Which of the following is not seen with hepatitis C infection
Correct Answer: PAN
Description: Hepatitis C virus causes both acute and chronic infection. New HCV infections are usually asymptomatic. Some persons get acute hepatitis which does not lead to a life-threatening disease. Around 30% (15-45%) of infected persons spontaneously clear the virus within 6 months of infection without any treatment. The remaining 70% (55-85%) of persons will develop chronic HCV infection. Of those with chronic HCV infection, the risk of cirrhosis ranges between 15% and 30% within 20 years. Transmission The hepatitis C virus is a bloodborne virus. It is most commonly transmitted through: injecting drug use through the sharing of injection equipment; the reuse or inadequate sterilization of medical equipment, especially syringes and needles in healthcare settings; the transfusion of unscreened blood and blood products; sexual practices that lead to exposure to blood (for example, among men who have sex with men, paicularly those with HIV infection or those taking pre-exposure prophylaxis against HIV infection). HCV can also be transmitted sexually and can be passed from an infected mother to her baby; however, these modes of transmission are less common. Hepatitis C is not spread through breast milk, food, water or casual contact such as hugging, kissing and sharing food or drinks with an infected person. WHO estimates that in 2015, there were 1.75 million new HCV infections in the world (23.7 new HCV infections per 100 000 people). Symptoms The incubation period for hepatitis C ranges from 2 weeks to 6 months. Following initial infection, approximately 80% of people do not exhibit any symptoms. Those who are acutely symptomatic may exhibit fever, fatigue, decreased appetite, nausea, vomiting, abdominal pain, dark urine, grey-coloured faeces, joint pain and jaundice (yellowing of skin and the whites of the eyes). Testing and diagnosis Because new HCV infections are usually asymptomatic, few people are diagnosed when the infection is recent. In those people who go on to develop chronic HCV infection, the infection is also often undiagnosed because it remains asymptomatic until decades after infection when symptoms develop secondary to serious liver damage. HCV infection is diagnosed in 2 steps: Testing for anti-HCV antibodies with a serological test identifies people who have been infected with the virus. If the test is positive for anti-HCV antibodies, a nucleic acid test for HCV ribonucleic acid (RNA) is needed to confirm chronic infection because about 30% of people infected with HCV spontaneously clear the infection by a strong immune response without the need for treatment. Although no longer infected, they will still test positive for anti-HCV antibodies. After a person has been diagnosed with chronic HCV infection, they should have an assessment of the degree of liver damage (fibrosis and cirrhosis). This can be done by liver biopsy or through a variety of non-invasive tests. The degree of liver damage is used to guide treatment decisions and management of the disease Ref Harrison20th edition pg 997
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