[Music]
we'll move on to our next case a 37 year
old woman is seen in clinic after a
recent diagnosis of hepatitis C
infection she has a history of injection
drug use 15 years ago she feels well and
takes no medications vitals and physical
exam are normal lab studies show the
following her hepatitis C antibody is
positive her RNA PCR is also positive
with 1.2 million copies she has a
positive hepatitis B surface antibody
and her surface antigen and core
antibody are both negative what is the
best next step in management so let's go
through some key features here she has
unknown history of hepatitis C infection
from her exposure to intravenous drug
use she has a positive hepatitis C
antibody and a positive viral load which
indicates that she has an active
infection she also has an isolated
positive Hep B surface antibody so we'll
talk about what that means so let's talk
now about hepatitis C hepatitis C begins
with an acute infection a majority of
patients will then go on to develop
chronic inflammation and only a small
proportion of patients will develop
spontaneous cure so this is in contrast
to hepatitis B where most patients
develop spontaneous cure then after
chronic inflammation a small minority
will then go on to develop fibrosis and
eventually cirrhosis of the liver after
patients have developed advanced
fibrosis or cirrhosis
they are then at risk for cancer of the
liver or hepatocellular cancer so
hepatitis C is the most common
blood-borne infections in the United
States you should remember to always
screen individuals born between 1945 and
1965 and patients are usually
asymptomatic carriers of this infection
so the treatment for hepatitis C has
actually evolved quite a bit in the last
10 years we now have new therapies that
are over 95% effective in allowing
treatment for all individuals with
hepatitis C the goal really is to stop
disease progression prevent cirrhosis
and prevent the end-stage complications
that occur with cirrhosis the type of
direct antiviral agents that we use
depends on the person's hepatitis C
genotype one example that you may hear
about is this combination of safar subur
and the led to best fear so now let's
return to our case our 37 year old woman
with a known hepa site Peppa Titus C
infection from her IV drug use she has a
positive antibody to hepatitis C and a
positive viral load which indicate an
active infection and we review now her
positive hepatitis B surface antibody
because it's an isolation in the case
that she has had prior vaccine and
immunity to have B so what is the best
next step in management we know that she
has an active hepatitis C infection so
she should be treated for her hepatitis
C you would first start with checking
her hepatitis C genotype which will
guide you in what drugs to use for her
treatment and as part of the screening
you should obtain an abdominal
ultrasound or transient elastography to
screen for fibrosis
[Music]