True statement regarding hepatitis C infection:
Most patients have severe symptoms when infected for first time
Highly likely to cause chronic ongoing infection
Transmitted by eating raw oysters
It is DNA virus
Ans: (b) Highly likely to cause chronic ongoing infectionRef: Harrison's Principles of Internal Medicine, 19th edition, Page 2040; Sleisenger and Fordtran's Gastrointestinal and Liver Disease, Page 1332Acute hepatitis C is rarely seen in clinical practice, because nearly all cases are asymptomatic.Chronic hepatitis C follows acute hepatitis C in 50-70% of cases20-25% of patients with chronic hepatitis C progress to cirrhosisProgression of liver disease depends on:AgeLonger duration of infection - most important factorConcomitant other liver diseaseObesityHIV infectionLong-term prognosis for chronic hepatitis C in a majority of patients is relatively benign o The best prognostic indicator in chronic hepatitis C is liver histologyAminotransferase levels tend to fluctuate more (the characteristic episodic pattern of aminotransferase activity)Interesting and occasionally confusing finding in patients with chronic hepatitis C is the presence of autoantibodies Anti LKMDrugs used in the treatment of hepatitis C infection: PEG IFN-a plus ribavirinAgentGenotype(s)DoseCommentProtease InhibitorsBoceprevir1800 mg three times dailyUsed in combination with pegylated interferon and ribavirin; no longer recommendedTelaprevir11125 mg twice dailyUsed in combination with pegylated interferon and ribavirin; no longer recommendedSimeprevir1 and 4150 mg once dailyUsed in combination with pegylated interferon and ribavirin or with sofosbuvirParitaprevir1 and 4150 mg once dailyUsed in combination with ombitasvir and dasabuvir; ritonavir boostedAsunaprevir1 and 4200 mg twice dailyUsed in combination with daclatasvir or with daclatasvir and BMS-791324Grazoprevir1,2, 4-6100 mg once dailyUsed in combination with eibasvirNon-nucleos(t)ide Polymerase InhibitorsDasabuvir1 and 4250 mg twice dailyUsed in combination with paritaprevir and ombitasvirBMS-791325175 mg twice dailyUsed in combination with daclatasvir and asunaprevirNucleos(t)ide Polymerase InhibitorSofosbuvir1-6400 mg once dailyUsed in combination with pegylated interferon and ribavirin (all genotypes) or with ribavirin alone (genotypes 2 and 3) or with simeprevir (genotypes 1 and 4) or with declatasvir (all genotypes) or with ledipasvir (genotypes 1,3 and 4) or with GS-5861 (under study)NS5A InhibitorsDaclatasvir1-660 mg once dailyUsed in combination with sofosbuvir (genotypes 1-6) or with pegylated interferon and ribavirin (genotype 4) or with asunaprevir (with or without BMS-791325; under study)Ledipasvir1,3 and 490 mg once dailyUsed in combination with sofosbuvirOmbitasvir1 and 425 mg once dailyUsed in combination with paritaprevir and dasabuvirEibasvir1-650 mg once dailyUsed in combination with grazoprevirGS-58161-6100 mg once dailyUsed in combination with sofosbuvir
Infection