For all my criticism of them (which still stands), at least the CDC has easily-accessible information on the basics. Robertson stopped evaluating the extent of Davon's liver disease - and possible co-morbid conditions - when he should have kept going. He still needs the genotyping done to make sure he doesn't have more than one strain of HCV, and to determine the likelihood that he'll even respond to treatment. And in light of the increased risk for disorders like diabetes (and his weight loss and fatigue), his glucose should be monitored more regularly to determine what his ranges are. Davon should also be treated like a human being, not a veterinary specimen - no one seems to really be trying to educate him on his medical condition or lab results, or even ask him about his fatigue, weight loss, headaches, etc. despite hearing concerns from Julie multiple times a week.
CDC HCV FAQs:
Who should be tested for HCV infection?
HCV testing is recommended for anyone at increased risk for HCV infection, including:
- Persons who have ever injected illegal drugs, including those who injected only once many years ago
- Recipients of clotting factor concentrates made before 1987
- Recipients of blood transfusions or solid organ transplants before July 1992
- Patients who have ever received long-term hemodialysis treatment
- Persons with known exposures to HCV, such as
- healthcare workers after needlesticks involving HCV-positive blood
- recipients of blood or organs from a donor who later tested HCV-positive
- All persons with HIV infection
- Patients with signs or symptoms of liver disease (e.g., abnormal liver enzyme tests)
- Children born to HCV-positive mothers (to avoid detecting maternal antibody, these children should not be tested before age 18 months)
What blood tests are used to detect HCV infection?
Several blood tests are performed to test for HCV infection, including:
- Screening tests for antibody to HCV (anti-HCV)
- enzyme immunoassay (EIA)
- enhanced chemiluminescence immunoassay (CIA)
- Recombinant immunoblot assay (RIBA)
- Qualitative tests to detect presence or absence of virus (HCV RNA polymerase chain reaction [PCR])
- Quantitative tests to detect amount (titer) of virus (HCV RNA PCR)
How do I interpret the different tests for HCV infection?
A table on the interpretation of HCV test results is available at http://www.cdc.gov/hepatitis/HCV/PDFs/hcv_graph.pdf [PDF - 1 page].
Is an algorithm for HCV diagnosis available?
A flow chart on HCV infection testing for diagnosis is available at http://www.cdc.gov/hepatitis/HCV/PDFs/hcv_flow.pdf [PDF - 1 page].
What is the next step after a confirmed positive anti-HCV test?
The level of ALT (alanine aminotransferase, a liver enzyme) in the blood should be measured. An elevated ALT indicates inflammation of the liver. The patient should be checked further for chronic liver disease and possible treatment. The evaluation should be performed by a healthcare professional familiar with chronic Hepatitis C.
Can a patient have a normal liver enzyme (e.g., ALT) level and still have chronic Hepatitis C?
Yes. It is common for patients with chronic Hepatitis C to have liver enzyme levels that go up and down, with periodic returns to normal or near normal levels. Liver enzyme levels can remain normal for over a year despite chronic liver disease.
Management and Treatment
What should be done for a patient with confirmed HCV infection?
HCV-positive persons should be evaluated (by referral or consultation, if appropriate) for presence of chronic liver disease, including assessment of liver function tests, evaluation for severity of liver disease and possible treatment, and determination of the need for Hepatitis A and Hepatitis B vaccination.
When might a specialist be consulted in the management of HCV-infected persons?
Any physician who manages a person with Hepatitis C should be knowledgeable and current on all aspects of the care of a person with Hepatitis C; this can include some internal medicine and family practice physicians as well as specialists such as infectious disease physicians, gastroenterologists, or hepatologists.
What is the treatment for chronic Hepatitis C?
Combination therapy with pegylated interferon and ribavirin is the treatment of choice, resulting in sustained virologic response (defined as undetectable HCV RNA in the patient's blood 24 weeks after the end of treatment) rates of 40%–80% (up to 50% for patients infected with genotype 1, the most common genotype found in the United States, and up to 80% for patients infected with genotypes 2 or 3). Combination therapy using interferon and ribavirin is FDA-approved for use in children ages 3–17 years. Treatment success rates are now being improved with the addition of polymerase and protease inhibitors to standard pegylated interferon/ribavirin combination therapy.
How many different genotypes of HCV exist?
At least six distinct HCV genotypes (genotypes 1–6) and more than 50 subtypes have been identified. Genotype 1 is the most common HCV genotype in the United States.
Is it necessary to do viral genotyping when managing a person with chronic Hepatitis C?
Yes. Because there are at least six known genotypes and more than 50 subtypes of HCV, genotype information is helpful in defining the epidemiology of Hepatitis C and in making recommendations regarding treatment. Knowing the genotype can help predict the likelihood of treatment response and, in many cases, determine the duration of treatment.
- Patients with genotypes 2 and 3 are almost three times more likely than patients with genotype 1 to respond to therapy with alpha interferon or the combination of alpha interferon and ribavirin
- When using combination therapy, the recommended duration of treatment depends on the genotype. For patients with genotypes 2 and 3, a 24-week course of combination treatment is adequate, whereas for patients with genotype 1, a 48-week course is recommended.
Once the genotype is identified, it need not be tested again; genotypes do not change during the course of infection.
Can superinfection with more than one genotype of HCV occur?
Superinfection is possible if risk behaviors (e.g., injection drug use) for HCV infection continue, but it is believed to be very uncommon.
Does chronic Hepatitis C affect only the liver?
A small percentage of persons with chronic HCV infection develop medical conditions due to Hepatitis C that are not limited to the liver. These conditions are thought to be attributable to the body's immune response to HCV infection. Such conditions can include
- Diabetes mellitus, which occurs three times more frequently in HCV-infected persons
- Glomerulonephritis, a type of kidney disease caused by inflammation of the kidney
- Essential mixed cryoglobulinemia, a condition involving the presence of abnormal proteins in the blood
- Porphyria cutanea tarda, an abnormality in heme production that causes skin fragility and blistering
- Non-Hodgkins lymphoma, which might occur somewhat more frequently in HCV-infected persons
Where can I find more information about management and treatment of patients with chronic Hepatitis C?
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