Hcv In Chronic Kidney Disease
Hepatitis C adversely affects survival in those with chronic kidney disease, especially those on dialysis. In addition, HCV seems to play a role in the rate of progression of kidney disease. Drug metabolism of many of the drugs used for HCV is altered in people with severe renal impairment and those on dialysis. Sufficient data is available for the following statement to be made by the American Association for the Study of Liver Disease and the Infectious Disease Society of America:
No dose adjustment in direct-acting antivirals is required when using recommended regimens
Excellent cure rates have been shown for direct acting agents in chronic kidney disease including those on dialysis.
Laboratory Studies For Evaluation Of Initial Infection
The key laboratory studies utilized in the evaluation of possible acute hepatitis C are HCV RNA, anti-HCV, and alanine aminotransferase . Patients who become infected with hepatitis C virus typically develop abnormal laboratory findings in the following order: detectable HCV RNA, followed by elevation in ALT, and then anti-HCV . Patients who develop a clinical illness with acute HCV infection usually have onset of symptoms well after the onset of viremia, but soon after or concomitant with increases in ALT levels.
HCV RNA
Antibodies to HCV
Antibodies to HCV typically become detectable at about 50 to 60 days after infection the detection of HCV-specific antibodies significantly lags behind detectable HCV RNA levels. After 12 weeks, more than 90% of patients will have a positive HCV antibody test. The time period from initial infection until seroconversion is often referred to as the serologic window period . The use of only an HCV antibody test to diagnose acute HCV is not reliable, since only approximately 50 to 70% of patients have detectable HCV antibodies at the onset of symptoms. Further, a positive HCV antibody test does not differentiate acute from chronic HCV infection.
Hepatitis C Core Antigen
Alanine Aminotransferase
Prevention Of Hepatic Failure
One of the easiest ways to prevent liver failure is to moderate your drinking. The Mayo Clinic recommends that healthy women limit their alcohol consumption to one drink per day. Healthy men over the age of 65 should also limit their alcohol consumption to one drink a day. Men under 65 should consume no more than two drinks per day.
Other preventive measures include:
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Can Hepatitis C Be Prevented
There is no vaccine for hepatitis C. But you can help protect yourself from hepatitis C infection by
- Not sharing drug needles or other drug materials
- Wearing gloves if you have to touch another person’s blood or open sores
- Making sure your tattoo artist or body piercer uses sterile tools and unopened ink
- Not sharing personal items such toothbrushes, razors, or nail clippers
- Using a latex condom during sex. If your or your partner is allergic to latex, you can use polyurethane condoms.
NIH: National Institute of Diabetes and Digestive and Kidney Diseases
But Even If You’ve Been Cured It Can Have Lifelong Health Implications
“Hepatitis C is a lot more than just a liver disease,” Reau says. “It has been associated with many medical conditions, such as an increased risk of developing diabetes, kidney disease and cancer.”
While curing hepatitis C significantly reduces the risk of serious complications, like liver failure, liver cancer and the need for transplantation, it doesn’t completely eliminate the health risks associated with the disease.
“Hep C is linked to scarring of the liver or cirrhosis and the more scar tissue that develops, the greater the likelihood of complications,” Reau says. “If there is a lot of scarring, you will need lifelong monitoring.”
Reau also recommends leading a healthy lifestyle to help prevent re-infection and further liver damage: Limit alcohol consumption, control your weight, avoid high-risk activities and manage diabetes if you have it.
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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:
Baby Boomers Are Especially Vulnerable
“The hepatitis C virus didn’t have a name or a screening test until in 1989,” Reau says. “That means people born between 1945 and 1965, the group referred to as ‘baby boomers,’ are at highest risk of infection. They grew up before health care facilities started taking standard precautions, like not sharing vials of medicine among patients and requiring staff to wear gloves.”
The CDC reports that baby boomers are five times more likely to have Hepatitis C than other adults, accounting for 75% of those living with the disease.
These are some other reasons you may be at risk:
- You have engaged in high-risk behaviors like IV drug use or unprotected sex
- Your biological mother has/had hepatitis C
- You received blood transfusions, an organ transplant or dialysis before 1989
- You were or are currently incarcerated
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Diagnosis Of Acute Hcv
In the United States, the gold standard for the laboratory diagnosis of acute HCV is an HCV antibody seroconversion , combined with a positive HCV RNA test and elevated ALT. In clinical practice, many patients do not present early enough after a potential exposure and so it is not always possible to demonstrate an initial negative antibody followed by a positive antibody. Thus, a probable diagnosis of acute HCV is made when an individual has a positive HCV RNA and evidence of a negative HCV antibody in the prior 6 months. It can be challenging to differentiate an acute infection from chronic infection in patients who have not previously undergone HCV antibody testing.
Potential Missed Diagnosis of Acute HCV with HCV Reflex Testing Protocol
Laboratory Testing Following Known Exposure to HCV
In situations where patients have encountered high-risk exposures, follow-up with serial laboratory testing is the key to promptly establishing the diagnosis of acute HCV infection. The following briefly outlines the recommended laboratory testing following a known exposure to hepatitis C virus :
- At Initial Presentation: HCV antibody, HCV RNA, and ALT
- At 4 Weeks from Time of Suspected Exposure: HCV RNA and ALT
- At 12 Weeks from Time of Suspected Exposure: HCV antibody, HCV RNA, and ALT
- At 24 Weeks from Time of Suspected Exposure: HCV antibody and HCV RNA
Treatment Of Acute Viral Hepatitis
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Supportive care
For most people with acute viral hepatitis, special treatment is not necessary. However, people with severe acute hepatitis may require hospitalization so that symptoms can be treated. If doctors suspect that fulminant hepatitis is developing, the person is hospitalized so that mental status can be monitored, liver tests can be done, and doctors can determine whether liver transplantation is needed.
After the first several days, appetite usually returns and people do not need to stay in bed. Severe restrictions of diet or activity are unnecessary, and vitamin supplements are not required. Most people can safely return to work after the jaundice clears, even if their liver test results are not quite normal.
People with hepatitis should not drink alcohol until they have fully recovered.
The infected liver may not process drugs normally. So a doctor may need to stop a drug or reduce the dosage of a drug that could accumulate to harmful levels in the body . Thus, people with hepatitis should tell their doctor all the drugs they are taking , so that the dosage of the drug can be adjusted if necessary.
If itching occurs, cholestyramine, taken by mouth, is often effective.
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Treating Hepatitis C Matters
When you see your doctor and start treatment for a chronic hep C infection, you can prevent these problems, improve them, or keep them from getting worse. New drugs can clear the virus from your body in a few months with fewer side effects than older medicines. If thereâs no virus in your blood 3 months after treatment, youâre considered cured.
Getting rid of the infection protects others, too. Hepatitis C spreads through blood-to-blood contact. You could infect a loved one if you accidentally use their toothbrush or cut yourself and donât clean up the blood properly. People who get hep C treatment greatly lower the odds that they will pass the virus to someone else.
If you arenât sure if you have hepatitis C, talk to your doctor to see if you should get tested. Learn why you should get tested for hepatitis C.
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
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Vaccines And Immune Globulin
Vaccines to prevent hepatitis A and hepatitis B are available in the United States. A vaccine for hepatitis E is currently available only in China. No vaccines against hepatitis C or D virus are available. However, vaccination against hepatitis B virus also reduces the risk of infection with hepatitis D virus. Hepatitis vaccines are given by injection into muscle.
Routine vaccination with the hepatitis A vaccine Hepatitis A Vaccine The hepatitis A vaccine helps protect against hepatitis A. Typically, hepatitis A is less serious than hepatitis B. Hepatitis A often causes no symptoms, although it can cause fever, nausea… read more and hepatitis B vaccine Hepatitis B Vaccine The hepatitis B vaccine helps protect against hepatitis B and its complications . Generally, hepatitis B is more serious than hepatitis A and… read more is recommended in the United States for all children and for adults at high risk of getting hepatitis Hepatitis is common throughout the world. Hepatitis can be Acute read more ).
As with most vaccines, protection requires allowing a number of weeks for the vaccine to reach its full effect as the immune system gradually creates antibodies against the particular virus.
Babies born to mothers with hepatitis B are given hepatitis B immune globulin and hepatitis B vaccine.
What Is Chronic Hepatitis
Hepatitis is an inflammation of the liver. In chronic hepatitis, liver inflammation continues for at least six months. This condition may be mild, causing relatively little damage, or more serious, causing many liver cells to be destroyed. Some cases lead to cirrhosis and liver failure.
Chronic hepatitis from infection is most often caused by these viruses:
- Hepatitis B and C. Often the person infected is unaware of any initial symptoms. Or the symptoms were so mild that the person did not seek medical attention. This is especially true for chronic hepatitis C. Over time, perhaps a decade or more, both types may lead to the serious complication of cirrhosis due to ongoing destruction of liver cells and resultant scarring. A minority of patients with cirrhosis develop liver cancer over time.
- Hepatitis D. Hepatitis D infects only patients already infected with hepatitis B, and it generally results in a flare of active hepatitis.
This information helps to determine the best treatment and to assess your risk of developing cirrhosis and liver failure. A liver biopsy also can help to check for other disorders, such as alcoholic liver injury or fatty liver.
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The Icd Code B19 Is Used To Code Viral Hepatitis
Viral hepatitis is liver inflammation due to a viral infection. It may present in acute or chronic forms. The most common causes of viral hepatitis are the five unrelated hepatotropic viruses Hepatitis A, Hepatitis B, Hepatitis C, Hepatitis D, and Hepatitis E. In addition to the nominal hepatitis viruses, other viruses that can also cause liver inflammation include Herpes simplex, Cytomegalovirus, EpsteinBarr virus, and Yellow fever.
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How Is Acute Hepatitis C Treated
Acute hepatitis C is typically monitored and not treated. Treatment during the acute stage doesnt change the risk that the disease will progress to the chronic form. An acute infection may resolve on its own without treatment. The following treatment may be all thats necessary:
- proper rest
- adequate fluids
- a healthy diet
Some people may need treatment with prescription medication. Your doctor will be able to work with you about what treatment options may be best for you.
Those most at risk for acute and chronic hepatitis C are people who use or share contaminated needles. Mothers can transmit HCV to their babies during childbirth, but not through breastfeeding. Other risk factors for transmission of HCV include:
- healthcare work, especially work around needles
- getting a tattoo or body piercing with unsterile equipment
- undergoing hemodialysis
- living in a household with someone with HCV
- sharing personal hygiene products, such as razors or toothbrushes
- engaging in sexual activity with multiple partners without condoms or dental dams
- having a blood transfusion or organ transplant before July 1992 or receiving clotting factors before 1987
The most serious long-term risk of acute hepatitis C is developing chronic hepatitis C, which can lead to cirrhosis and liver cancer. In 75 to 85 percent of those with acute hepatitis C, the disease will progress to the more serious chronic hepatitis C.
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What Might Complicate It
Individuals who survive one or more episodes of hepatic coma are occasionally left with residual neurologic abnormalities, such as tremor of the head or arms, asterixis, grimacing, choreatic twitching of the limbs, dysarthria, ataxia of gait, or impairment of intellectual functioning. These symptoms may worsen with repeated attacks of stupor and coma.
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Relationship Of Symptoms And Spontaneous Clearance
Overall, when combining data from multiple historical studies, approximately 25 to 35% of person with acute HCV infection have spontaneous clearance of HCV. The rates of spontaneous clearance are significantly lower in persons who are Black and in those individuals who have HIV coinfection. In contrast, rates of spontaneous clear are higher in females and in persons who acquired HCV in childhood. It has also been demonstrated that patients who present with symptomatic acute HCV infection and jaundice have higher rates of spontaneous clearance of HCV, in the range of 35 to 50%. The presence of jaundice is believed to reflect hepatic inflammation caused by a more robust initial immune response against HCV.
Prevention Is The Best Medicine
Even though hepatitis C rarely spreads within a household, if you or a family member have the disease, it’s wise to take precautions to prevent its spread especially if anyone in your home is immune compromised, or has cuts or open sores that increase the risk of infection.
In general, use these common sense preventive tips:
- Unless you are in a long-term, monogamous relationship, practice safe sex.
- Clean up spilled or dried blood with a bleach-based cleaning solution and wear rubber gloves.
- Do not share razors.
- Do not share toothbrushes. “Though hepatitis C is not transmitted through saliva, there might be blood on the toothbrush,” Reau says.
Note that hepatitis C is not transmitted by sharing eating utensils, hugging, kissing, coughing or sneezing.
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