eMedicine Specialties > Pediatrics: General Medicine > Infectious Disease

Hepatitis C: Follow-up

Author: Nicholas John Bennett, MBBCh, PhD, Staff Physician, Department of Pediatrics, State University of New York Upstate Medical University
Coauthor(s): Joseph Domachowske, MD, Professor of Pediatrics, Microbiology and Immunology, Department of Pediatrics, Division of Infectious Diseases, State University of New York-Upstate Medical University; Donald K Strickland, MD, National Liaison, Avastin, Genentech BioOncology
Contributor Information and Disclosures

Updated: Aug 12, 2008

Follow-up

Further Inpatient Care

  • Usually, inpatient care is necessary only if complications of chronic hepatitis C virus (HCV) infection, such as portal hypertension and HCC, are present.

Further Outpatient Care

  • Perform ongoing studies to monitor the status of hepatitis C virus infection.
    • Serum ALT levels have no consistent relationship to liver histologic findings.
    • Longitudinal assessment of hepatitis C virus RNA provides a strong correlation with liver histologic results but is a weaker predictor of rate of progression.
    • The prothrombin time is useful for assessing liver function.
    • The serum alpha-fetoprotein assay is a potential screening test for HCC.
    • Ultrasonography is potentially useful to monitor for hepatitis C virus–related complications such as portal hypertension and HCC.
  • Identify suitable candidates for antiviral therapy, although all patients with chronic infection are potential candidates.
    • Treatment is recommended for patients with chronic infection who have a persistently elevated serum ALT level, portal or bridging fibrosis, and at least moderate inflammation and necrosis at liver biopsy.
    • Consider treatment for other patients on an individual basis. Do not treat patients with decompensated cirrhosis by using antiviral therapy.
  • Perform immunization against hepatitis A virus and hepatitis B virus.

Deterrence/Prevention

  • No vaccine has been developed for hepatitis C virus.
  • Discourage users of intravenous drugs from sharing needles.
  • Adhere to universal precautions.
  • Infected patients with multiple partners should use barrier protection during sex. No special precautions are needed for monogamous relationships.
  • Instruct the patient not to share personal care articles such as toothbrushes or razors.
  • Blood, organ, or sperm donation from patients with hepatitis C virus infection is not permitted.

Complications

  • Fulminant hepatitis (rare)
  • Cirrhosis, which may result in portal hypertension and liver failure
  • Hepatocellular carcinoma
  • Extrahepatic manifestations
    • Porphyria cutanea tarda
    • Sialadenitis resembling Sjögren syndrome
    • Mooren corneal ulcers, a form of chronic ulcerative keratitis
    • Type II cryoglobulinemia
    • Membranoproliferative glomerulonephritis
    • Non-Hodgkin lymphoma

Prognosis

  • Most patients chronically infected with hepatitis C virus remain asymptomatic and do not have significant liver disease.
  • The prognosis is guarded for those who have hepatitis C virus–related complications such as HCC and liver failure.

Patient Education

Miscellaneous

Special Concerns

  • For individuals exposed to hepatitis C virus (HCV), passive immunization is not recommended.
  • Screen patients for hepatitis C virus infection if any of the following applies:
    • History of illegal injected drug use
    • Transfusion with clotting factor concentrates before 1987
    • Use of blood or blood components or organ transplants before July 1992
    • Use of hepatitis C virus–contaminated blood from a donor
    • Individuals on long-term hemodialysis or those who have persistently abnormal serum ALT levels
    • Needle sticks, accidents with sharps, or mucosal exposures to hepatitis C virus–positive blood
  • Considering hepatitis C virus testing in patients with HIV may be prudent, especially in those who acquired HIV through intravenous drug use. Hepatitis C virus is more easily transmitted than HIV, and the 2 viruses are often co-infections.
 


More on Hepatitis C

Overview: Hepatitis C
Differential Diagnoses & Workup: Hepatitis C
Treatment & Medication: Hepatitis C
Follow-up: Hepatitis C
References
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References

  1. Narciso-Schiavon et al. Anti-hepatitis C virus-positive blood donors: are women any different?. Transfus Med. Jun 2008;18(3):175-83. [Medline].

  2. Abdoul et al. Serum Alpha-Fetoprotein Predicts Treatment Outcome in Chronic Hepatitis C Patients Regardless of HCV Genotype. PLoS ONE. June 2008;3(6):[Medline]. [Full Text].

  3. Scherzer et al. Hepatocellular carcinoma in long-term sustained virological responders following antiviral combination therapy for chronic hepatitis C. J Viral Hepat. Jul 2008;[Medline].

  4. Arico M, Maggiore G, Silini E, et al. Hepatitis C virus infection in children treated for acute lymphoblastic leukemia. Blood. Nov 1 1994;84(9):2919-22. [Medline]. [Full Text].

  5. Cesaro S, Petris MG, Rossetti F, et al. Chronic hepatitis C virus infection after treatment for pediatric malignancy. Blood. Aug 1 1997;90(3):1315-20. [Medline]. [Full Text].

  6. Conry-Cantilena C, VanRaden M, Gibble J, et al. Routes of infection, viremia, and liver disease in blood donors found to have hepatitis C virus infection. N Engl J Med. Jun 27 1996;334(26):1691-6. [Medline]. [Full Text].

  7. Donahue JG, Munoz A, Ness PM, et al. The declining risk of post-transfusion hepatitis C virus infection. N Engl J Med. Aug 6 1992;327(6):369-73. [Medline].

  8. Elmowalid GA, Qiao M, Jeong SH, Borg BB, Baumert TF, Sapp RK, et al. Immunization with hepatitis C virus-like particles results in control of hepatitis C virus infection in chimpanzees. Proc Natl Acad Sci. May 2007;e-pub ahead of print:[Medline]. [Full Text].

  9. FDA. Donor Screening Assays for Infectious Agents and HIV Diagnostic Assays (Includes serologic and nucleotide tests for screening, diagnosis and quantitative analysis). FDA. Available at http://www.fda.gov/cber/products/testkits.htm.

  10. Hartman C, Berkowitz D, Rimon N, Shamir R. The effect of early treatment in children with chronic hepatitis. J Pediatr Gastroenterol Nutr. Sep 2003;37(3):252-7. [Medline].

  11. Heller T, Saito S, Auerbach J, et al. An in vitro model of hepatitis C virion production. Proc Natl Acad Sci U S A. Feb 15 2005;102(7):2579-83. [Medline]. [Full Text].

  12. Jacobson IM, Gonzalez SA, Ahmed F, et al. A randomized trial of pegylated interferon alpha-2b plus ribavirin in the retreatment of chronic hepatitis C. Am J Gastroenterol. Nov 2005;100(11):2453-62. [Medline]. [Full Text].

  13. Locasciulli A, Testa M, Pontisso P, et al. Prevalence and natural history of hepatitis C infection in patients cured of childhood leukemia. Blood. Dec 1 1997;90(11):4628-33. [Medline].

  14. Lucidarme D, Dumas F, Arpurt JP, et al. [Rapid progress of cirrhosis in hepatitis C: the role of age at the time of viral contamination]. Presse Med. Apr 4 1998;27(13):608-11. [Medline].

  15. McHutchison JG, Gordon SC, Schiff ER, et al. Interferon alfa-2b alone or in combination with ribavirin as initial treatment for chronic hepatitis C: Hepatitis Interventional Therapy Group. N Engl J Med. Nov 19 1998;339(21):1485-92. [Medline]. [Full Text].

  16. NIH. Management of hepatitis C. NIH Consens Statement. Mar 24-26 1997;15(3):1-41. [Medline].

  17. Paul IM, Sanders J, Ruggiero F, et al. Chronic hepatitis C virus infections in leukemia survivors: prevalence, viral load, and severity of liver disease. Blood. Jun 1 1999;93(11):3672-7. [Medline]. [Full Text].

  18. Poynard T, Bedossa P, Opolon P. Natural history of liver fibrosis progression in patients with chronic hepatitis C. The OBSVIRC, METAVIR, CLINIVIR, and DOSVIRC groups. Lancet. Mar 22 1997;349(9055):825-32. [Medline].

  19. Shepherd J, Brodin H, Cave C, et al. Pegylated interferon alpha-2a and -2b in combination with ribavirin in the treatment of chronic hepatitis C: a systematic review and economic evaluation. Health Technol Assess. Oct 2004;8(39):iii-iv, 1-125. [Medline]. [Full Text].

  20. Sook-Hyang Jeong, Ming Qiao, Michelina Nascimbeni, Zongyi Hu, Barbara Rehermann, Krishna Murthy, et al. Immunization with Hepatitis C Virus-Like Particles Induces Humoral and Cellular Immune Responses in Nonhuman Primates. J Virol. July 2004;78(13):6995-7003. [Medline]. [Full Text].

  21. Villano SA, Vlahov D, Nelson KE, et al. Persistence of viremia and the importance of long-term follow-up after acute hepatitis C infection. Hepatology. Mar 1999;29(3):908-14. [Medline].

  22. Vogt M, Lang T, Frosner G, et al. Prevalence and clinical outcome of hepatitis C infection in children who underwent cardiac surgery before the implementation of blood-donor screening. N Engl J Med. Sep 16 1999;341(12):866-70. [Medline]. [Full Text].

  23. WHO. Hepatitis C: global prevalence. Wkly Epidemiol Rec. Nov 14 1997;72(46):341-4. [Medline].

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Further Reading

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Keywords

hepatitis C virus, HCV, HCV infection, infectious hepatitis, viral hepatitis, viral hepatitis type C, non-A/non-B hepatitis, Flaviviridae, portal hypertension, liver failure, hepatocellular carcinoma, HCC, cirrhosis, malaise, anorexia, jaundice, hepatomegaly, ascites, splenomegaly, spider nevi

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Contributor Information and Disclosures

Author

Nicholas John Bennett, MBBCh, PhD, Staff Physician, Department of Pediatrics, State University of New York Upstate Medical University
Nicholas John Bennett, MBBCh, PhD is a member of the following medical societies: Alpha Omega Alpha and American Academy of Pediatrics
Disclosure: Nothing to disclose.

Coauthor(s)

Joseph Domachowske, MD, Professor of Pediatrics, Microbiology and Immunology, Department of Pediatrics, Division of Infectious Diseases, State University of New York-Upstate Medical University
Joseph Domachowske, MD is a member of the following medical societies: Alpha Omega Alpha, American Academy of Pediatrics, American Society for Microbiology, Infectious Diseases Society of America, Pediatric Infectious Diseases Society, and Phi Beta Kappa
Disclosure: Nothing to disclose.

Donald K Strickland, MD, National Liaison, Avastin, Genentech BioOncology
Donald K Strickland, MD is a member of the following medical societies: American Society of Hematology, American Society of Pediatric Hematology/Oncology, and Southern Medical Association
Disclosure: Nothing to disclose.

Medical Editor

Leonard R Krilov, MD, Chief of Pediatric Infectious Diseases, Vice Chair, Department of Pediatrics, Professor of Pediatrics, Winthrop University Hospital
Leonard R Krilov, MD is a member of the following medical societies: American Academy of Pediatrics, American Pediatric Society, Infectious Diseases Society of America, Pediatric Infectious Diseases Society, and Society for Pediatric Research
Disclosure: Medimmune Grant/research funds Cliinical trials; Medimmune Honoraria Speaking and teaching; Medimmune Consulting fee Consulting

Pharmacy Editor

Mary L Windle, PharmD, Adjunct Assistant Professor, University of Nebraska Medical Center College of Pharmacy, Pharmacy Editor, eMedicine
Disclosure: Pfizer Inc Stock Investment from broker recommendation; Avanir Pharma Stock Investment from broker recommendation

Managing Editor

Mark R Schleiss, MD, American Legion Chair of Pediatrics, Professor of Pediatrics, Division Director, Division of Infectious Diseases and Immunology, Department of Pediatrics, University of Minnesota School of Medicine
Mark R Schleiss, MD is a member of the following medical societies: American Pediatric Society, Infectious Diseases Society of America, Pediatric Infectious Diseases Society, and Society for Pediatric Research
Disclosure: Nothing to disclose.

CME Editor

Robert W Tolan Jr, MD, Chief, Division of Allergy, Immunology and Infectious Diseases, The Children's Hospital at Saint Peter's University Hospital; Clinical Associate Professor of Pediatrics, Drexel University College of Medicine
Robert W Tolan Jr, MD is a member of the following medical societies: American Academy of Pediatrics, American Medical Association, American Society for Microbiology, American Society of Tropical Medicine and Hygiene, Infectious Diseases Society of America, Pediatric Infectious Diseases Society, Phi Beta Kappa, and Physicians for Social Responsibility
Disclosure: GlaxoSmithKline Honoraria Speaking and teaching; MedImmune Honoraria Consulting; MedImmune Honoraria Speaking and teaching; Merck Honoraria Speaking and teaching; Novartis Honoraria Speaking and teaching; sanofi pasteur Grant/research funds Unrestricted research grant; sanofi pasteur  Consulting; sanofi pasteur Honoraria Speaking and teaching; Tap Honoraria Speaking and teaching

Chief Editor

Russell W Steele, MD, Head, Division of Pediatric Infectious Diseases, Ochsner Children's Health Center; Clinical Professor, Department of Pediatrics, Tulane University School of Medicine
Russell W Steele, MD is a member of the following medical societies: American Academy of Pediatrics, American Association of Immunologists, American Pediatric Society, American Society for Microbiology, Infectious Diseases Society of America, Louisiana State Medical Society, Pediatric Infectious Diseases Society, Society for Pediatric Research, and Southern Medical Association
Disclosure: None None None

 
 
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