Monday, May 27, 2024

Chronic Hepatitis C Without Hepatic Coma

How Long Does It Last

Hepatic Encephalopathy Q& A with Dr. Yapp

Hepatitis A can last from a few weeks to several months.

Hepatitis B can range from a mild illness, lasting a few weeks, to a serious, life-long condition. More than 90% of unimmunized infants who get infected develop a chronic infection, but 6%10% of older children and adults who get infected develop chronic hepatitis B.

Hepatitis C can range from a mild illness, lasting a few weeks, to a serious, life-long infection. Most people who get infected with the hepatitis C virus develop chronic hepatitis C.

Hcv And Cerebral And Systemic Inflammation

As discussed above, chronic HCV infection is associated with systemic and local inflammation that may play a role in the pathogenesis of neuropsychiatric disorders as well. Huckans et al identified a proinflammatory profile in HCV-positive patients, significantly correlated with neuropsychiatric symptoms. In HCV infected patients, a local inflammatory response mediated by IL-8 and TNF- derived from HCV-infected brain macrophages/microglia has been described. Chronic activation of the immune system results in the production of such cytokines as IL-1, IL-6, IL-4, and TNF-, which are responsible for the neuronal changes underlying neurological impairment. Peripheral proinflammatory cytokines, like IL-1 and IL-6, can interfere with neurotransmitter systems thus predisposing to neuropsychiatric disorders indeed, increased levels of IL-6 have been reported to be associated with impairment of memory and spatial learning in chronic HCV infection moreover, an inverse correlation between plasma levels of IL-6 and both cognitive performance and executive function has been described.

Tests To Diagnose Hepatitis C

How is Hepatitis C diagnosed?

There are two main blood tests typically used to diagnose Hepatitis C. First, youll have a screening test that shows if youve ever had Hepatitis C at some point in your life. If this test is positive, youll have a second test to see if you have Hepatitis C now. These blood tests are described below:

Hepatitis C antibody test

This is the screening test used by doctors to show whether or not you have ever been exposed to Hepatitis C at some time in your life, by detecting antibodies in your blood. Antibodies are substances your body makes to fight off all kinds of infections. If you were ever infected with Hepatitis C, your body would have made antibodies to fight the virus.

If the test result is:

  • Negative, it means you have not been exposed to Hepatitis C and further testing is usually not needed.
  • Positive, you have had Hepatitis C at some point. However, it does not tell you whether you have it now. Youll need to see your doctor for another test the Hepatitis C RNA test to determine if the virus is still active and present in your blood.

Hepatitis C RNA Qualitative Test

This test will determine whether or not you are currently infected with Hepatitis C. It is often called the PCR test because of the process used . It looks for the genetic material of the Hepatitis C virus in your blood.

If the test result is:

Hepatitis C RNA Quantitative Test

Recommended Reading: Can Alcoholic Hepatitis Be Cured

What Is Viral Hepatitis

Hepatitis means inflammation of the liver. The liver is a vital organ that processes nutrients, filters the blood, and fights infections. When the liver is inflamed or damaged, its function can be affected. Heavy alcohol use, toxins, some medications, and certain medical conditions can cause hepatitis. However, hepatitis is often caused by a virus. In the United States, the most common types of viral hepatitis are hepatitis A, hepatitis B, and hepatitis C.

Cms National Coverage Policy


Social Security Act Standard References:

  • Title XVIII of the Social Security Act, Section 1833 states that no payment shall be made to any provider of services or other person under this part unless there has been furnished such information as may be necessary in order to determine the amounts due such provider or other person under this part for the period with respect to which the amounts are being paid or for any prior period.

You May Like: Is There Now A Cure For Hepatitis C

Electronic Medical Record Screening Protocol

Where possible, the EMR offers an essential component of successful HCV screening through a best practice alert that notifies clinicians and staff when a patient is eligible for screening . Ideally this alert links to a one-time HCV screening test for eligible patients with the appropriate diagnosis code . After the test is completed, the BPA should turn off but highlight a positive result. The most efficient test to order is an anti-HCV antibody that reflexes to a quantitative HCV RNA on the same blood sample to confirm chronic HCV. This is essential as 15-35% of anti-HCV antibody positive patients have cleared the infection. In summary:Eligible patients for HCV screening:

  • Birth year 1945-1965

Exclusion from eligibility:

  • Prior record of HCV diagnosis based on ICD-9-CM or ICD-10 codes
  • Prior record of any HCV test based on an array of Current Procedural Terminology codes .
  • Z11.59 Encounter for screening for other viral diseases
  • B17.11 Acute hepatitis C with hepatic coma
  • B18.2 Chronic viral hepatitis C
  • B17.10 Acute hepatitis C without hepatic coma
  • B19.20 Unspecified viral hepatitis C without hepatic coma
  • B19.21 Unspecified viral hepatitis C with hepatic coma
  • Z22.52 Carrier of Hepatitis C

ICD-9 codes:

CPT codes:

  • 86804: Hepatitis C antibody, confirmatory test
  • 87520: Hepatitis C, direct probe technique
  • 87521: Hepatitis C, amplified probe technique
  • 87522: Hepatitis C, quantification

For a more complete list, visit Support Path

Blood And Vessel Problems

People with hepatitis C often get a condition called cryoglobulinemia. This happens when certain proteins in your blood stick together in cold weather. They can build up in vessels and block blood flow, which causes swelling and damage. The condition can affect your skin, organs, nerves, and joints.

Hepatitis C also can cause problems with blood itself. You may not make enough white blood cells, which fight infections, or platelets, which help your blood clot.

The infection can also make you bruise easily or get red or purple spots under your skin. Those are signs of a bleeding disorder called immune thrombocytopenic purpura.

Also Check: Can Chronic Hepatitis B Be Cured

Hcv And Direct Neuroinvasion

Since HCV core and non-structural NS3 and NS5A proteins have been found to activate macrophages/microglia as well as astrocytes of infected patients, HCV proteins have been hypothesized to have a role in inducing neurotoxicity. HCV core protein has been described to mediate neuronal injury by suppression of neuronal autophagy and through immune activation. Specifically, HCV core protein has been demonstrated to activate both toll-like receptor 2 signaling and extracellular signal-related kinase neurotoxicity has been described to result from prolonged TLR2-mediated activation of ERK.

Brain microvascular endothelial cells have been recently demonstrated to support HCV tropism and replication. HCV has been shown to induce apoptosis in these cells, leading to changes in the permeability of the blood brain barrier, microglia activation, and diffusion of pro-inflammatory cytokines into the CNS.

However, evidence for an association between HCV neuroinvasion and neuropsychiatric disorders is currently scarce indeed, replication of quasispecies occurs at a very low level within the CNS and HCV RNA is almost undetectable in cerebrospinal fluid finally, a poor correlation between viral load and clinical manifestations has been reported.

What Are The Common Types Of Viral Hepatitis

An Overview of Hepatic Encephalopathy

Although the most common types of viral hepatitis are HAV, HBV, and HCV, some clinicians had previously considered the acute and chronic phases of hepatic infections as “types” of viral hepatitis. HAV was considered to be acute viral hepatitis because the HAV infections seldom caused permanent liver damage that led to hepatic failure. HBV and HCV produced chronic viral hepatitis. However, these terms are outdated and not currently used as frequently because all of the viruses that cause hepatitis may have acute phase symptoms . Prevention techniques and vaccinations have markedly reduced the current incidence of common viral hepatitis infections however, there remains a population of about 1 to 2 million people in the U.S. with chronic HBV, and about 3.5 million with chronic HCV according to the CDC. Statistics are incomplete for determining how many new infections occur each year the CDC documented infections but then goes on to estimate the actual numbers by further estimating the number of unreported infections .

Hepatitis A

Hepatitis B

Hepatitis C

Types D, E, and G Hepatitis

Individuals who already have chronic HBV infection can acquire HDV infection at the same time as they acquire the HBV infection, or at a later time. Those with chronic hepatitis due to HBV and HDV develop cirrhosis rapidly. Moreover, the combination of HDV and HBV virus infection is very difficult to treat.

  • HIV patients
  • People with hemophilia who receive blood clotting factors

Read Also: How Did You Get Hepatitis C

How Is Viral Hepatitis Diagnosed

Diagnosis of viral hepatitis is based on symptoms and physical findings as well as blood tests for liver enzymes, viral antibodies, and viral genetic materials.

Symptoms and physical findings

Diagnosis of acute viral hepatitis often is easy, but the diagnosis of chronic hepatitis can be difficult. When a patient reports symptoms of fatigue, nausea, abdominal pain, darkening of urine, and then develops jaundice, the diagnosis of acute viral hepatitis is likely and can be confirmed by blood tests. On the other hand, patients with chronic hepatitis due to HBV and HCV often have no symptoms or only mild nonspecific symptoms such as chronic fatigue. Typically, these patients do not have jaundice until the liver damage is far advanced. Therefore, these patients can remain undiagnosed for years to decades.

Blood tests

There are three types of blood tests for evaluating patients with hepatitis: liver enzymes, antibodies to the hepatitis viruses, and viral proteins or genetic material .

Liver enzymes: Among the most sensitive and widely used blood tests for evaluating patients with hepatitis are liver enzymes, called aminotransferases. They include aspartate aminotransferase and alanine aminotransferase . These enzymes normally are contained within liver cells. If the liver is injured , the liver cells spill the enzymes into the blood, raising the enzyme levels in the blood and signaling that the liver is damaged.

Examples of tests for viral antibodies are:

Treatment Of Hepatic Failure

Treatment depends on the stage of the disease.

Your doctor may prescribe medications. If only part of your liver is damaged, surgery may be recommended to remove the damaged part. A doctor can also take imagingtests of your liver to look for damage.

If a healthy liver is damaged, it can grow back.

If the damage is too severe, which can sometimes be the case with fast-acting acute liver failure, a liver transplant may be necessary.

You May Like: Hepatitis B How Do You Catch It

Hcv Infection And Cerebrovascular Events

In chronic HCV infection, cerebrovascular acute and chronic events have been reported with a higher prevalence than that observed in the general population in many cases, such neurologic conditions were associated with the presence of mixed cryoglobulinemia. Enger et al, in the largest retrospective study to date, including 21919 HCV-positive subjects and 67109 HCV-negative control subjects, reported a strict association between HCV and stroke, with a higher adjusted estimated risk of stroke for anti-HCV positive subjects . Gutierrez et al showed a close association between HCV infection and stroke in a retrospective study of subjects from the NHANES cohort during the period 2005-2010. However, it should be underscored that the two above studies have thus far been published only in an abstract form. Nonetheless, in a prospective study, involving a large population cohort from Taiwan, Liao et al established an association between HCV infection and stroke . Recently, in a large retrospective cohort from Taiwan, Hsu et al also found a higher risk of stroke in HCV infected subjects. Likewise, we recorded a higher prevalence of HCV infection in patients with stroke when compared with a large age- and gender-matched control group . In addition, HCV infection turned out to be an independent risk factor for stroke .

What Happens During The Chronic Phase


After six months, most people with hepatitis C go into the chronic phase of the disease. This means their body hasnt been able to fight off the virus and they have developed a long-term infection.

Most people still dont have any symptoms during the chronic phase. Often, people arent diagnosed until they get screened or until their doctor detects high levels of liver enzymes during a routine blood test.

You May Like: What Hepatitis Is Not Curable

Life Expectancy And Prognosis

Can you die from hepatitis? Technically, the complications of chronic hepatitis C are fatal. About 30,000 people in the U.S. die each year from cirrhosis.

How long can you live with untreated hep C? The disease affects everyone differently, so thereâs no rule. But about 70% to 80% of people with will get chronic help C. Within 20 years, about 20% to 30% of those people will get cirrhosis. From there, it depends on what type of cirrhosis you have, your treatment, and if you can get a liver transplant.

Can hepatitis C go away on its own? Yes. From 15% to 20% of people with hep C clear it from their bodies without treatment. Itâs more likely to happen in women and people who have symptoms. But it usually happens between 4 and 18 months after symptoms start.

American Liver Foundation Hep C 123: âFrequently Asked Questions.â

Gastroenterology: âExtrahepatic morbidity and mortality of chronic hepatitis C.â

National Institute of Diabetes and Digestive and Kidney Diseases: âHepatitis C.â

Therapeutic Advances in Infectious Disease: âExtrahepatic Manifestations of Chronic Hepatitis C Virus Infection.â

The Hepatitis C Support Project: âAn Overview of Extrahepatic Manifestations of Hepatitis C.â

BioDrugs: âManagement of hepatitis C virus-related arthritis.â

Frontiers in Endocrinology: âDiabetes and Hepatitis C: A Two-Way Association.â

U.S. National Library of Medicine: âAtherosclerosis,â âPreventing Hepatitis B or C.â

Chronic Phase Of Hepatitis C

After six months 70% to 85% of those infected will have failed to clear the virus spontaneously. After this period the hepatitis C virus enters what is known as the chronic phase. This is when hepatitis C becomes a chronic or long-term infection. The diagnosis is confirmed when over a six month period hepatitis C RNA viral presence is detectable on at least two occasions.

A diagnosis of chronic hepatitis C means the battle between the virus and the immune system that occurs during the acute stage has finally been won by the virus. It is now highly unlikely that the virus can be cleared without treatment.

How the disease then progresses varies significantly from person to person. After many years some people will have minimal liver damage with no scarring while others can progress to cirrhosis within less than ten years. On average it takes about twenty years for significant liver scarring to develop. It is still not known whether chronic hepatitis C infection inevitably leads to cirrhosis. At present it is thought that this is a very likely outcome, although for some people it may take at least 50 years or more. They may well die of other unrelated diseases or conditions before cirrhosis develops. The rate of progression of liver damage cannot be accurately determined by liver enzyme levels, viral load or by genotype.

Liver damage and fibrosis during the chronic stage

Free Radicals and Fibrosis

Read Also: Liver Disease Caused By Hepatitis C

Hcv And Changes In Metabolic Pathways

On proton magnetic resonance spectroscopy, metabolic abnormalities of choline/creatine ratio in basal ganglia and white matter have been detected in patients with histologically proven mild hepatitis C with respect to both healthy volunteers and chronic hepatitis B patients, suggesting a role for HCV itself in affecting cerebral functions. Moreover, significant correlations have been reported between cognitive dysfunction and HCV replication and between degree of impairment and the choline/creatine ratio in the basal ganglia and white matter in contrast to what is commonly observed in hepatic encephalopathy, a higher content in cerebral choline has been recorded in these patients. Although the exact significance of elevated choline in the white matter remains uncertain, it may be implicated in glial activation secondary to oxidative stress a similar mechanism has been suggested for chronic fatigue syndrome in HIV infection.

Unspecified Viral Hepatitis C Without Hepatic Coma

Hepatitis C Virus
    2016201720182019202020212022Billable/Specific Code
  • B19.20 is a billable/specific ICD-10-CM code that can be used to indicate a diagnosis for reimbursement purposes.
  • The 2022 edition of ICD-10-CM B19.20 became effective on October 1, 2021.
  • This is the American ICD-10-CM version of B19.20 – other international versions of ICD-10 B19.20 may differ.
  • Applicable To annotations, or

Don’t Miss: Can You Get Hepatitis C Twice

Hcv Infection And Psychiatric Disorders

Psychiatric symptoms such as brain fog, fatigue, weakness, depression, and anxiety have been reported with high frequency in patients with chronic HCV infection, causing interference with patient ability to perform daily activities and impairment of quality of life. Mere knowledge of HCV serological status is itself an important reason for poor health-related quality of life, due to impairment of intimate and family relationships, changes in dietary habits, reduced sense of well-being because of fear of contagion and prognosis, social marginalization, fatigue, anger, hopelessness, depression, and stigma. Moreover, the possible relation between HCV and psychiatric disorders is further strengthened by the results of studies comparing health-related quality of life between HBV and HCV patients. Specifically, a strong relationship between HCV infection and impaired physical health, as well as an inverse correlation between levels of brain-derived neurotrophic factor and physical health, has been documented in patients with HCV but not in those with HBV infection.

One report suggested that HCV genotype 3 infected patients might be at increased risk of depression. However, it should be remembered that such patients are often drug users, which itself puts them at risk of depression. Moreover, depression was independently associated with perceived barriers to accessing HCV care, thus creating a vicious circle.

What Happens During The Acute Phase

The first six months of hepatitis C infection is called the acute or short-term phase.

Most people who have recently been infected with HCV dont have any symptoms. Those who do develop symptoms may experience:

  • abdominal pain
  • joint pain
  • nausea, vomiting
  • a yellowing of the skin and whites of the eyes called jaundice, which is a sign that the liver isnt working normally

In about one in four people, the immune system destroys the virus during this phase. Most people infected with HCV progress to the chronic phase.

Also Check: What Is Hepatic Flexure Cancer

Popular Articles
Related news