Page 247 - fourth year book

HEPATITIS C VIRUS

virus (HCV RNA PCR). Historically, qualitative assays have been
more sensitive than quantitative assays. With the recent availability of
real time PCR- based assays and transcription-mediated amplification

(TMA) assays, with sensitivities of 10-50 IU/mL, there is no longer
need for qualitative assays.
HCV RNA done in:

a. Patients with a positive anti-HCV test,

b. Patients for whom antiviral treatment is being considered, using
a sensitive quantitative assay,

c. Patients with unexplained liver disease whose anti-HCV test is

negative and who are immunocompromised or suspected of
having acute HCV infection.

 HCV genotyping should be performed in all HCV-infected persons
prior to interferon-based treatment in order to determine what type(s)
of HCV an individual carries. This information is useful for making
treatment decisions—what dose, duration and response for treatment.

Genotype 1 is more resistant to treatment hence patients require a 48-
week course of therapy and genotypes 2 and 3 have a high probability

of favourable response hence patients require 24 weeks of treatment.
Some studies suggested that HCV genotype 4 may be associated with
poorer outcomes, lower response rates to interferon therapy, and a
more rapid fibrosis progression rate following liver transplantation.

HCV genotype 4 is widely distributed throughout Africa and the Middle East.
The highest prevalence of 91% is reported from a population-based survey from
15 regions of Egypt.

C. Assess the liver Function.

Biochemical or Liver Function Tests

The most common measurements of liver inflammation are:

 Alanine aminotransferase (ALT, formerly known as SGPT) and
 Aspartate aminotransferase (AST, formerly known as SGOT).

ALT and AST are enzymes released into the blood when liver cells are damaged.

They are often—but not always—elevated in people with hepatitis C.
 Alkaline phosphatase (ALK) and

 Gamma-glutamyl transpeptidase (GGT).

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