Final Hep C Challenge of 2018

In this final hepatitic C quiz for 2018, you’ll get a chance to test your knowledge of HCV classification, acute hepatitis C infection, hepatitis B reactivation, and more. Here’s your first question:

1. Hepatitis C belongs to which virus family?

A. FiloviridaeB. FimoviridaeC.FlaviviridaeD.Fuselloviridae

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Answer: C. Flaviviridae.  Flaviviruses (family Flaviviridae) are enveloped icosahedral viruses that have a positive-strand RNA genome of 9-12 kb, According to the textbook, Molecular Pathology of Human Pathogenic Viruses. The family has many members that are mosquito-borne viruses, such as dengue virus and West Nile fever virus, but also blood-borne hepatitis C virus (HCV). For many years, HCV was the only named species in the genus Hepacivirus. However, in the past several years, viruses with similar genome structures have been found in dogs, horses, rats, and other hosts, leading some researchers to propose that the taxonomy be updated.

2. Approximately what proportion of acute HCV infections are clinically evident?

A. 10%

B. 25%

C. 50%

D. Nearly 100%

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Answer: A. 10%.  Estimates are that only about 10% of acute hepatitis C infections are clinically evident, Mayberry and Lee wrote recently in Medical Clinics of North America. Because so few cases are clinically apparent, most go unrecognized and become chronic. When it is clinically apparent, symptoms include nausea, vomiting, fatigue, and jaundice. A considerable proportion of patients with acute hepatitis C-up to 50% in some studies-will spontaneously clear the virus without need for treatment, a finding that has implications for diagnosis and management that are outlined in HCV guidelines.

3. What is the proportion of HCV-positive patients with resolved hepatitis B virus (HBV) infection who experienced HBV reactivation on direct-acting antiviral (DAA) therapy, according to a recent meta-analysis?

A. 1.4%

B. 11.4%

C. 24.4%

D. 39.4%

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Answer: A. 1.4%.  This systematic review and meta-analysis, published in The Lancet, was prompted by concerns that DAA therapy for HCV infection may increase the risk for HBV reactivation in HBV-coinfected patients. Authors found 17 observational studies including 1,621 patients with chronic or resolved HBV infection who received DAAs. The pooled proportion of patients with HBV reactivation was 24% among patients with chronic HBV infection. However, the proportion was only 1.4% for individuals with resolved HBV infection. Moreover, there was no HBV-reactivation-related hepatitis reported in patients with resolved HBV infection.

Based on these findings, investigators concluded that HBV reactivation is rare among patients with resolved HBV infection.

4. Which group(s) of patients with chronic kidney disease (CKD) can safely be considered candidates for DAA therapy for HCV, according to recent guidelines from KDIGO (Kidney Disease: Improving Global Outcomes)?

A. Hemodialysis

B. Hemodialysis, kidney transplant

C. Hemodialysis, kidney transplant, CKD stage 4

D. Hemodialysis, kidney transplant, CKD stage 4-5

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Answer: D. Patients on hemodialysis, kidney transplant patients, CKD stage 4-5 patients. DAAs have revolutionized HCV treatment in patients with chronic kidney disease, according to the new guidelines from KDIGO. The treatments result in sustained virologic response rates exceeding 90% with few adverse effects consistently across all studied populations. That includes patients with stage 4-5 CKD, kidney transplant recipients, and those on hemodialysis. As a result, KDIGO recommends evaluating all patients with CKD for potential treatment with an interferon‐free regimen. According to the group, the choice of DAA regimen should be based on factors such as HCV genotype, viral load, and prior treatment, hepatic fibrosis, glomerular filtration rate, among other factors.

5. Which HCV genotype has been associated with higher steatosis rates, faster cirrhosis progression, and higher rates of hepatocellular carcinoma?

A. HCV genotype 1

B. HCV genotype 2

C. HCV genotype 3

D. HCV genotype 4

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Answer: C. HCV genotype 3. Out of the 6 major clinical HCV genotypes, genotype 3 represents a unique entity, according to authors of a recent review in the journal Drugs. In multiple studies, this genotype has been associated with higher rates of steatosis and more rapid fibrosis progression, they said, while noting that cure rates for this genotype have “lagged behind” that of the other genotypes. Moreover, genotype 3 is associated with higher rates of hepatocellular carcinoma, even after successful DAA therapy; probably due to more advanced disease. “The DAA era has truly revolutionized HCV therapy, but we must still work to ensure that no subgroup, regardless of genotype, cirrhosis, or treatment experience, is left by the wayside,” authors said in their report.