Hepatitis C — Work-Up

If Hep C Antibody Positive, order:   HepC Viral Load  [HCV RNA by PCR]
  • Order it “Qualitative, with Reflex to Quantitative”

RESULTS

Undetectable “qualitative” HCV RNA means  NO Chronic Hep C

Detectable HCV RNA means  Chronic Hep C  Infection
  • If too low to quantitate, repeat in 6 mos. to R/O acute infection en route to resolution
HCV RNA level is prognostic for response to Tx
  • <1,000,000 is better than >1-3 million
Genotype is prognostic for response to Tx
  • Genotypes 2 & 3 respond much better than 1 & 4
  • All Genotypes have same disease-progression
Progression of untreated Chronic Hep C  (“ballpark” numbers)
  • 10% develop cirrhosis in 10 years
  • 30% develop cirrhosis in 30 years
  • 50% develop cirrhosis in 50 years
  • Cirrhosis usually fatal within 5 years
  • Hepatocellular Carcinoma usually only occurs after cirrhosis
Liver Biopsy  —  Stages of Fibrosis
  • Stage 1 = No liver damage
  • Stage 2 = Mild damage, ? repeat biopsy in 4-5 yrs.
  • Stage 3 = Significant damage, urge Tx
  • Stage 4 = Cirrhosis; poor response to Tx
  • “Inflammation” (Grades 1-4) estimates likelihood of future progression of fibrosis
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