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Acute Hepatitis C Management and Monitoring Case Study

Learn about acute hepatitis C case study, monitoring, treatment, predictors of clearance, counseling, and recommendations. Case details, lab results, treatment, and follow-up included.

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Acute Hepatitis C Management and Monitoring Case Study

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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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