-acting antiviral regimens have high cure rates over 12 weeks for most genotypes and disease stages. Treatment is recommended for those with significant fibrosis to reduce complications of cirrhosis like liver failure and cancer.
This document provides information about hepatitis C virus (HCV) including its structure, genome, genotypes, epidemiology, transmission, pathogenesis, diagnosis, and management. It discusses:
- HCV has a single-stranded RNA genome within the Flaviviridae family. It exists as different genotypes that determine treatment response.
- HCV is a major cause of liver disease worldwide, with transmission primarily through blood exposure. Diagnosis involves antibody and RNA testing.
- Treatment aims to eradicate HCV and involves pegylated interferon and ribavirin combinations. Response is monitored via viral load decline. Adverse effects require monitoring and management. New direct-acting antivirals are improving treatment outcomes.
Best Practices in the Management of HCV/HIV Coinfection.Optimizing Treatment ...hivlifeinfo
This document discusses best practices for managing HCV/HIV coinfection. It begins with background on HCV/HIV coinfection epidemiology and the accelerated progression of liver disease in coinfected patients. It then reviews screening guidelines before discussing the challenges of current interferon-based HCV treatment and factors to consider in deciding whether to treat or defer therapy. The document summarizes recent studies on using telaprevir or boceprevir with pegylated interferon and ribavirin in coinfected patients. It concludes with recommendations on coadministering direct-acting antivirals with select antiretrovirals.
Hepatitis C is a global health problem that causes 700,000 deaths per year. In Bangladesh, 1% of the population has HCV. New guidelines recommend screening high-risk groups and treating with direct-acting antiviral drugs, which have cure rates over 90% and shorter treatment durations compared to previous interferon-based regimens. Proper treatment can prevent cirrhosis, liver cancer and death from HCV. While challenges remain, scientists hope to eliminate HCV globally by 2030 with new pan-genotypic drugs. Prevention through injection safety, screening blood products, and educating healthcare workers is also important to control the disease.
This meta-analysis evaluated the efficacy and safety of adding ribavirin (RBV) to Sofosbuvir/Velpatasvir (SOF/VEL) treatment for genotype 3 hepatitis C virus (HCV) compensated cirrhosis patients. The analysis included 7 studies and 1088 subjects, 506 received SOF/VEL+RBV and 582 received SOF/VEL. Sustained virologic response at 12 weeks (SVR12) was similar between those who received RBV and those who did not, indicating RBV provided no significant benefit. However, addition of RBV was associated with a higher risk of treatment-related adverse events. Therefore, routine addition of RBV to
CYPRESS COLLEGE DIVISION OF HEALTH SCIENCE HS 147 Hi.docxwhittemorelucilla
CYPRESS COLLEGE
DIVISION OF HEALTH SCIENCE
HS 147
Hints for writing your final disease report: (not in any order)
1. In your abstract, don't give a history of your disorder. Give the reader a
short synopsis of what the research is going to cover. Don’t forget “key
words”. Research papers are not a "friendly format”, don’t add personal
comments or opinions or slang. Assume this will be printed in a journal.
2. Use 12 point, Geneva style font (or similar) for your paper, with a 1”
margin on all sides.
3. Number your pages in the upper right corner. Your report will be about 7-9
pages not counting the cover page and reference page. Remember to
print the "word count" on cover page (1500 minimum).
4. Do not list or use bullets. Write in complete sentences and paragraphs.
5. Section headings help the reader. Remember to only double space,
even between headings or paragraphs.
6. Don't start a sentence with "according to......". Instead start with the
information and use an in-text citation at the end of the sentence or
paragraph.
7. If you start a sentence with a number, you must write out the number.
8. For your report remember, you are writing as a professional to another
professional and not to a patient or “lay person”. Do not explain things
that you would expect that the reader would already know.
9. Have someone else read your report before you turn it in for grammar,
spelling and punctuations.
10. Do not use a separate page for each section or heading (double space
only).
11. Include the website that the information was retrieved from, not the
search engine the school used (EBSCO). Use the APA format in your
syllabus.
Good luck!
June 15, 2015 ◆ Volume 91, Number 12 www.aafp.org/afp American Family Physician 835
Diagnosis and Management of Hepatitis C
THAD WILKINS, MD; MARIAM AKHTAR, MD; and EUNICE GITITU, MD, Georgia Regents University, Augusta, Georgia
CHRISTINE JALLURI, MD, and JASON RAMIREZ, MD, University of Maryland, Baltimore, Maryland
H
epatitis C virus (HCV) infec-
tion is a major cause of chronic
liver disease and cirrhosis.1
The World Health Organi-
zation reports that there are at least 185
million persons worldwide with the infec-
tion, causing 350,000 deaths annually.1 In
the United States, an estimated 2.7 mil-
lion individuals are chronically infected
with HCV.2 The burden of HCV infection
in the United States is expected to increase
because of the high proportion of persons
who were infected in the 1960s and 1970s.3
In 2013, the total cost of HCV infection in
the United States was estimated at $6.5 bil-
lion.4 Chronic HCV infection leads to sig-
nificantly more lost days of work, decreased
productivity, and increased health care
costs.5 This article focuses on chronic HCV
infection in adults and excludes special
groups, such as children, pregnant women,
transplant recipients, and persons coi.
The document discusses the prevention of hepatitis B and C infections in hemodialysis patients, noting that bloodborne virus transmission was recognized as a hazard in renal units in the 1960s. It recommends screening and surveillance of patients and staff, segregation and immunization of infected patients, implementation of universal precautions including hand hygiene and personal protective equipment, and disinfection of equipment to prevent the spread of hepatitis B and C viruses in hemodialysis settings.
Best Practices in the Management of HCV/HIV Coinfection: Optimizing Treatment...Hivlife Info
Jürgen K. Rockstroh, MD, provides an update on the importance of HCV screening and the latest emerging treatment options for patients with HCV/HIV coinfection.
The document discusses hepatitis C virus (HCV), including its structure, genome, genotypes, epidemiology, pathogenesis, diagnosis, and management. Some key points:
- HCV is a single-stranded RNA virus of the Flaviviridae family with a genome encoding both structural and nonstructural proteins.
- It exists as different genotypes globally, with genotypes 1, 2, 3 being most common. Genotype helps determine treatment duration and response.
- HCV is a major cause of liver disease worldwide and is transmitted through blood exposure. Diagnosis involves HCV antibody and RNA testing.
- Treatment aims to eradicate the virus and involves use of pegylated interferon and ribavirin
Hepatitis C is caused by the hepatitis C virus (HCV), which is a single-stranded RNA virus from the Flaviviridae family. It is transmitted through blood and bodily fluids. HCV replicates within liver cells and evades the immune system, leading to persistent infection in some cases. Symptoms are often mild or absent. Diagnosis involves testing for HCV antibodies or RNA. Treatment involves direct-acting antiviral drugs, which have high cure rates. Special populations like those with HIV/HCV coinfection, kidney disease, or other liver diseases may require modified treatment approaches.
This document summarizes information about hepatitis C in Ireland, including epidemiology, natural history, burden, treatment programs, and guidelines. Some key points:
- An estimated 20,000-30,000 people in Ireland have chronic hepatitis C infection, though about 60% are undiagnosed.
- Most infections are in people who inject drugs, though cases in men who have sex with men are increasing.
- A national hepatitis C treatment program was established in 2015 to treat all infected individuals over several phases, with a goal of eliminating hepatitis C in Ireland by 2026.
- National hepatitis C screening guidelines were developed using an evidence-based process and are due to be launched in July 2017 to facilitate increased
HAART, or highly active antiretroviral therapy, involves using a combination of antiretroviral drugs to treat HIV. The goals of ART include increased survival, improved quality of life, reduction of viral load, immune reconstitution, and limiting drug toxicity while maintaining treatment options and adherence. Commonly used drug classes include NRTIs, NNRTIs, integrase inhibitors, and protease inhibitors. Treatment involves monitoring viral load, CD4 count, adverse effects, and potential treatment failure or immune reconstitution inflammatory syndrome. Guidelines provide recommendations on treatment initiation and first, second, and third-line regimens for both adults and children.
This document summarizes guidelines for the management of hepatitis C virus (HCV) infection from the European Association for the Study of the Liver (EASL). Key points include:
- HCV infects an estimated 160 million people worldwide and is a major cause of chronic liver disease. New direct-acting antiviral drugs have improved treatment outcomes.
- The guidelines provide recommendations on diagnosing, assessing, and treating HCV infection. They address issues like determining liver disease severity, HCV genotyping, treatment goals and endpoints, and contraindications to therapy.
- For HCV genotype 1, the current standard of care is combination therapy with pegylated interferon, ribavirin, and one of two protease
Hepatitis c. diagnosis and treatment.assld guidelines.2016 .2017Dr. Afzal Haq Asif
A 45-year-old woman presented with fatigue, weakness, loss of appetite, and anemia. Liver function tests showed elevated AST, ALT, and bilirubin levels indicating liver inflammation and damage. A liver biopsy revealed necroinflammation and fibrosis. This suggests a diagnosis of chronic hepatitis C, which would be confirmed by a positive HCV RNA test. The best course of action would be to treat the patient with direct-acting antiviral therapy to cure the hepatitis C infection, advise lifestyle changes to protect the liver, and monitor for complications like cirrhosis or liver cancer.
Virus is an obligatory intracellular parasite made up of protein and RNA/DNA that replicates solely within host cells. Hepatitis C virus (HCV) is a small enveloped RNA virus that causes both acute and chronic hepatitis. It is classified into 11 genotypes and infects approximately 170 million people worldwide, with 50-80% developing chronic infection. HCV is transmitted through blood and bodily fluids, with the most common routes being contaminated needles and transfusions. While 80% of infections are asymptomatic, acute symptoms may include fatigue, nausea, and jaundice. HCV is diagnosed through antibody screening and molecular tests like PCR. Treatment aims to halt disease progression and includes antiviral drugs like interferon, ribavirin, and direct
This document discusses the prevention of hepatitis B and C. It notes that India has an overall HBsAg positivity rate of 2-4.7% among pregnant women. Hepatitis B can be transmitted through blood or body fluids, from mother to child during birth, or through sexual contact. High-risk groups include those with multiple sexual partners or intravenous drug use. The hepatitis B vaccine is effective at preventing infection and involves a 3-dose series over 6 months. For exposure, hepatitis B immune globulin and vaccination provides good protection if started within 2 weeks. Universal precautions and immunization are key to prevention in healthcare settings.
Современное лечение ВИЧ: лечение ВИЧ у пациентов с вирусными гепатитами.Conte...hivlifeinfo
Современное лечение ВИЧ: лечение ВИЧ у пациентов с вирусными гепатитами.Contemporary Management of HIV. Managing HIV in Viral Hepatitis Coinfection.2016
In this downloadable slideset, David L. Wyles, MD, and Program Director Eric S. Daar, MD, review key data and optimal approaches for ART management in patients with HIV and viral hepatitis coinfection.
Format: Microsoft PowerPoint (.ppt)
File size: 1.85 MB
This study evaluated the safety and efficacy of pegylated interferon alpha-2a (PEG-IFN) monotherapy in 78 hepatitis C virus (HCV) positive hemodialysis patients. An early viral response was seen in 61.5% of patients at 12 weeks. However, only 19.2% had undetectable HCV RNA levels at end of treatment. A sustained viral response was achieved in 14.1% of the initial population. Adherence was poor, with 32% unable to complete the 48-week treatment due to adverse effects. Adverse events were common, occurring in 83% of patients. The incidence of serious adverse events was high at 0.19 per patient-year. The study
A 45-year-old woman presents with fatigue, weakness, loss of appetite, and abnormal liver function tests. Laboratory results show elevated AST, ALT, bilirubin levels and positive tests for HCV antibody and RNA. A liver biopsy revealed severe inflammation and bridging fibrosis. The patient is diagnosed with chronic hepatitis C virus infection based on her history of blood transfusion, symptoms, laboratory abnormalities and biopsy findings. The best course of action is to treat her HCV infection with antiviral therapy to reduce liver damage and prevent progression to cirrhosis.
Every year universal expiries after viral hepatitis are 1.4 million. The organization has known a method to treat 80% of HCV patients by 2030. In Pakistan, HCV occurrence is 1%. There is no correct indication about the real occurrence of HCV chronic infection, though current meta-analyses approximation that currently, about 130-150 million people live with chronic hepatitis C and that HCV reasons about 500,000 deaths each year The purpose of this review article to describes the introduction of HCV, risk factors of HCV, Early treatment option sand result of sofosbuvir plus Ribavirin on the treatment of HCV.
Our backs are like superheroes, holding us up and helping us move around. But sometimes, even superheroes can get hurt. That’s where slip discs come in.
This document provides information about hepatitis C virus (HCV) including its structure, genome, genotypes, epidemiology, transmission, pathogenesis, diagnosis, and management. It discusses:
- HCV has a single-stranded RNA genome within the Flaviviridae family. It exists as different genotypes that determine treatment response.
- HCV is a major cause of liver disease worldwide, with transmission primarily through blood exposure. Diagnosis involves antibody and RNA testing.
- Treatment aims to eradicate HCV and involves pegylated interferon and ribavirin combinations. Response is monitored via viral load decline. Adverse effects require monitoring and management. New direct-acting antivirals are improving treatment outcomes.
Best Practices in the Management of HCV/HIV Coinfection.Optimizing Treatment ...hivlifeinfo
This document discusses best practices for managing HCV/HIV coinfection. It begins with background on HCV/HIV coinfection epidemiology and the accelerated progression of liver disease in coinfected patients. It then reviews screening guidelines before discussing the challenges of current interferon-based HCV treatment and factors to consider in deciding whether to treat or defer therapy. The document summarizes recent studies on using telaprevir or boceprevir with pegylated interferon and ribavirin in coinfected patients. It concludes with recommendations on coadministering direct-acting antivirals with select antiretrovirals.
Hepatitis C is a global health problem that causes 700,000 deaths per year. In Bangladesh, 1% of the population has HCV. New guidelines recommend screening high-risk groups and treating with direct-acting antiviral drugs, which have cure rates over 90% and shorter treatment durations compared to previous interferon-based regimens. Proper treatment can prevent cirrhosis, liver cancer and death from HCV. While challenges remain, scientists hope to eliminate HCV globally by 2030 with new pan-genotypic drugs. Prevention through injection safety, screening blood products, and educating healthcare workers is also important to control the disease.
This meta-analysis evaluated the efficacy and safety of adding ribavirin (RBV) to Sofosbuvir/Velpatasvir (SOF/VEL) treatment for genotype 3 hepatitis C virus (HCV) compensated cirrhosis patients. The analysis included 7 studies and 1088 subjects, 506 received SOF/VEL+RBV and 582 received SOF/VEL. Sustained virologic response at 12 weeks (SVR12) was similar between those who received RBV and those who did not, indicating RBV provided no significant benefit. However, addition of RBV was associated with a higher risk of treatment-related adverse events. Therefore, routine addition of RBV to
CYPRESS COLLEGE DIVISION OF HEALTH SCIENCE HS 147 Hi.docxwhittemorelucilla
CYPRESS COLLEGE
DIVISION OF HEALTH SCIENCE
HS 147
Hints for writing your final disease report: (not in any order)
1. In your abstract, don't give a history of your disorder. Give the reader a
short synopsis of what the research is going to cover. Don’t forget “key
words”. Research papers are not a "friendly format”, don’t add personal
comments or opinions or slang. Assume this will be printed in a journal.
2. Use 12 point, Geneva style font (or similar) for your paper, with a 1”
margin on all sides.
3. Number your pages in the upper right corner. Your report will be about 7-9
pages not counting the cover page and reference page. Remember to
print the "word count" on cover page (1500 minimum).
4. Do not list or use bullets. Write in complete sentences and paragraphs.
5. Section headings help the reader. Remember to only double space,
even between headings or paragraphs.
6. Don't start a sentence with "according to......". Instead start with the
information and use an in-text citation at the end of the sentence or
paragraph.
7. If you start a sentence with a number, you must write out the number.
8. For your report remember, you are writing as a professional to another
professional and not to a patient or “lay person”. Do not explain things
that you would expect that the reader would already know.
9. Have someone else read your report before you turn it in for grammar,
spelling and punctuations.
10. Do not use a separate page for each section or heading (double space
only).
11. Include the website that the information was retrieved from, not the
search engine the school used (EBSCO). Use the APA format in your
syllabus.
Good luck!
June 15, 2015 ◆ Volume 91, Number 12 www.aafp.org/afp American Family Physician 835
Diagnosis and Management of Hepatitis C
THAD WILKINS, MD; MARIAM AKHTAR, MD; and EUNICE GITITU, MD, Georgia Regents University, Augusta, Georgia
CHRISTINE JALLURI, MD, and JASON RAMIREZ, MD, University of Maryland, Baltimore, Maryland
H
epatitis C virus (HCV) infec-
tion is a major cause of chronic
liver disease and cirrhosis.1
The World Health Organi-
zation reports that there are at least 185
million persons worldwide with the infec-
tion, causing 350,000 deaths annually.1 In
the United States, an estimated 2.7 mil-
lion individuals are chronically infected
with HCV.2 The burden of HCV infection
in the United States is expected to increase
because of the high proportion of persons
who were infected in the 1960s and 1970s.3
In 2013, the total cost of HCV infection in
the United States was estimated at $6.5 bil-
lion.4 Chronic HCV infection leads to sig-
nificantly more lost days of work, decreased
productivity, and increased health care
costs.5 This article focuses on chronic HCV
infection in adults and excludes special
groups, such as children, pregnant women,
transplant recipients, and persons coi.
The document discusses the prevention of hepatitis B and C infections in hemodialysis patients, noting that bloodborne virus transmission was recognized as a hazard in renal units in the 1960s. It recommends screening and surveillance of patients and staff, segregation and immunization of infected patients, implementation of universal precautions including hand hygiene and personal protective equipment, and disinfection of equipment to prevent the spread of hepatitis B and C viruses in hemodialysis settings.
Best Practices in the Management of HCV/HIV Coinfection: Optimizing Treatment...Hivlife Info
Jürgen K. Rockstroh, MD, provides an update on the importance of HCV screening and the latest emerging treatment options for patients with HCV/HIV coinfection.
The document discusses hepatitis C virus (HCV), including its structure, genome, genotypes, epidemiology, pathogenesis, diagnosis, and management. Some key points:
- HCV is a single-stranded RNA virus of the Flaviviridae family with a genome encoding both structural and nonstructural proteins.
- It exists as different genotypes globally, with genotypes 1, 2, 3 being most common. Genotype helps determine treatment duration and response.
- HCV is a major cause of liver disease worldwide and is transmitted through blood exposure. Diagnosis involves HCV antibody and RNA testing.
- Treatment aims to eradicate the virus and involves use of pegylated interferon and ribavirin
Hepatitis C is caused by the hepatitis C virus (HCV), which is a single-stranded RNA virus from the Flaviviridae family. It is transmitted through blood and bodily fluids. HCV replicates within liver cells and evades the immune system, leading to persistent infection in some cases. Symptoms are often mild or absent. Diagnosis involves testing for HCV antibodies or RNA. Treatment involves direct-acting antiviral drugs, which have high cure rates. Special populations like those with HIV/HCV coinfection, kidney disease, or other liver diseases may require modified treatment approaches.
This document summarizes information about hepatitis C in Ireland, including epidemiology, natural history, burden, treatment programs, and guidelines. Some key points:
- An estimated 20,000-30,000 people in Ireland have chronic hepatitis C infection, though about 60% are undiagnosed.
- Most infections are in people who inject drugs, though cases in men who have sex with men are increasing.
- A national hepatitis C treatment program was established in 2015 to treat all infected individuals over several phases, with a goal of eliminating hepatitis C in Ireland by 2026.
- National hepatitis C screening guidelines were developed using an evidence-based process and are due to be launched in July 2017 to facilitate increased
HAART, or highly active antiretroviral therapy, involves using a combination of antiretroviral drugs to treat HIV. The goals of ART include increased survival, improved quality of life, reduction of viral load, immune reconstitution, and limiting drug toxicity while maintaining treatment options and adherence. Commonly used drug classes include NRTIs, NNRTIs, integrase inhibitors, and protease inhibitors. Treatment involves monitoring viral load, CD4 count, adverse effects, and potential treatment failure or immune reconstitution inflammatory syndrome. Guidelines provide recommendations on treatment initiation and first, second, and third-line regimens for both adults and children.
This document summarizes guidelines for the management of hepatitis C virus (HCV) infection from the European Association for the Study of the Liver (EASL). Key points include:
- HCV infects an estimated 160 million people worldwide and is a major cause of chronic liver disease. New direct-acting antiviral drugs have improved treatment outcomes.
- The guidelines provide recommendations on diagnosing, assessing, and treating HCV infection. They address issues like determining liver disease severity, HCV genotyping, treatment goals and endpoints, and contraindications to therapy.
- For HCV genotype 1, the current standard of care is combination therapy with pegylated interferon, ribavirin, and one of two protease
Hepatitis c. diagnosis and treatment.assld guidelines.2016 .2017Dr. Afzal Haq Asif
A 45-year-old woman presented with fatigue, weakness, loss of appetite, and anemia. Liver function tests showed elevated AST, ALT, and bilirubin levels indicating liver inflammation and damage. A liver biopsy revealed necroinflammation and fibrosis. This suggests a diagnosis of chronic hepatitis C, which would be confirmed by a positive HCV RNA test. The best course of action would be to treat the patient with direct-acting antiviral therapy to cure the hepatitis C infection, advise lifestyle changes to protect the liver, and monitor for complications like cirrhosis or liver cancer.
Virus is an obligatory intracellular parasite made up of protein and RNA/DNA that replicates solely within host cells. Hepatitis C virus (HCV) is a small enveloped RNA virus that causes both acute and chronic hepatitis. It is classified into 11 genotypes and infects approximately 170 million people worldwide, with 50-80% developing chronic infection. HCV is transmitted through blood and bodily fluids, with the most common routes being contaminated needles and transfusions. While 80% of infections are asymptomatic, acute symptoms may include fatigue, nausea, and jaundice. HCV is diagnosed through antibody screening and molecular tests like PCR. Treatment aims to halt disease progression and includes antiviral drugs like interferon, ribavirin, and direct
This document discusses the prevention of hepatitis B and C. It notes that India has an overall HBsAg positivity rate of 2-4.7% among pregnant women. Hepatitis B can be transmitted through blood or body fluids, from mother to child during birth, or through sexual contact. High-risk groups include those with multiple sexual partners or intravenous drug use. The hepatitis B vaccine is effective at preventing infection and involves a 3-dose series over 6 months. For exposure, hepatitis B immune globulin and vaccination provides good protection if started within 2 weeks. Universal precautions and immunization are key to prevention in healthcare settings.
Современное лечение ВИЧ: лечение ВИЧ у пациентов с вирусными гепатитами.Conte...hivlifeinfo
Современное лечение ВИЧ: лечение ВИЧ у пациентов с вирусными гепатитами.Contemporary Management of HIV. Managing HIV in Viral Hepatitis Coinfection.2016
In this downloadable slideset, David L. Wyles, MD, and Program Director Eric S. Daar, MD, review key data and optimal approaches for ART management in patients with HIV and viral hepatitis coinfection.
Format: Microsoft PowerPoint (.ppt)
File size: 1.85 MB
This study evaluated the safety and efficacy of pegylated interferon alpha-2a (PEG-IFN) monotherapy in 78 hepatitis C virus (HCV) positive hemodialysis patients. An early viral response was seen in 61.5% of patients at 12 weeks. However, only 19.2% had undetectable HCV RNA levels at end of treatment. A sustained viral response was achieved in 14.1% of the initial population. Adherence was poor, with 32% unable to complete the 48-week treatment due to adverse effects. Adverse events were common, occurring in 83% of patients. The incidence of serious adverse events was high at 0.19 per patient-year. The study
A 45-year-old woman presents with fatigue, weakness, loss of appetite, and abnormal liver function tests. Laboratory results show elevated AST, ALT, bilirubin levels and positive tests for HCV antibody and RNA. A liver biopsy revealed severe inflammation and bridging fibrosis. The patient is diagnosed with chronic hepatitis C virus infection based on her history of blood transfusion, symptoms, laboratory abnormalities and biopsy findings. The best course of action is to treat her HCV infection with antiviral therapy to reduce liver damage and prevent progression to cirrhosis.
Every year universal expiries after viral hepatitis are 1.4 million. The organization has known a method to treat 80% of HCV patients by 2030. In Pakistan, HCV occurrence is 1%. There is no correct indication about the real occurrence of HCV chronic infection, though current meta-analyses approximation that currently, about 130-150 million people live with chronic hepatitis C and that HCV reasons about 500,000 deaths each year The purpose of this review article to describes the introduction of HCV, risk factors of HCV, Early treatment option sand result of sofosbuvir plus Ribavirin on the treatment of HCV.
Semelhante a hepatitis c in primary care.pptx (20)
Our backs are like superheroes, holding us up and helping us move around. But sometimes, even superheroes can get hurt. That’s where slip discs come in.
Local Advanced Lung Cancer: Artificial Intelligence, Synergetics, Complex Sys...Oleg Kshivets
Overall life span (LS) was 1671.7±1721.6 days and cumulative 5YS reached 62.4%, 10 years – 50.4%, 20 years – 44.6%. 94 LCP lived more than 5 years without cancer (LS=2958.6±1723.6 days), 22 – more than 10 years (LS=5571±1841.8 days). 67 LCP died because of LC (LS=471.9±344 days). AT significantly improved 5YS (68% vs. 53.7%) (P=0.028 by log-rank test). Cox modeling displayed that 5YS of LCP significantly depended on: N0-N12, T3-4, blood cell circuit, cell ratio factors (ratio between cancer cells-CC and blood cells subpopulations), LC cell dynamics, recalcification time, heparin tolerance, prothrombin index, protein, AT, procedure type (P=0.000-0.031). Neural networks, genetic algorithm selection and bootstrap simulation revealed relationships between 5YS and N0-12 (rank=1), thrombocytes/CC (rank=2), segmented neutrophils/CC (3), eosinophils/CC (4), erythrocytes/CC (5), healthy cells/CC (6), lymphocytes/CC (7), stick neutrophils/CC (8), leucocytes/CC (9), monocytes/CC (10). Correct prediction of 5YS was 100% by neural networks computing (error=0.000; area under ROC curve=1.0).
Does Over-Masturbation Contribute to Chronic Prostatitis.pptxwalterHu5
In some case, your chronic prostatitis may be related to over-masturbation. Generally, natural medicine Diuretic and Anti-inflammatory Pill can help mee get a cure.
Osteoporosis - Definition , Evaluation and Management .pdfJim Jacob Roy
Osteoporosis is an increasing cause of morbidity among the elderly.
In this document , a brief outline of osteoporosis is given , including the risk factors of osteoporosis fractures , the indications for testing bone mineral density and the management of osteoporosis
Cell Therapy Expansion and Challenges in Autoimmune DiseaseHealth Advances
There is increasing confidence that cell therapies will soon play a role in the treatment of autoimmune disorders, but the extent of this impact remains to be seen. Early readouts on autologous CAR-Ts in lupus are encouraging, but manufacturing and cost limitations are likely to restrict access to highly refractory patients. Allogeneic CAR-Ts have the potential to broaden access to earlier lines of treatment due to their inherent cost benefits, however they will need to demonstrate comparable or improved efficacy to established modalities.
In addition to infrastructure and capacity constraints, CAR-Ts face a very different risk-benefit dynamic in autoimmune compared to oncology, highlighting the need for tolerable therapies with low adverse event risk. CAR-NK and Treg-based therapies are also being developed in certain autoimmune disorders and may demonstrate favorable safety profiles. Several novel non-cell therapies such as bispecific antibodies, nanobodies, and RNAi drugs, may also offer future alternative competitive solutions with variable value propositions.
Widespread adoption of cell therapies will not only require strong efficacy and safety data, but also adapted pricing and access strategies. At oncology-based price points, CAR-Ts are unlikely to achieve broad market access in autoimmune disorders, with eligible patient populations that are potentially orders of magnitude greater than the number of currently addressable cancer patients. Developers have made strides towards reducing cell therapy COGS while improving manufacturing efficiency, but payors will inevitably restrict access until more sustainable pricing is achieved.
Despite these headwinds, industry leaders and investors remain confident that cell therapies are poised to address significant unmet need in patients suffering from autoimmune disorders. However, the extent of this impact on the treatment landscape remains to be seen, as the industry rapidly approaches an inflection point.
- Video recording of this lecture in English language: https://youtu.be/Pt1nA32sdHQ
- Video recording of this lecture in Arabic language: https://youtu.be/uFdc9F0rlP0
- Link to download the book free: https://nephrotube.blogspot.com/p/nephrotube-nephrology-books.html
- Link to NephroTube website: www.NephroTube.com
- Link to NephroTube social media accounts: https://nephrotube.blogspot.com/p/join-nephrotube-on-social-media.html
Clinic ^%[+27633867063*Abortion Pills For Sale In Tembisa Central19various
Clinic ^%[+27633867063*Abortion Pills For Sale In Tembisa Central Clinic ^%[+27633867063*Abortion Pills For Sale In Tembisa CentralClinic ^%[+27633867063*Abortion Pills For Sale In Tembisa CentralClinic ^%[+27633867063*Abortion Pills For Sale In Tembisa CentralClinic ^%[+27633867063*Abortion Pills For Sale In Tembisa Central
Rasamanikya is a excellent preparation in the field of Rasashastra, it is used in various Kushtha Roga, Shwasa, Vicharchika, Bhagandara, Vatarakta, and Phiranga Roga. In this article Preparation& Comparative analytical profile for both Formulationon i.e Rasamanikya prepared by Kushmanda swarasa & Churnodhaka Shodita Haratala. The study aims to provide insights into the comparative efficacy and analytical aspects of these formulations for enhanced therapeutic outcomes.
Hiranandani Hospital in Powai, Mumbai, is a premier healthcare institution that has been serving the community with exceptional medical care since its establishment. As a part of the renowned Hiranandani Group, the hospital is committed to delivering world-class healthcare services across a wide range of specialties, including kidney transplantation. With its state-of-the-art facilities, advanced medical technology, and a team of highly skilled healthcare professionals, Hiranandani Hospital has earned a reputation as a trusted name in the healthcare industry. The hospital's patient-centric approach, coupled with its focus on innovation and excellence, ensures that patients receive the highest standard of care in a compassionate and supportive environment.
4. Chronic HCV
Infected
Diagnosed and
Aware
Access to
Care
HCV
Confirmation
Liver Disease
assessment
Prescribed HCV
Treatment
Achieved
SVR
9%
For Malaysia, this is the largest gap i.e. up to 90-95% individuals living with
HCV are UNAWARE that they are infected
DAAs only help
once you get here
Left side of the cascade
equally/more important
Gaps Along the HCV Care Continuum
4
5. Background
• Most chronic hepatitis C Virus (HCV) infected individuals are asymptomatic
& thus unaware of their infection. Many remained undetected.
• Failure to identify them prevents linkage to care & successful control of
HCV.
• Therefore, screening of HCV is an important step towards improving
detection & ultimately treatment & cure of infected individuals.
5
7. Timely Treatment Can
Arrest The Disease
Progression And
Prevent Death
7
50% F3 in 10 years 28% in 10 years
HCV Infection - Natual History
8.
9.
10. 2. Healthcare, emergency medical, and
public safety workers after needle
sticks, sharps, or mucosal
exposures to HCV-infected blood
Risk of HCV infection varies depending
upon the frequency of medical
procedures (i.e. number of
injections/person/year) and level of
infection control practices. High frequency
of injections and low level of infection
control can result in high prevalence of
HCV in the general population.
HEPATITIS
C
3. Recipients of blood / blood products /
clotting factor concentrates / organ
transplant before July 1994
There is a high risk of HCV infection via
transfusion of unscreened blood and blood
products.
1. People who inject drugs (PWID)
PWID have the highest risk of infection.
Globally, the prevalence of HCV is 67%
among PWID. In Malaysia, 59% HCV
infection acquired through injecting drugs.
WHO TO SCREEN?
10
11. 4. Persons on long-term
hemodialysis (ever)
Risk of HCV infection among dialysis
patient is high in condition where
level of infection-control practices
is low / ignored. Risk of HCV infection
also varies depending upon the frequency
of medical procedures (i.e.no of
injections/person/year). A study reported
that 53.9% of patient on dialysis from
1985 and September 1991 were positive
for anti-HCV.
HEPATITIS
C
5. Intranasal illicit drug use
Non-injecting drug use (e.g. through
sharing of inhalation equipment for
cocaine) is associated with a higher risk of
HCV infection. The present of blood and
HCV RNA in the nasal secretions of HCV-
positive long-term drug sniffers can be
transferred onto sniffing implements (i.e.,
straws) during simulated intranasal drug
use.
WHO TO SCREEN?
11
12. 9. Children born to HCV infected
women
HCV transmission risk is estimated as 4 –
8% among mothers without HIV
infection. Transmission risk is estimated
as 17-25% among mothers with HIV
infection.
7. Persons who were ever incarcerated
Persons who were incarcerated are at risk
for Hepatitis C because many people in jails
or prisons already have Hepatitis C
6. Persons with HIV infection, in
particular MSM, are at increased
risk of HCV infection through
unprotected sex
Persons with HIV infection, in particular
MSM, are at increased risk of HCV
infection through unprotected sex.
8. Unexplained chronic liver disease
and/or chronic hepatitis including
elevated ALT levels
Approximately 60% to 70% of chronically
(HCV) infected person will eventually develop
chronic liver disease.
WHO TO SCREEN?
12
13. 10. People with sexual partners
who are HCV infected
There is low or no risk of sexual
transmission of HCV among HIV-
uninfected heterosexual couples and HIV-
uninfected men who have sex with men
(MSM). The risk of sexual transmission is
strongly linked to pre-existing HIV
infection.
11. Solid organ donors
(deceased and living)
There is a risk of HCV infection in
unscreened organ donors.
12. Persons with percutaneous/parenteral exposures in an unregulated setting
Tattoo recipients have higher prevalence of HCV compared with persons without tattoos (odds ratio =
2.24, 95% CI 2.01, 2.50).
WHO TO SCREEN?
13
14.
15. • Prior to initiation of treatment, hepatitis C must be assessed to
identify presence of co morbidity and to determine cirrhosis status.
• The following investigations need to be performed:
o full blood count (FBC)
o liver function test (LFT)
o serum creatinine
o international normalisation ration (INR)
o HIV & HBsAg screening
Pre-treatment Assessment
15
41. Pre-treatment assessment of concomitant medication should be
done to avoid DDI
Prescribers may consult the University of Liverpool webpage on hepatitis drug
interactions at https://www.hep-druginteractions.org/checker
Drug-drug Interactions (DDIs)
41
42.
43.
44.
45.
46.
47. • HIV Co-infection
• Hepatitis B Co-infection
• Chronic Kidney Disease/End-Stage Renal Disease (CKD/ESKD)
• Pregnancy
• Acute hepatitis C
• Hepatitis C in children & adolescents
Introduction: Special Groups
47
49. • People with HIV/HCV co-infection are advised to start ART soon after
being diagnosed with HIV (WHO 2016).
• This is especially so if CD4 cell count is below 350 cells/µL; to improve
immune function.
• Treatment of these patients requires special attention due to the
complexity of drug-drug interactions (DDI) that can occur between
DAAs & antiretroviral medications.
• HIV treatment should not be interrupted in order to start hepatitis C
treatment.
When to start DAAs?
49
50. • SOF/DCV has no significant DDI with NRTIs.
• SOF/LDV increases tenofovir levels when given as tenofovir disoproxil
fumarate (TDF), which may increase the risk of tenofovir-associated
renal toxicity.
• SOF/VEL increases tenofovir levels when given as TDF, which may
increase the risk of tenofovir-associated renal toxicity.
o These combinations should be used with caution with close monitoring of renal
profile in patients with an eGFR <60 ml/min/1.73 m2.28
DDIs - NRTIs
50
28. AASLD-IDSA HCV Guidance Panel. Clin Infect Dis. 2018;67(10):1477-92.
51. • The dose of DCV should be increased from 60 mg to 90 mg when
used with potent inducer of cytochrome P450 (CYP) 3A4 e.g.
efavirenz (EFV), etravirine (ETV) or nevirapine (NVP).
• LDV’s AUC decreases by 34% when co-administered with EFV-
containing regimes.
o Although no dose adjustments of LDV are recommended to account for these
interactions, the combinations should be used with cautions & frequent renal
monitoring.28
• SOF/VEL is not recommended to be used in patients on EFV, NVP
or ETV.
DDIs - NNRTIs
51
52. • HBV/HCV co-infection is more common among people who
inject drugs (PWID) or in areas where these 2 viruses are
endemic.
• Co-infection of HBV/HCV increases risk for HCC by 13.3%.46
• HBV/HCV co-infected patients should be treated similar to
HCV mono-infected once HBV status has been assessed.
52
Hepatitis B (HBV) Co-infection
46. Tsai JF et al. Br J Cancer. 1997;76(7):968-74.
53. Why Need to Treat?
Meta-analysis of 17 cohort studies on HBV/HCV co-infection:47
• When receiving DAAs treatment, HBV reactivation occurred more frequently in
patients with chronic 24% [hepatitis B surface antigen (HBsAg)] than resolved 1.4%
[HBsAg-negative/hepatitis B core antibody (HBcAb)-positive] infection.
• In chronic HBV infection, the risk of HBV-reactivation-related hepatitis was
significantly lower in patients with HBV DNA below the lower limit of quantification
at baseline than in those with quantifiable HBV DNA (RR=0.17, 95% CI 0.06 to 0.50).
Hepatitis B (HBV) Co-infection
53
47. Mücke MM et al. Lancet Gastroenterol Hepatol. 2018;3(3):172-80.
54. Source: Centres for Disease Control and Prevention. Available at: https://www.cdc.gov/hepatitis/hbv/hbvfaq.htm
Hepatitis B (HBV) Co-infection
54
55. • HCV infection in CKD is associated with:
o increased liver-related morbidity & mortality rates
o accelerated progression to ESRD
o risk of cardiovascular events
o increase the morbidity & mortality rates of both dialysis &
kidney transplant (KT) patients
CKD/ESKD
55
56. • Studies showed:63 - 64
o once-daily oral regime of GZV/EBR for 12 weeks achieved high rates of SVR
97.4 - 99%
o an acceptable safety profile in patients with HCV genotype 1 infection &
advanced CKD with or without dialysis
• Treatment with GLE/PIB for 12 weeks:65
o resulted in an SVR of 98% (95% 95 to 100) in patients with stage 4 or 5 CKD &
HCV infection.
CKD/ESKD
56
63. Bruchfeld A et al. Lancet Gastroenterol Hepatol 2017;2(8):585-59.
64. Roth D et al. Lancet. 2015;386(10003):1537-45.
65. Gane E et al. N Engl J Med. 2017;377(15):1448-55
57. • A meta-analysis of 21 cohort studies of moderate quality showed that:62
o regime including SOF could be proposed for HCV-infected CKD patients with
or without HD
o it should be associated with close clinical, biological, cardiovascular &
therapeutic drug monitoring.
CKD/ESKD
57
62. Li M et al. Virol J. 2019;16(1):34.
58. Treatment Algorithm of CKD using DAAs
according to HCV Genotype & eGFR
58
Source: Kim SM et al. Korean J Intern Med. 2018 Jul;33(4):670-678.
59. • Treatment of hepatitis C should not be initiated until pregnancy has been excluded due to the lack
of safety & efficacy data.28
Adapted: Kushner et al. Hepatology Communications. 2019;3(1).
Pregnancy
59
28. AASLD-IDSA HCV Guidance Panel. Clin Infect Dis. 2018;67(10):1477-9
60. • Women of reproductive age with HCV should be counselled about the benefit
of antiviral treatment prior to pregnancy to improve the health of the mother &
eliminate the low risk of mother-to-child transmission (MTCT).
• Women who become pregnant while on DAA therapy (with or without ribavirin)
should discuss the risks versus benefits of continuing treatment with their
physicians.
• Ribavirin is contraindicated in pregnancy due to its known teratogenicity. In
addition, the risk for teratogenicity persists for up to 6 months after ribavirin
cessation & applies to women taking ribavirin & female partners of men taking
ribavirin.
Pregnancy
60
61. • Most patients with acute hepatitis C are asymptomatic. Spontaneous
viral clearance varies from 14% to 50%.
• A minimum of 6 months of monitoring for spontaneous clearance is
recommended before deciding to initiate treatment .
• If decision is to initiate treatment during the acute infection period,
HCV RNA monitoring for at least 12 to 16 weeks before starting
treatment is recommended.
• Patients who spontaneously clear after acute hepatitis C, antiviral
treatment is not recommended.
Acute Hepatitis C
61
63. • The United Nations Convention on the Rights of the Child defines a child as an
individual below the age of 18 years; WHO defines an adolescent as a person
between the ages of 10 & 19.
• Major route of infection in:
o mother-to-infant transmission in children
o adolescents are at risk of infection via injecting drug use.
• Numerous trials of PEG-IFN & RBV in children but current treatment options with
DAAs are limited.
• The use of SOF/LDV for 12 weeks in children ages 12 - 17, weighing greater than
35 kg (genotype 1, 4, 5 and 6) have resulted in SVR rate of 98%.11,14
• Combination of SOF & RBV has also been proposed for genotypes 2 & 3 for
adolescents.11,14
Hepatitis C in Children & Adolescents
63
11. World Health Organization. Geneva: WHO; 2018.
14. European Association for the Study of the Liver. J Hepatol. 2018;69(2):461-511.
64. • Adolescents aged ≥12 years, infected with genotype 2 or 3, who are
treatment-naïve or treatment-experienced, without cirrhosis or with
compensated cirrhosis (CPS A*) can be treated with other regimens
approved for adults, with caution pending on more safety data in this
population.11,14
• In children younger than 12 years, treatment should be deferred until
DAAs, including pan-genotypic regimens, are approved for this age
group.11,14
*CPS A: Page 10 in CPG
Hepatitis C in Children & Adolescents
64
65. 65
• A treatment interruption was defined as treatment interruption for
>7 days or treatment discontinuation.
• If the interruption of treatment was for ≤7 days, treatment was
continued for the remaining duration as prescribed & SVR12 was
assessed 12 weeks after the completion of treatment.
• If interruption of treatment was >7 days & the patient had taken
treatment for <4 weeks, then the treatment was started afresh.
• If interruption of treatment was >7 days & the patient had taken
treatment for ≥4 weeks or more, then HCV RNA was measured
after 12 weeks of cessation of drug to assess for SVR12.
Monitoring During DAAs
6
5
Missed Dosing
66. When to Refer
• cirrhosis
• treatment failure
• hepatitis B co-infection
• CKD stage 4 & 5
• extrahepatic manifestation
• haemoglobinopathies
• solid organ transplantation
66
Patient with compensated cirrhosis,
treatment-naïve should be able to be treated at Klinik Kesihatan or any
physician base clinic.
When to Refer
66
67. When to Refer
• CPG Management of Chronic Hepatitis C in Adults
• EASL Recommendations on Treatment of Hepatitis C 2018
67
Referance
67