(HCV) is a major public health problem throughout the world, Disease progression after HCV infection depends on several factors like gender, co infection with HIV, alcohol consumption, and duration of chronic infection Acute HCV infection is asymptomatic in most cases, and only 15% of cases are symptomatic with symptoms such as fatigue, nausea, joint pain or signs of liver damage (jaundice and increased liver enzymes). The majority of adults develop chronic infection (55–85%), with 15–45% resolving infection within the first six months. Chronic hepatitis C (CHC) shows a variable clinical course, ranging from mild histopathological changes to active hepatitis and the development of hepatic fibrosis, cirrhosis and HCC
There are estimated to be at least 185 million HCV carriers worldwide, It has been reported that about 350,000 to 500,000 people die each year due to HCV related chronic liver disease such as liver cirrhosis or HCC
Hepatitis C viral infection is endemic in Egypt with the highest prevelance rate in the world
With the ultimate goal of achieving a more potent strategy to control transmission of HCV in Egypt, The Ministry of Health has set up 32 specialized centers for the nationwide therapy of HCV infection. The prevalence of HCV in adults decreases (7%)
Screening for HCV antibody (HCV Ab) facilitates HCV surveillance in the community
In the case of suspected acute hepatitis C or in immunocompromised patients, HCV RNA testing should be part of the initial evaluation. If anti_HCV antibodies are detected, HCV RNA should be determined by a sensitive molecular method. HCV core antigen is a surrogate marker of HCV replication and can be used instead of HCV RNA to diagnose acute or chronic infection when HCV RNA assays are not available or not affordable (core antigen assays are slightly less sensitive than HCV RNA assays for detection of viral replication) New era for management of chronic HCV using direct antiviral agents (DAAs) started in 2013. DAAs are molecules that target specific nonstructural proteins of the virus and results in disruption of viral replication and infection. There are four classes of DAAs, all are nonstructural proteins 3/4A(NS3/4A) protease inhibitors (PIs) (NS5B nucleoside polymerase inhibitors (NPIs) (e.g. sofosbuvir), NS5B non-nucleoside polymerase inhibitors (e.g. Dasabuvir) and NS5A inhibitors (e.g., Daclatasvir, Ledipasvir, Ombitasvir, Elbasvir
**********************
People at risk for HCV are those who:
Inject street drugs or share a needle with someone who has HCV
Have been on long-term kidney dialysis
Have regular contact with blood at work (such as a health care worker)
Have unprotected sexual contact with a person who has HCV
Were born to a mother who had HCV
Received a tattoo or acupuncture with needles that were not disinfected properly after being used on another person (risk is very low with practitioners who have a tattoo license or permit or an acupuncture license)
Received an organ transplant from a donor who has HCV
Share personal items, such as toothbrushes and razors, with someone who has HCV (less common)
*****************
Hepatitis C is an infectious disease caused by hepatitis C virus (HCV) which mainly attacks the liver cells. Near eighty percent of patients develop CHC that after many years may lead to cirrhosis or liver cancer.
Egypt has the highest prevalence rate of HCV in the world. About 14.7% of the Egyptian people have HCV antibodies and 9.8% have an active infection. The death rate due to liver disease about 40,000 each year (near10% of all deaths). It is the second after the cardiac diseases.
With the ultimate goal of achieving a more potent strategy to control transmission of HCV in Egypt, The Ministry of Health has set up 32specialized centers for the nationwide therapy of HCV infection.
Standard treatment for chronic hepatitis C infection was pegylated-interferon (Peg IFN) and ribavirin (RBV).
New era for management of chronic HCV using direct antiviral agents (DAAs) started in 2013.
Clinically significant portal hypertension (CSPH) is defined as hepatic venous pressure gradient (HVPG) of 10 mmHg or greater . Ascites and gastroesophageal varices are the most frequent manifestations of clinically significant portal hypertension. Other complications as variceal bleeding, spontaneous bacterial peritonitis (SBP), and infections other than SBP, hepato-renal syndrome and hepatic encephalopathy parallel the severity of portal hypertension and substantially worsen the prognosis.
The aim of this study is to assess Doppler haemodynamic changes suggestive of portal hypertension in cirrhotic HCV Egyptian patients after sustained virological response to direct antiviral agents, and their correlation with liver stiffness measurements by Fibroscan. This study has been conducted at Viral Hepatitis Unit at Ain Shams University Hospital and Al-Agouza Police Hospital during the period from May 2018 to July 2019.
The study included 50 Egyptian treatment-naïve chronic hepatitis C patients with cirrhosis on Sofosbuvir, Daclatasvir for 12 weeks.
Patients were subjected to history and full physical examination, radiology assessment (Abdominal Ultrasound and color Doppler), Upper GI endoscopy and Fibroscan before treatment and 6 months after treatment.
And Followed up with CBC, AST, ALT, Total bilirubin, Albumin, creatinine and Coagulation profile before and after 12 weeks of treatment And HCV RNA by PCR and HCV CORE Antigen before and then after 12 weeks of treatment.
0 Comments