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MCQs in Tropical Medicine

Rob Skelly DTM+H FRCP

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Answer 38

Hepatitis C

a. cirrhosis develops in most untreated cases
b. blood transfusion is the commonest mode of transmission in the UK.
c. most children born to hepatitis C infected mothers will have the infection
d. a normal serum alanine transaminase level excludes active liver disease
e. genotype 1 has the most favourable response to treatment

All false

Most of those with antibody to HCV are also HCV RNA positive by PCR and therefore have chronic infection.

The ALT level is not closely associated with the severity of liver disease so most HCV-RNA positive patients are offered liver biopsy.

10-20% of cases develop chronic active hepatitis or cirrhosis. 3% develop hepatocellular carcinoma.

HCV transmission: most cases are due to intravenous drug abuse / needle-sharing. Sexual transmission accounts for about 5% of cases as does vertical transmission. In the U.K. all donated blood has been screened since 1991.

40-80% of patients have an initial response to alpha-interferon. Half of these have a sustained response. Genotype 1 responds less well than types 2 and 3 to interferon therapy. Ribavirin may have some useful action in the treatment of HCV.

Copyright: Rob Skelly 2006