Hepatitis C Clinical Manifestations and Treatment Strategies

Mike is a 23-year-old white male admitted for severe depression. He has a history of bipolar disorder and is currently taking valproate (Depakote) 500 mg XR daily. His psychiatrist ordered LFT’s to follow the valproate therapy. LFT’s were abnormal: ALT 1178 u/L, AST 746 u/L. the patient was asymptomatic. He denies fever, abdominal pain, nausea, vomiting or jaundice. He denies using other medication or alcohol but admits using illicit IV drugs starting about 8 weeks ago and continuing to present. He never had a blood transfusion. Aside from Depakote he is presently taking clonazepam 1 mg prn and fluoxetine (Prozac) 40 mg qd.
Other blood work: Direct bili 1 mg/dL, alk phos 188 u/L, anti-HCV negative on hospital day 1, positive on day 3. HCV-RNA PCR positive. Hep A, B, and D markers negative.

Patient diagnosis: Acute Hepatitis C.

List some clinical manifestations typically seen in Hepatitis C and major treatment strategies.
Post your initial response by Wednesday at midnight. Respond to one student by Sunday at midnight. Both responses must be a minimum of 150 words, scholarly written, APA formatted, and referenced. A minimum of 2 references are required (other than your text). Refer to grading rubric for online discussion.

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Thank you for your thorough post. As a provider, there are many resources available to help us treat this population. You may want to look at the ECHO project and keep this resource for clinical: https://www.hcvguidelines.org/

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Steven Bartos posted Feb 24, 2021 7:33 PM
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Hepatitis C (HVC) is a virus that predominantly infects the hepatocytes of the liver. It is estimated that 85% of patients with an acute infection eventually develop a chronic infection. Patients initially show elevated liver labs, AST and ALT. Chronic HCV is associated with liver failure, cirrhosis, and liver cancer. Patients used to be treated with interferon (IFN)-based interventions, but those had several negative side effects. These days, patients are treated with direct acting antiviral agents (DAAs) which have been shown to provide a functional cure, known as sustained virologic response (Tang, 2016).Other manifestations include arthralgia/myalgia, which is reported in 40 – 80% of patients, and displays as symmetric joint pain primarily in the knees and hands. INF treatments for the HCV may actually worsen these joint symptoms, which makes these cases that much more complicated. Sicca syndrome is an immune disorder that attacks salivary and tear glands of the mouth and eyes, causing them to dry up. This is another symptom that has been shown to subside with HCV treatment (Cacoub et al., 2016). Diabetes mellitus type 2 has also been linked with chronic HCV. Small focused studies with DAA interventions have shown decreased diabetes markers such as A1C, but research notes that larger studies need to be replicate results. Lastly, membranoproliferative glomerulonephritis is one of the most common manifestations of the kidneys. Patients present with renal insufficiency, proteinuria, and hematuria. DAAs usually lead to improvement of such manifestations and overall kidney function (Tang, 2016).Cacoub, P., Comarmond, C., Domont, F., Savey, L., Desbois, A.C., & Saadoun, D. (2016). Extrahepatic manifestations of chronic hepatitis C virus infection. Therapeutic Advances in Infections Disease, 3(1), 3 – 14. https://doi.org/10.1177/2049936115585942less1 UnreadUnread5 ViewsViews
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Last post March 7 at 6:26 PM by Sheryl Dixon
Tang, L., Marcell, L., & Kottilil, S. (2016). Systemic manifestations of hepatitis C infection. Infectious Agents and Cancer, 11(1), 1 – 8. https://dx.doi.org/10.1186/s13027-016-0076-7
References
HCV is a systemic disease, where the manifestations of HCV extend beyond the liver as extrahepatic manifestations. One of the more common manifestations is cryoglobulinemic syndrome (MCS), which is small vessel vasculitis resulting in symptoms such as skin lesions / ulcers, joint pain, peripheral neuropathy, and renal disease. Treatment that targets this syndrome include rituximab and antiviral therapy. B cell Non-Hodgkin’s Lymphoma (B-NHL) is another typical manifestation of HCV. IFN-based treatments have been shown to benefit patients with B-NHL; however, DAA treatment studies are limited to case reports, but the results remain promising as lymphoma regression was noted with DAA therapy (Cacoub et al., 2016).
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Lois Chappell posted Mar 3, 2021 9:23 PM
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Huether, S. E., McCance, K. L., & Brashers, V. L. (2020). Understanding pathophysiology (7th ed.). Elsevier.
Chung, R. T., Ghany, M. G., Kim, A. Y., Marks, K. M., Naggie, S., Vargas, H. E., Aronsohn, A. I., Bhattacharya, D., Broder, T., Falade-Nwulia, O. O., Fontana, R. J., Gordon, S. C., Heller, T., Holmberg, S. D., Jhaveri, R., Jonas, M. M., Kiser, J. J., Linas, B. P., Lo Re, V.,…Workowski, K. A. (2018). Hepatitis c guidance 2018 update: Aasld-idsa recommendations for testing, managing, and treating hepatitis c virus infection. Clinical Infectious Diseases, 67(10), 1477–1492. https://doi.org/10.1093/cid/ciy585
The goal for treatment of Hepatitis C is to have the absence of detectable HCV RNA in blood samples 12 weeks after completion of treatment (Chung et al., 2018). The most common treatment for HCV is anti-viral medications given to an infected patient for between 8-12 weeks (Chung et al., 2018). The duration of treatment is dependent on if cirrhosis is involved and if there is cirrhosis, a patient will undergo treatment for the longer extent of 12 weeks (Chung et al., 2018). Liver transplant may become necessary if liver inflammation causes too much damage to the liver (Falade- Nwulia et al., 2017). Treatment should also include education on ways to prevent re-infection.
Hepatitis C (HVC) is a viral disease that most commonly effects the liver and is commonly transmitted by contact of infected body fluids, intravenously, or by broken skin and mucous membranes (Huether et al., 2020). HVC is generally a chronic condition that is often times asymptomatic, but can present with symptoms of cirrhosis, hepatocellular carcinoma, and glomerulonephritis (Falade- Nwulia et al., 2017). HCV effects an estimated 3.2-5 million people in the United States and is the leading indication of liver transplants and cause of infectious disease death in the US (Falade- Nwulia et al., 2017).
Hepatitis C Clinical Manifestations and treatment strategiesSubscribe
Lois Chappell posted Feb 24, 2021 8:58 PM
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Hepatitis C virus is responsible for approximately 15-20% of all acute hepatitis cases (Li & Lo, 2015). Rates of infection are noted to be greater than 70 million worldwide for chronic Hepatitis C infections (World Health Organization, 2020), which may lead to cirrhosis, hepatocellular carcinoma, insulin resistance, Type II Diabetes Mellitus, glomerulopathies, oral manifestations and death (Li & Lo, 2015). The Hepatitis C virus is small, and enveloped, has many genotypes, of which all currently are hepatogenic and pathogenic (Li & Lo, 2015). It is important for healthcare providers to understand the risk factors, testing, and treatment of this contagious disease to improve clinical outcomes and decrease transmission rates. The majority of patients diagnosed with Hepatitis C will be asymptomatic, like Mike in our case study. Many will have elevated ALT levels, but some may not. Direct and indirect tests are used to detect Hepatitis C virus in hosts. Indirect tests include IgM for recent infection, and IgG for recent or past infection. Direct tests will include virus isolation, detection of viral antigens and nucleic acids (Li & Lo, 2015). Acute hepatitis is diagnosed when there is a presence of HCV RNA and an absence of anti-HCV antibodies (Li & Lo, 2015). In certain subsets of patients including dialysis, immunocompromised, and agammaglobunemic individuals, HCV RNA maybe present without the presence of HCV antibodies (Li & Lo, 2015). Andrews, R. (2018). Family physicians can manage adults with chronic hepatitis C. American Family Physicians, 98 (7). Doi: 10.4254/wjh.v7.i10.1377.less1 UnreadUnread5 ViewsViews
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View profile card for Sheryl Dixon
Last post February 28 at 8:29 PM by Sheryl Dixon
World Health Organization (2020). Hepatitis C. Retrieved from https://www.who.int/news-room/facr-sheets/detail/hepatitis-c.
Li, Hui-Chun, & Lo, Shih-Yen. (2020). Hepatitis C virus: virology, diagnosis, and treatment. World Journal of Hepatology, 7 (10).
References
The World Health Organization (2020) suggests both testing and treatment guidelines that include pegylated interferon with ribavirin (see attached algorhythm). The American Academy of Family of Family Physicians has published guidelines ad sources to aide primary care physicians treat and monitor chronic hepatitis C infected individuals. Since hepatitis C represents the only chronic viral illness curable by medication and most deadly (Andrews, 2018), it is imperative we recognize the risks, know the tests, and provide treatment to decrease morbidity and mortality from hepatitis C infection.
Exposure to hepatitis C is through direct percutaneous exposure to blood from an infected individual; knowing risk factors can aid with prevention and detection. At risk individuals include those with illicit injection of drugs, tattoo use, dialysis, born to infected mother, incarceration, intranasal illicit drug use, intercourse with infected partner, and blood transfusions before July 1992 (Li & Lo, 2015). Prevention, through education, is essential to reducing hepatitis C infection rates.
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Hilary Szpara posted Feb 24, 2021 8:45 PM
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People with hepatitis C virus (HCV) often present as asymptomatic, but about 25-30% of people present with symptoms such as jaundice, fever, and abdominal pain (Millman et al., 2017). Many people are not aware that they have the infection, and just present with vague symptoms like nausea and malaise (Kish et al., 2017). The current major treatments include combinations of direct-acting antiviral (DAAs) medications which work against targets of the HCV replication cycle to both block virus replication and to induce progressive clearance of the virus through cellular death of infected cells (Horsley-Silva & Vargas, 2017). The first DAA treatments were approved in 2011 and were boceprevir and telaprevir. These agents were used in conjunction with pegylated interferon-alpha and ribavirin and were only effective against HCV genotype 1 infections, had low barrier to resistance, and unfavorable side effects. These factors led to the discontinued use of these agents and introduction of newer DAA agents (Horsley-Silva & Vargas, 2017). Simeprevir was the DAA agent of choice starting at the end of 2013 and it was not a perfect treatment option but worked well in combination with sofosbuvir as the first viable, interferon free treatment regimen against HCV genotypes 1 and 4 infections (Horsley-Silva & Vargas, 2017). Other current treatment regimens include the use of nonstructural 5A complex inhibitors and nonstructural 5B polymerase inhibitors (Horsley-Silva & Vargas, 2017).Horsley-Silva, J. L., & Vargas, H. E. (2017). New Therapies for Hepatitis C Virus Infection. Gastroenterology & hepatology, 13(1), 22–31. Millman, A. J., Nelson, N. P., & Vellozzi, C. (2017). Hepatitis C: Review of the Epidemiology, Clinical Care, and Continued Challenges in the Direct Acting Antiviral Era. Current epidemiology reports, 4(2), 174–185. https://doi.org/10.1007/s40471-017-0108-xless2 UnreadUnread7 ViewsViews
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Kish, T., Aziz, A., & Sorio, M. (2017). Hepatitis C in a New Era: A Review of Current Therapies. P & T : a peer-reviewed journal for formulary management, 42(5), 316–329.
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Dennies Jones posted Feb 24, 2021 4:07 PM
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Hep C can progress to advanced liver disease if left untreated. In 15% to 20% ofinfection. Among those with cirrhosis, liver failure occurs in 20% to 30% andPrior to starting antiviral therapy, several bases- line laboratory tests need to be obtained. This includes a complete blood count, various tests of liver function (albumin, total and direct bilirubin, ALT, AST, alkaline phosphatase levels, and INR), calculated kidney function, HCV genotype and subtype, quantitative HCV RNA (HCV viral load), and HIV serology since coinfection complicates treatment ( Sulkowski, 2019, p. 56). Harding, Mariann M., Kwong, Jeffrey, Roberts, Dottie, Hagler, Debra, Reinisch, Courtney. Lewis’s Medical-Surgical Nursing E-Book (Kindle Locations 52504-52507). Elsevier Health Sciences. Sulkowski, M. S. (2019). New Options in the Treatment of Hepatitis C (HCV): Economic and Clinical Consideration for Improved Patient Outcomes. Journal of Managed Care Medicine, 22(2), 54–59. less2 UnreadUnread10 ViewsViews
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WONG, R., RUSSELL, C., & KRUGER, D. (2016). Hepatitis C virus infection: signs, symptoms, and screening. Clinical Advisor, 19(2), 37–44.
Sagnelli, E., Starace, M., Minichini, C., Pisaturo, M., Macera, M., Sagnelli, C., & Coppola, N. (2018). Resistance detection and re-treatment options in hepatitis C virus-related chronic liver diseases after DAA-treatment failure. Infection, 46(6), 761–783. https://doi-org.wilkes.idm.oclc.org/10.1007/s15010-018-1188-3
Pockros, P. J. (2021). Direct-acting antivirals for the treatment of hepatitis C virus infection. Retrieved February 24, 2021, from https://www.uptodate.com/contents/direct-acting-antivirals-for-the-treatment-of-hepatitis-c-virus-infection#
Kindle Edition.
Reference:
Sagneli et al. 2018 stated that “treatment of HCV infection has been revolutionized by the recent availability of the well-tolerated, potent directly acting antivirals (DAAs), which, used in combination, allow excellent chances for an HCV clearance, prevention of disease progression and reduction of both liver-related and overall mortality” (p. 762). There are four classes of DAAs, which are defined by their mechanism of action and therapeutic target. The four categories are nonstructural proteins 3/4A (NS3/4A) protease inhibitors (PIs), NS5B nucleoside polymerase inhibitors (NPIs), NS5B non-nucleoside polymerase inhibitors (NNPIs), and NS5A inhibitors (Pockros,2020). Pockros (2020) further explained that the main targets of the direct-acting antiviral agents are the HCV-encoded proteins vital to replicating the virus. The infectious viral structure is comprised of envelope glycoproteins in a lipid bilayer that contains the viral core protein and RNA.
hepatocellular carcinoma in 10% to 15% over ten years (Wong et al., 2016).
patients with chronic HCV, cirrhosis occurs within 15 to 40 years after the initial
According to Harding et al. (2020), “Hepatitis C virus (HCV) causes a type of hepatitis that can result in both acute illness and chronic infection. Acute hepatitis C, which can be mild in presentation, can be hard to detect unless a diagnosis is made with laboratory testing. The most common causes of acute hepatitis C outbreaks are among injection drug users and MSM with HIV infection” (p. 52499). Most patients experience dark urine, nausea, jaundice, and pain.
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Jazmin Jerez-Rivera posted Feb 24, 2021 1:18 PM
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There are an array of manifestations depending on the stage of the virus. It can range from a lack of symptoms to liver failure. Some early symptoms include jaundice, fatigue, malaise, gastrointestinal and respiratory symptoms (Huether et. al., 2020). Pain in the abdomen is caused by an enlarged liver and it is common to see clay-colored stool and dark urine. A study by Yarlott et. al. reveals chronic symptoms to be hepatic encephalopathy, liver cirrhosis that can lead to hepatocellular carcinoma, portal hypertension, neuroinflammation and neuro cognitive impairment (2016). Treatment for Hepatitis C is dependent on genotype, viral load and the extent of liver damage, but is primarily treated with antiviral medications. Peginterferon alfa and ribavirin was used for initial treatment, but there are currently direct acting medications depending on the genotype of the virus (Mathew et. al., 2016). Some treatment plans include fixed and combination therapies that include “paritaprevir/ritonavir/ ombitasvir plus dasabuvir [PrOD]” (Mathew et. al., 2016, p. 6). Treatment can last 12 to 24 weeks depending on severity of symptoms and liver cirrhosis. Liver transplantation can be considered for serious complications.Huether, S. E., McCance, K. L., Brashers, V. L. (2020). Understanding Pathophysiology (7 Ed.). Elsevier.Yarlott, L., Heald, E., & Forton, D. (2017). Hepatitis C virus infection, and neurological and psychiatric disorders–A review. Journal of Advanced Research, 8(2), 139-148.less1 UnreadUnread5 ViewsViews
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Mathew, S., Faheem, M., Ibrahim, S. M., Iqbal, W., Rauff, B., Fatima, K., & Qadri, I. (2016). Hepatitis C virus and neurological damage. World journal of hepatology, 8(12), 545–556. https://doi.org/10.4254/wjh.v8.i12.545
References
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Gisselle Mustiga posted Feb 25, 2021 10:56 AM
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Hepatitis C is a progressive viral disease of the early. This disease can be transmitted through blood and bodily fluids (Wong et al., 2016). Common modes of transmissions include unsterilized need sharing, occupational hazards, and household items (toothbrushes and razors). This disease may be asymptomatic when first infected, which is relatable with Mike. It can also be inferred that Mike was infected from illicit IV drug use. The initial manifestations of this disease can be limited to mild hepatomegaly. Mike’s blood work showed abnormal LFTs and positive Hep C, however are uncommonly found early on in the disease. The patient can develop liver cirrhosis anywhere from 15-40 years after the initial infection. Due to cirrhosis individuals can progress to liver failure and hepatocellular carcinoma. Some other manifestations include hypoalbuminemia with edema, ascites, fluid retention, lethargy, coagulopathy. Patients face other challenges including, nausea, vomiting, and pruritus. Imaging can show hepatomegaly with a decrease in nodule size. On physical exam jaundice, spider nevi, gynecomastia, and testicular atrophy can be noted. Another noted manifestation is non-healing skin ulcers, the study that reported this was based on one case study, more data will need to be collected in order to solidify these findings (Fraser, 2020). The infection may affect other organs such as the kidneys, skin, joints, and the nervous system (Wong et al., 2016). There have been some drugs approved by the FDA, Peginterferon alfa-2a, Peginterferon alfa-2b, and Ribavirin. Drug treatment utilized depends on the HCV genotype, viral load, comorbidities, presence of cirrhosis, and previously utilized treatments. Clinicians are trying to get a sustained virological response. This is an undetectable HCV-RNA level 24 weeks after the completion of the treatment therapy.Wong, R., Russell, C., & Kruger, D. (2016). Hepatitis C virus infection: signs, symptoms, and screening. Clinical Advisor, 19(2), 37–44. less1 UnreadUnread7 ViewsViews
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Last post February 27 at 10:02 AM by Candice Russell
Fraser, B. (2020). Chronic hepatitis C-related cryoglobulinaemic vasculitis manifesting as non-healing skin ulcers: a case presentation. Wound Practice & Research, 28(4), 181–188.
References
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Sheryl Dixon posted Feb 24, 2021 8:20 PM
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The major risk factors for Hepatitis C Virus (HCV) acquisition are injection drug use, receipt of a blood transfusion or organ transplant prior to 1992, exposure to an infected sexual partner, occupational needle stick injury, non-sterile tattooing, and mother-to-child transmission. During the past decade there has been a surge in the number of reported new annual acute HCV infections that in large part is attributable to the opioid epidemic and associated injection drug use. In addition, there has been recognition of a sexually transmitted hepatitis C epidemic among men who have sex with men (MSM), particularly men with HIV infection (Brau, 2013).Malaise, anorexia, and fatigue are common signs and symptoms, sometimes with low-grade fever and nonspecific upper abdominal discomfort. Jaundice is usually absent. A few patients with chronic hepatitis develop manifestations of cholestasis (eg, jaundice, pruritus, pale stools, and steatorrhea. Brau N. (2013). Evaluation of the hepatitis C virus-infected patient: the initial encounter. Clinical infectious diseases: an official publication of the Infectious Diseases Society of America, 56(6), 853–860. https://doi.org/10.1093/cid/cis957less1 UnreadUnread3 ViewsViews
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View profile card for Hilary Szpara
Last post February 25 at 11:45 AM by Hilary Szpara
Kim, A.I & Saab, S. (2019). Treatment of hepatitis C. Retrieved from https://www.amjmed.com/article/S0002-9343 (05)00335-9/pdf
References
The objective of therapy is to eradicate the virus and prevent potential complications from chronic hepatitis C infection. The risk of chronic disease in infected patients is greater than 80%.Among patients who develop chronic infection, 5% to 20% might develop cirrhosis, generally over the course of 20 to 30 years; among these cirrhotic patients, there is a 30% risk of developing decompensated liver disease after a decade, and a 1% to 2% yearly risk of developing hepatocellular carcinoma. Extra hepatic manifestations, such as cryoglobulinemia, that may lead to additional morbidity, and mortality must also be considered. Efficacy of the treatment is assessed by measurements of hepatitis C RNA viral load. The goal is to achieve a sustained virologic response, defined by the continued absence of hepatitis C RNA 6 months after the completion of treatment (Kim & Sab, 2019).
The only way to confirm a hepatitis C infection is through a blood test. The most common test is an HCV antibody test. A positive result means you’ve been exposed to the virus, but you may not have an infection. To confirm an HCV infection, you must undergo an HCV viral load test to check for genetic material (RNA)
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Aina Oluwo posted Feb 24, 2021 11:54 PM
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According to the center for disease control, Hepatitis C virus (HCV) infection affects millions of people in the United States and more studies over the years have shown that untreated Hepatitis C infections will eventually become chronic, which may progress to cirrhosis and complicated by hepatic de-compensation and hepatocellular carcinoma (HCC). In our case study patient Mike, he was essentially diagnosed with Hep C based on a lab order for LFT due to his use of depakote as Liver function tests (LFTs) are routinely performed for patients using valproic acid due to the risk of liver damage, but LFTs that are as high as Mike’s would be very unusual if related to his use of valproic acid (Gayam et al., 2018).Acute hepatitis C virus (HCV) infection should be suspected in patients with clinical labs or manifestations of acute hepatitis or with possible exposure to HCV (e.g., from a needle-stick). History from our patient gives a clear admission to illicit IV drug use approx. 8 weeks ago and with lab values as indicated with Mike’s ALT 1178 u/L and AST 746 u/L the clinical suspicion for Hep C is very high on the diagnosis. The ALT is normally <50 u/L in males and AST is >36 u/L in males or females (CDC, 2020). Additionally, he has elevated bilirubin and alkaline phosphatase levels which also point to liver disease. The confirmatory testing for Hep C will be the presence of HCV RNA and antibodies in the serum. The timing of testing is influenced by when HCV RNA and antibodies become detectable in the blood. As with our patient Mike, we note that his initial blood work for anti-HCV was negative on hospital day 1 however positive on day 3. A HCV-RNA PCR was then positive and all other Hepatitis marker were negative. This is likely due to the serology conversion time factor as acute hepatitis typically develops 35 to 72 days after exposure to hepatitis C virus (HCV), with a mean onset of 7 to 8 weeks (Huether et al., 2020). This is why the anti-HCV (antibodies to HCV) should be followed up by the HCV-RNA PCR quantitative polymerase chain reaction test to confirm the diagnosis of hepatitis C.
The clinical manifestation of Acute infection with Hep C can be deceptive as most patients are typically asymptomatic as seen with our patient Mike who denied any abdominal pain, nausea, vomiting or jaundice. These symptoms are typically notable in chronic hepatitis once the disease has progressed causing liver damage and injury. Hepatitis C virus is responsible for most persistent viral infections of the liver, chronic hepatitis, liver cirrhosis and/ or hepatocellular carcinoma. (Vashakidze et al 2016). Other manifestations of liver damage caused by hepatitis C virus (HCV) are fatigue, anorexia, headache, poor appetite, dark urine, jaundice, clay-colored stool, and liver pain upon palpation in the icteric phase which begins about 1 to 2 weeks after the prodromal phase (Huether et al., 2020). More advanced manifestations include fluid buildup in your abdomen (ascites), Confusion, drowsiness and slurred speech (hepatic encephalopathy). The strategies important to curtailing the rising prevalence of disease include the efficient diagnosis of acute hepatitis through adequate history taking and laboratory values and most importantly the management and treatment of the disease. The major treatment strategies for hepatitis C include direct-acting antiviral (DAA) therapy which is both low cost and effective (Shiha et al., 2020). The use of interferon-free, direct acting antiviral (DAA) agents for chronic HCV essentially result in sustained virologic response [SVR] and this is considered a functional cure for hepatitis. (Tang et al 2016)

References

Gayam, V., Mandal, A. K., Khalid, M., Shrestha, B., Garlapati, P., & Khalid, M. (2018).Valproic acid induced acute liver injury resulting in hepatic encephalopathy- a case reportand literature review. Journal of community hospital internal medicine perspectives, 8(5),311–314. https://doi.org/10.1080/20009666.2018.1514933

Hepatitis C questions and answers for health professionals. (2020, September 8). Centers forDisease Control and Prevention. https://www.cdc.gov/hepatitis/hcv/hcvfaq.htm#c3Huether, S., McCance, K., and Brashers, V. (2020). Understanding

Shiha, G., Soliman, R., Mikhail, N. N. H., & Easterbrook, P. (2020). An educate, test and treateffectiveness in 73 villages. Journal of Hepatology, 72(4), 658– infection. Infectious agents and cancer, 11, 29. https://doi.org/10.1186/s13027-016-0076-7Vashakidze, E., Mikadze, I., & Pachkoria, E. (2016). EPIDEMIOLOGY OF CLINICALLY(258), 37–39.less0 UnreadUnread

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MANIFESTED ACUTE HEPATITIS C CASES IN GEORGIA. Georgian medical news,
Tang, L., Marcell, L., & Kottilil, S. (2016). Systemic manifestations of hepatitis C

  1. https://doi.org/10.1016/j.jhep.2019.11.004
    model towards the elimination of hepatitis C infection in Egypt: Feasibility and
    Pathophysiology (7th ed.). Elsevier.
    Module 6 DiscussionSubscribe
    Eleany Yasein posted Feb 23, 2021 10:14 PM
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    Hepatitis C is a viral infection in the liver that is caused by hepatitis C RNA virus (Basit, 2021). It is a blood-borne disease that is linked with high morbidity and mortality. It affects about 185 million people in the world. There are many different types of genotypes of Hepatitis C virus. However, the most common genotype is genotype 1. This genotype is associated with liver cancer. Patients with acute hepatitis virus mostly do not show symptoms. However, some symptoms that are associated with acute hepatitis C virus infection include nausea, right upper quadrant pain, malaise and jaundice. Chronic hepatitis C is associated with symptoms of end-stage liver disease. These signs and symptoms include temporal muscle wasting, ankle edema, cyanosis, clubbing, gynecomastia, small testes, enlarged parotid gland, neurocognitive changes and hepatosplenomegaly. Moreover, esophageal varices, ascites, coagulopathy, and encephalopathy can be seen in some patients (Basit, 2021). Direct-acting antiviral (DAA) agents have shown improvements in treating hepatitis C (Horsley-Silva & Vargas, 2017). These medications block virus replication and achieve progressive clearance of the virus. There are different class of DAAs, and each class of medication act on different viral targets. The classes of DAAs include NS3/4A protease inhibitors, NS5A inhibitors, and NS5B polymerase inhibitors (Horsley-Silva & Vargas, 2017).References less0 UnreadUnread
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    Horsley-Silva, L. J., & Vargas, E. H., (2017, January 13). New Therapies for Hepatitis C Virus Infection. Gastroenterology & Hepatology, 13(1), 22-31. Retrieved from https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5390323/
    Basit, H., Tyagi, I., & Koirala, J. (2021, January 24). Hepatitis C. Retrieved from StatPearls website: https://www.ncbi.nlm.nih.gov/books/NBK430897/
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    Candice Russell posted Feb 23, 2021 6:11 PM
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    The Centers for Disease Control and Prevention (CDC) defined Hepatitis as inflammation of the liver. Liver inflammation or damage can greatly diminish its function. The many causes of hepatitis are alcohol use, toxins, medications, and medical conditions. Hepatitis is most commonly caused by a virus. Huether (2020) described viral hepatitis as a “relatively common systemic disease that affects primarily the liver” (p. 903). Huether (2020) further states various strains of the virus cause different types of hepatitis. Hepatitis C (HCV), along with hepatitis B (HBV) is the most common cause of hepatitis. Prevention is the best form of treatment. Stopping the use of illicit drugs, using caution during performance of body art and the practice of safe sex, are some of the ways to decrease your risk of contracting HCV. The U.S. Preventive Service Task Force recommends screening for hepatitis C, for ages ranging from 18 to 79. It is documented that HCV is curable. Interferon injections and oral treatment with ribavirin, are older forms of treatment. These medications were said to boost the immune system, however, did not target the virus.WebMD noted the different genotypes of hepatitis C and documented not all treatment works on all genotypes. Chayama et al. (2016) documented “HCV genotype 1 is the most common genotype worldwide and the most difficult to treat with interferon-based therapy. The therapy for patients with chronic HCV infection is complicated by poor tolerability and inadequate rates of sustained virological response (SVR)” (p. 153). The types of treatment and effectiveness of treatment is also dependent on how advanced the disease and how damaged the liver is. Zajac et al. (2019, p. 230) stated “before treatment, in order to prescribe a suitable medication regimen, patients are examined for the presence of the following” anti-HCV antiantiboides, genetic material in the blood, virus genotype, baseline viral load, extent of hepatic fibrosis, presence of co-existing diseases, and thyroid activity. New “direct-acting” antiviral medications or new “virus-specific direct-acting” antivirals have been developed. “The next advance in HCV therapy was the development of direct‐acting antivirals (DAAs), which strongly inhibit replication of HCV by directly targeting essential viral proteins” (Chayama, et al., 2016, p. 153). People are experiencing fewer side effects and better outcomes. After liver transplant the rate of hepatitis C-related disease progression and increases in viral load, are generally faster than in hepatitis C infected pre-transplant patient. This is due to the body’s lower resistance to fighting the virus caused by the immunosuppressant drugs. As with hepatitis C infection before transplant, the outcome varies significantly between individuals. (Hepatitis C Trust, n.d.) Chayama, K., Imamura, M., & Hayes, C. N. (2016). Hepatitis C virus treatment update — A new era of all‐oral HCV treatment. Advances in Digestive Medicine, 3(4), 153-160. https://doi.org/10.1016/j.aidm.2016.03.002Recurrence of hepatitis C after a transplant. Hepatitis C Trust. http://www.hepctrust.org.uk/information/treatment/liver-transplants/recurrence-hcv-after-transplant.Zając, M., Muszalska, I., Sobczak, A., Dadej, A., Tomczak, S., & Jelińska, A. (2019). Hepatitis C – new drugs and treatment prospects. European Journal of Medicinal Chemistry, 165, 225-249. https://doi.org/10.1016/j.ejmech.2019.01.025 less0 UnreadUnread
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    WebMD. (2020, October 13). Hepatitis C Treatment Options. WebMD. https://www.webmd.com/hepatitis/understanding-hepatitis-c-treatment.
    Huether, S. E., McCance, K. L., & Brashers, V. L. (2020). Understanding pathophysiology / Sue E. Huether, Kathryn L. McCance ; section editor, Valentina L. Brashers (7th ed.). Elsevier.
    Centers for Disease Control and Prevention. (2020, August 7). Hepatitis C Questions and Answers for Health Professionals. Centers for Disease Control and Prevention. https://www.cdc.gov/hepatitis/hcv/hcvfaq.htm#d1.
    Reference:
    The use of new medication, paired with older medication, has been the treatment for some. With the newer medication, comes shorter treatment time, for many, as little as 8 weeks. Treatment is said to be successful if no virus is detected in the blood, 12 weeks after treatment completion. In advanced disease states liver transplantation may be the treatment of choice. Reoccurrence of hepatitis C is possible after a liver transplant, due to low levels of hep C genetic material that remains in the body.
    Huether (2020) states “clinical manifestations of the various types of hepatitis are very similar. The spectrum of manifestations ranges from absence of symptoms to fulminating hepatitis, with rapid onset of liver failure and coma” (p. 904). There are three stages in the clinical course of viral hepatitis, phases are proceeded by the incubation phase. New signs and symptoms develop with each phase, some symptoms continuing into the next phase can become more severe. Those with acute, or newly acquired, HCV are commonly asymptomatic or present with mild symptoms. Some signs and symptoms are fever, fatigue, dark-colored urine, clay-colored stool, abdominal pain/discomfort, loss of appetite, nausea, vomiting, joint pain, jaundice, and headache. Enlarged liver with pain and discomfort during percussion and palpation is evident during later phases. Chronic HCV infection may produce no symptoms or have non-specific symptoms, such as fatigue and depression. WebMD’s list of chronic hepatitis C symptoms includes ascites, easy bleeding, easy bruising, hepatic encephalopathy, hives, rashes, itchy skin, spider angiomas, swelling of lower extremities, and weight loss. Chronic infection can lead to chronic liver disease, which ranges in severity, slowly progressing to cirrhosis and liver cancer. Abnormal liver enzymes, AST and ALT, are elevated in acute viral hepatitis, however, “not consistent with the extent of cellular damage” (Heuther, 2020, p. 904).
    Hepatitis C is a liver infection caused by the hepatitis C virus (HCV), the virus is found primarily in the blood and some body fluids. HCV is spread, most commonly, through direct percutaneous transmission, even with small amounts of blood. When blood from an infected person enters the body of someone who is not infected, HCV transmission can occur. HCV can be transmitted through sharing items, such as drug use equipment. Injection of “street” drugs from syringes, needles, and tourniquets. The use of pipes to smoke or snort drugs can have blood on it. Contaminated blood can be spread by the use of used, nonsterile, tattoo, and piercing tools. The spread of infection through blood transfusions is still common in some countries. Nonsterile or improperly cleaned medical equipment, in between use, can spread HCV as well. There are many other ways of spreading the virus through sharing of or improper disposal of grooming and hygiene items, through pregnancy and birth, needle stick injuries, and with low incidence through unprotected sex.
    Hepatitis CSubscribe
    Tallona Boddy posted Feb 22, 2021 3:46 PM
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    Mike is a 23 year old male recently diagnosed with Hepatitis C (HCV). A common mode of transmission for HCV is illicit drug use (Center for Disease Control and Prevention, 2020b). It is common for HCV positive patients to be asymptomatic (Center for Disease Control and Prevention, 2020a). If a HCV positive person does experience symptoms it is typically after liver damage has already occurred. Some of these symptoms include nausea, dark urine, itchy skin, jaundice and poor appetite (Mayo Clinic, n.d.). Due to the prevalence of asymptomatic HCV it is imperative for the health-care provider to screen the patient for any behaviors that may increase a patient’s exposure to HCV, such as, illicit drug use. It appears that Mike’s HCV at this point has a newer onset and is not yet chronic, as evidenced by his initial anti-HCV negative result on his day 1 hospital stay. For the initial treatment (a patient that has not had HCV in the past) a regimen of Glecaprevir (300 mg) / pibrentasvir (120 mg )could be prescribed with a dosing regimen of 8 weeks. Sofosbuvir (400 mg) / velpatasvir (100 mg) for 12 weeks is the other potential medication regimen recommended for the initial treatment of HCV (American Association, 2020). 12 weeks or later, after the patient has completed his prescribed medication regimen a HCV RNA lab draw should be ordered to confirm that HCV is no longer detectable (American Association, 2020). American Association for the Study of Liver Diseases and the Infectious Diseases Society of America. (2020, August 27). Simplified HCV treatment for treatment-naive adults without cirrhosis. https://www.hcvhttps://www.cdc.gov/hepatitis/hcv/index.htmguidelines.org/treatment-naive/simplified-treatmenCenters for Disease Control and Prevention. (2020b, August 7). Hepatitis C questions and answers for healthcare professionals. https://www.cdc.gov/hepatitis/hcv/hcvfaq.htm#b8 less1 UnreadUnread2 ViewsViews
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    View profile card for Amandeep Kaur
    Last post February 23 at 11:12 AM by Amandeep Kaur
    Mayo Clinic. (n.d.) Hepatitis C. https://www.mayoclinic.org/diseases-conditions/hepatitis-c/symptoms-causes/syc-20354278
    Centers for Disease Control and Prevention. (2020a, July 28). Hepatitis C. https://www.cdc.gov/hepatitis/hcv/index.htm
    References
    Fritzinger Discussion Wk 6Subscribe
    Cassie Fritzinger posted Feb 23, 2021 12:07 AM
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    Hepatitis is a viral disease which is common, and this disease affects the liver. There are five types of hepatitis A, B, C, D, & E with Hepatitis B & C being the most common cause of patient’s experiencing acute illnesses. For the purpose of this discussion, we will take a closer look at Hepatitis C Virus (HCV). The route of transmission for HCV is through contact of infected body fluids through broken skin or mucus membranes, another route of transmission includes intravenously such as the use hypodermic needles which are shared between patients who are infected with the disease (Heuther, McCance, & Brasher, 2020). As the most common chronic bloodborne infection reported by the CDC in 2016 acute HCV often leads progressively to a chronic condition and ultimately can lead to increased risks of cirrhosis, liver cancer, and the potential need for liver transplants. Unlike some of the other hepatitis’ there is no vaccine for HCV (Chaney, 2019).Treatment goals for patients with HCV include clearance of detectible levels of antibodies or HCV RNA which occurs about 12 weeks after completion of treatment. However, because patients are often not diagnosed in their acute phase many patient’s progress to chronic HCV and further liver failure occurs (Heuther, McCance & Brasher, 2020). Direct acting antivirals are molecules targeting nonstructural proteins at a specific step in the HCV life cycle which results in a disruption of viral replication. These are four classes of direct acting antivirals, nonstructural proteins (NS3/4A) protease inhibitors (PIs), nucleoside polymerase inhibitors (NPIs) and non-nucleoside polymerase inhibitors (NNPIs) (Pockros, 2019). In order to have successful treatment it is important to identify the genotype of the HCV. The direct acting antiviral protease inhibitors boceprevir and telaprevir began as treatments for HCV in 2011 which was found to be more efficacious than historical interferon and ribavirin which had a low cure rate and significant adverse reactions. Others were created since that time including those known as pangenotypic drugs which have been developed to treat all 6 HCV genotypes with a 90-98% cure rate (Chaney, 2019).The patient Mike in our case study this week was diagnosed with Hepatitis C after having a positive HCV RNA panel and HCV Antibody test on day 3 of his hospitalization. While he presented to the hospital for depression and his routine labs indicated elevated liver function tests prompting further investigation for hepatitis, specifically with the reported risk factor of Illicit IV drug use. The patient is also on medications such as the valproate (Depakote) which has a box warning for hepatotoxic (PDR.net), and the fluoxetine (Prozac) has been found to cause cytolytic hepatitis and should be considered for discontinuation should this be suspected (Cai, Talbot, Devadas, Swanson, Olson, & Kirchner, 1999). Since the patient is asymptomatic and yet has positive antibody levels for HCV, I would suspect he is in the acute HCV prodromal phase which begins about 2 weeks after exposure and continues through presentation of symptoms. This is also the time which the HCV is highly transmissible (Heuther, McCance, & Brasher, 2020). With Mike presenting with increased depression care must be taken in adding or adjusting any medications since many antidepressants are metabolized and affect the liver. Dose adjustments may be needed, and certain medications should be avoided completely. This is again another reason for the patient to be cared for by the multi-disciplinary team including the pharmacist who would have a much better understanding of medications and the risks associated to their use with elevated liver function tests, and HCV. Chaney, A. (2019). Caring for patients with chronic hepatitis C infection. Nursing 2019. 49(3) 36-42. Doi: 10.1097/01.NURSE.0000553271.39804.a4Davis, C. (2021). Liver Function Tests (Normal, Low, and High Ranges & Results) Medicine Net Retrieved February 20, 2021 from https://www.medicinenet.com/liver_blood_tests/article.htmPDR.net. (2000). Depakote ER (divalproex sodium) – Full Prescribing Information. Retrieved February 20, 2021 from https://www.pdr.net/full-prescribing-information/Depakote-ER-divalproex-sodium-10#section-!
    Pockros, P. (2019). Direct-acting antivirals for the treatment of hepatitis C virus infection. Up To Date. Retrieved February 21, 2021 from https://uptodate.com/contents/direct-acting-antivirals-for-the-treatment-of-hepatitis-c-virus-infection#
    Heuther, S. E., McCance, K. L., & Brashers, V. L. (2020). Understanding Pathophysiology (7th ed.). Elsevier.
    Cai, Q., Benson, M., Talbot, T. Devadas, G., Swanson, H., Olson, J., & Kirchner, J. (1999). Acute Hepatitis Due to Fluoxetine Therapy. Mayo Clinic Proceedings 74(7) p692-694. https://doi.org/10.4065/74.7.692
    References
    Patient success depends greatly on their compliance with life-style recommendations, coordination or a multi-disciplinary team including a mental health professional, substance abuse specialist, case manager, pharmacy and HCV specialists such as a hepatologist or gastroenterologist. Patient’s and their families should all be involved in patient education regarding risks/routes of transmission, importance of avoiding hepatotoxic substances such as alcohol, and the importance of vaccines for other hepatitis viruses (Chaney, 2019).
    The acute phase of HCV is often asymptomatic, and those who are symptomatic will often experience abdominal pain, fatigue, anorexia and/or jaundice. The single-stranded ribonucleic acid (RNA) virus which is unstable and has over 50 different subtypes of six major genotypes. This creates the inability for the body’s immune system to attack the virus effectively. The HCV virus attacks the liver targeting B lymphocytes and hepatocytes which leads to an inflammatory response creating fibrosis (Chaney, 2019). Following exposure to HCV, there is an incubation period is 35-72 days (Heuther, McCance, & Brasher, 2020), and HCV antibodies or HCV RNA can be detected approximately 2-3 weeks after the exposure (Chaney, 2019). Patients who are immunocompromised or on hemodialysis may not have detectable antibodies in their blood, thus they will need to have the HCV RNA testing performed to rule out HCV infection (Chaney, 2019). Other common testing which will be done is geared toward determining the extent of damage to the liver. Some of these studies will include but not limited to lab studies: complete metabolic panel (CMP), complete blood count (CBC) international normalized ratio (INR), Alanine transaminase (ALT), aspartate aminotransferase (AST), Albumin, Bilirubin, as well as diagnostic studies such as magnetic resonance elastography (MRE) or transient elastography both of which are less invasive than a liver biopsy which has increased potential for side effects (Davis, 2021). It is important to note that those patients with chronic HCV may have normal liver function tests because the body has compensated over a longer period of time (Chaney, 2019).

Hepatitis C is a long-term viral infection that affects about 185 million people globally. Approximately 215,000 people have this disease in the U.S. (Tang et al. 2016). It is associated with liver inflammation, which may sometimes lead to serious and severe liver damages. The disease spread through contaminated blood (Huether et al. 2020). Some of the major signs and symptoms of this condition include loss of appetite, flu-like symptoms, fatigue, abdominal pain, jaundice, weight loss, and confusion. These symptoms can sometimes be mistaken for other conditions since the disease doesn’t show noticeable symptoms until it damages the liver.The treatment plan for individuals with chronic hepatitis c involves taking prescription drugs to fight the virus, testing for liver damages, and lifestyle changes to reduce the disease’s severity. Treatment involves taking direct-acting antiviral tablets (DAA), which are believed to be the most effective and safest medicines available in the healthcare system. Patients should take these medications between 8 and 12 weeks (NHS, 2021). Some of these drugs include simeprevir, sofosbuvir, and their combinations.Huether, S., McCance, K. L. & Brashers, V. L. (2020). Understanding Pathophysiology 7th ed. Elsevier Mosby.Tang, L., Marcell, L., & Kottilil, S. (2016). Systemic manifestations of hepatitis C infection. Infectious agents and cancer, 11(1), 1-8. https://core.ac.us/download/pdf/81269554.pdf less1 UnreadUnread2 ViewsViews
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View profile card for Alfonsina Perez
Last post February 28 at 2:08 AM by Alfonsina Perez

NHS, (2021). Treatment: Hepatitis C. NHS.us. https://www.nhs.us/conditions/hepatitis-c/treatment/
References
The first clinical manifestation seen in hepatitis c is a mixed cryoglobulinemic syndrome, which can affect the patients’ blood vessels and manifest on other body organs including the kidney and skin. The second manifestation is B cell Non-Hodgkin’s lymphoma, which is highly associated with chronic HCV infection since 1994 (Tang et al. 2016). The other manifestations are diabetes mellites type 2 and kidney damage. Several researchers have proved that there is an association between HCV, diabetes and increased insulin resistance. HCV can also affect the brain leading to neurological impairment. The other manifestations include sicca syndrome, thyroid abnormalities, Mooren’s corneal ulcers, skin manifestations such as Porphyria cutanea tarda, Neuropsychiatric disorders, and Cardiovascular disease.
Hepatitis C the silent chronicitySubscribe
Caroline Otto posted Feb 25, 2021 6:26 PM
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The overall prevalence of chronic hepatitis C virus (HCV) infection has been estimated at between 1.2% and 1.7% in the adult global population. This suggests that 62 -89 million people are affected by this disease (Kish, Aziz, & Sorio, 2017).People who are exposed to HCV have an estimated 75% to 85% likelihood of developing chronic infection. The Clinical Manifestations for hepatitis C are similar with all the different strains because they all cause inflammation of the liver, thereby causing symptoms that are similar. These similar symptoms include jaundice, nausea, dark urine, and right upper quadrant pain (Huether, McCance, & Brashers. 2020). Patients who are acutely infected will have moderate to high serum; aminotransferase elevations, and aspartate transaminase (AST), and alanine transaminase (ALT) levels.The first phase is known as the Prodromal -preicteric phase beginning about 2 weeks after exposure and ending with jaundice, often marked with fatigue, anorexia, malaise, nausea, vomiting, headache, a cough, and a low-grade fever. It is during this phase that the patient has the highest ability to transmit the virus to others.The recovery phase is the third phase beginning with the dissolution of the jaundice, six to eight weeks after the initial exposure. The overall symptoms dissipate; however, the liver remains enlarged and tender. It is during this phase that the liver function and enzymes return to normal, two to twelve weeks after the onset of jaundice.The diagnosis of HCV infection is based on the presence of anti-HCV antibodies. HCV RNA quantification is important for assessment of the viral load to evaluate antiviral therapy for chronic HCV infection. To date there is no HCV vaccine in the USA. Primary health care is paramount. Individuals who exhibit high risk behaviors such as intravenous drug abuse should be identified and screened to improve overall healthcare outcomes. Treatment is costly. The overall management of this dreadful disease depends on an easily accessible health system that is available to everyone. Horsley-Silva, J. L., & Vargas, H. E. (2017). New Therapies for Hepatitis C Virus Infection. Gastroenterology & hepatology, 13(1), 22–31 Kish, T., Aziz, A., & Sorio, M. (2017). Hepatitis C in a New Era: A Review of Current Therapies. P & T : a peer-reviewed journal for formulary management, 42(5), 316–329.less1 UnreadUnread3 ViewsViews
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View profile card for Tallona Boddy
Last post February 27 at 9:55 PM by Tallona Boddy
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Huether, S. E., McCance, K.L. & Brashers, V.L. (2020). Understanding Pathophysiology 7th ed. Elsevier Mosby
References:
In short, Acute HCV has devastating consequences, as it often goes undiagnosed, and causes irreparable damage often resulting in Chronic Hepatitis C and Liver Failure. Patients who are infected often do not realize they have the disease and are not tested. Furthermore, the symptoms are vague and are not disease specific.
In the past HCV was treated with pegylated-interferon (PEG-IFN) alpha plus ribavirin (RBV) which was historically given for 24 or 48 weeks. However, this combination was not that successful and had some nasty side effects such as hemolytic anemia, flu-like symptoms, and psychiatric disturbances. There have been other treatments since then, but it was through a paradigm shift which occurred in late 2013 that Simeprevir (Olysio, Janssen) and sofosbuvir (Sovaldi, Gilead Sciences); which were released within weeks of one another, created the first oral once-daily treatments that were well tolerated and were able to produce sustained virologic response SVR rates greater than 90% either together in combination or with PEG-IFN plus RBV in select genotypes (Horsley-Silva & Vargas, 2017).
The second phase is known as the Icteric phase and it begins one to two weeks after the prodromal phase and lasts up to six weeks, with jaundice, dark urine, and clay-colored stools. On physical examination the patient’s liver will be found to be enlarged, smooth, and tender, and percussion or palpation of the livers causes pain. The patient will still have fatigue as well as abdominal pain which will be persistent or will increase in severity. This phase is seen as the actual phase of the illness. Patients who develop chronic HCV infection will not exhibit signs of jaundice here and may never actually be diagnosed.
The clinical course of hepatitis usually has three phases which follows through after the incubation phase.
If it were not for Mikes severe depression that caused him to seek out medical care, his Hepatitis C diagnosis would probably have gone unnoticed. Most patients who are acutely infected with HCV are asymptomatic (Huether, McCance, & Brashers, pg. 904).
Discussion 6Subscribe
Alfonsina Perez posted Feb 24, 2021 3:54 PM
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Hepatitis C is defined as an inflammatory process of the liver caused by the hepatitis C virus (Dirchwold et al., 2017. Patients with hepatitis C have an increased level in their Alaine Aminotransferase (ALT) of over ten times what is considered within normal limits (Dirchwold et al., 2017). Complications associated with chronic infection of the hepatitis C virus include hepatic fibrosis, liver cirrhosis, and hepatic carcinoma (Zhao et al., 2018). Unfortunately, many patients, about 85% of those with acute hepatitis, will develop chronic hepatitis. The high risk of developing chronic hepatitis is due to the fact that many patients with acute hepatitis do not show any symptoms until infection has developed into a chronic one (Zhao et al., 2018). Acute hepatitis C is when the infection occurs within 6 months of exposure (Huether et al., 2020). Chronic hepatitis C is lifelong, often leading to complications. Some of the symptoms associated with hepatitis C infection include abdominal pain, fatigue, sleep disturbance, depression, musculoskeletal pain and jaundice (Evon et al., 2019). Petta, N. G., Borzi, S., Tanno, F., Ridruejo, E., Barreyro, F., Shulman, C., Plaza, P.,Evon, D. M., Sarkar, S., Amador, J., Lok, A. S., Sterling, R. K., Stewart, P. W., Reeve, B. B.,Harrington, P. R., Komatsu, T. E., Deming, D. J., Donaldson, E. F., O’Rear, J. J., & Naeger, L.Huether, S. E., McCance, K. L. & Brashers, V. L. (2020). Understanding Zhao, N., Zheng, W., Wu, D., Wang, X., Yang, W., Yuan, L., Niu, Z., Jiang, X., Huang, F., &hepatitis C spontaneous clearance or treatment‐induced clearance. Journal of Medicalless1 UnreadUnread5 ViewsViews
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View profile card for Dennies Jones
Last post February 27 at 1:17 PM by Dennies Jones
Virology, 90(12), 1787-1792. https://doi.org/10.1002/jmv.25256
Li, Z. (2018). Clinical value of hepatitis C virus core antigen levels in monitoring acute
Pathophysiology 7th ed. Elsevier Mosby.
K. (2018;2017;). Impact of hepatitis C virus polymorphisms on direct‐acting antiviral treatment efficacy: Regulatory analyses and perspectives. Hepatology (Baltimore, Md.), 67(6), 2430-2448. https://doi.org/10.1002/hep.29693
Serper, M., Reau, N., Rajender Reddy, K., Di Bisceglie, A. M., Nelson, D. R., Golin, C. E., Lim, J. K., & Fried, M. W. (2019). Patient-reported symptoms during and after direct-acting antiviral therapies for chronic hepatitis C: The PROP UP study. Journal of Hepatology, 71(3), 486-497. https://doi.org/10.1016/j.jhep.2019.04.016
Carbonetti, R., Tadey, L., Schroder, T., & Fainboim, H. (2017). Clinical epidemiology of acute hepatitis C in south america. Journal of Medical Virology, 89(2), 276-283. https://doi.org/10.1002/jmv.24588
Dirchwolf, M., Marciano, S., Mauro, E., Ruf, A. E., Rezzonico, L., Anders, M., Chiodi, D.,
References
Although hepatitis C may not always require treatment as the person’s immunity may be able to clear the infection, antiviral medication may be prescribed in instances when treatment is required. Pan- genotype direct-acting antivirals (DAA’s) are the treatment of choice of hepatitis C (Harrington et al., 2018).

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