Hepatitis C secondary prevention: Difference between revisions

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{{Hepatitis C}}
{{Hepatitis C}}
{{CMG}}; {{AOEIC}} {{VK}}
{{CMG}} ; '''Associate Editor(s)-In-Chief:''' {{JA}}
 
==Overview==
Patients who are diagnosed with chronic hepatitis C require vaccination against other hepatitis viruses, limiting of alcohol intake, and evaluation for other comorbid conditions in order to limit further hepatic damage. Patients should be instructed on how to avoid HCV transmission to others.
==Secondary Prevention==
==Secondary Prevention==
People who have hepatitis C should consider making following changes to their lives:  
Patients who are diagnosed with chronic hepatitis C require specific measures to limit further hepatic damage and to avoid progression to cirrhosis.
*Reducing alcohol intake
===Important measures to avoid reduce the risk of further hepatic injury include:===
*Maintaining a well [[balanced diet]] i.e. low in fat and considering overall health maintenance.
* Assessment of alcohol intake for all patients with HCV infection and advising limitation of alcohol
*Consult a physician for regular monitoring of the condition and, if necessary, he may refer to a specialist.
* Behavioural alcohol reduction intervention in patients with moderate to high alcohol intake
*Immunization against other hepatitis viruses for which there are vaccines (i.e. [[hepatitis A]] and [[hepatitis B]]) should be considered.
* Maintaining a well [[balanced diet]] that is low in fat  
*Covering completely any cut or wound with a waterproof dressing would help in reduction of transmission of the virus.
* Evaluation for other conditions that may accelerate liver fibrosis, including HBV and HIV infections
*Should ensure that the injecting equipment are not shared.
* Immunization against other hepatitis viruses([[hepatitis A]] and [[hepatitis B]]) is highly recommended<ref name="aasld2014">AASLD/IDSA/IAS–USA. Recommendations for testing, managing, and treating hepatitis C. http://www.hcvguidelines.org. Accessed July 27, 2014.</ref><br>
*Should not donate blood or body organs.
* Studies have demonstrated an association between [[treatment]]-induced sustained [[virus|viral]] clearance and low extra-[[hepatic]] manifestations (such as, [[cryoglobulinemia|cryoglobulinemic]] [[vasculitis]], B-cell [[Non-Hodgkin lymphoma|nonHodgkin’s lymphoma]], [[acute coronary syndrome]]<ref name="pmid25398770">{{cite journal |vauthors=Hsu YC, Ho HJ, Huang YT, Wang HH, Wu MS, Lin JT, Wu CY |title=Association between antiviral treatment and extrahepatic outcomes in patients with hepatitis C virus infection |journal=Gut |volume=64 |issue=3 |pages=495–503 |date=March 2015 |pmid=25398770 |doi=10.1136/gutjnl-2014-308163 |url=}}</ref>, [[cardiovascular]] disease<ref name="pmid25716707">{{cite journal |vauthors=Innes HA, McDonald SA, Dillon JF, Allen S, Hayes PC, Goldberg D, Mills PR, Barclay ST, Wilks D, Valerio H, Fox R, Bhattacharyya D, Kennedy N, Morris J, Fraser A, Stanley AJ, Bramley P, Hutchinson SJ |title=Toward a more complete understanding of the association between a hepatitis C sustained viral response and cause-specific outcomes |journal=Hepatology |volume=62 |issue=2 |pages=355–64 |date=August 2015 |pmid=25716707 |doi=10.1002/hep.27766 |url=}}</ref>, [[insulin resistance]], and [[type 2 diabetes]]<ref name="pmid29703790">{{cite journal |vauthors=Cacoub P, Desbois AC, Comarmond C, Saadoun D |title=Impact of sustained virological response on the extrahepatic manifestations of chronic hepatitis C: a meta-analysis |journal=Gut |volume=67 |issue=11 |pages=2025–2034 |date=November 2018 |pmid=29703790 |doi=10.1136/gutjnl-2018-316234 |url=}}</ref>) risk for [[Hepatitis C]].<ref name="CacoubLongo2021">{{cite journal|last1=Cacoub|first1=Patrice|last2=Longo|first2=Dan L.|last3=Saadoun|first3=David|title=Extrahepatic Manifestations of Chronic HCV Infection|journal=New England Journal of Medicine|volume=384|issue=11|year=2021|pages=1038–1052|issn=0028-4793|doi=10.1056/NEJMra2033539}}</ref>
*Should not share personal items such as toothbrushes or razors.
*Any blood spills — including dried blood, which can still be infectious — should be cleaned using a dilution of one part household bleach to 10 parts water. Gloves should be worn when cleaning up blood spills.
 
==Recommendation for Counseling: AASLD Practice Guidelines 2009<ref name="pmid19554546">{{cite journal |author=Swan T, Curry J |title=Comment on the updated AASLD practice guidelines for the diagnosis, management, and treatment of hepatitis C: treating active drug users |journal=[[Hepatology (Baltimore, Md.)]] |volume=50 |issue=1 |pages=323–4; author reply 324–5 |year=2009 |month=July |pmid=19554546 |doi=10.1002/hep.23077 |url=http://dx.doi.org/10.1002/hep.23077 |accessdate=2012-02-21}}</ref>==
{{cquote|
'''1.''' Persons infected with HCV should be counseled on how to avoid HCV transmission to others, as indicated below (Class I, level C)
 
'''Measures to Avoid Transmission of HCV'''
* HCV-infected persons should be counseled to avoid sharing toothbrushes and dental or shaving equipment, and be cautioned to cover any bleeding wound in order to prevent contact of their blood with others
* Persons should be counseled to stop using illicit drugs. Those who continue to inject drugs should be counseled to avoid reusing or sharing syringes, needles, water, cotton or other [[paraphernalia]]; to clean the injection site with a new alcohol swab; and to dispose of syringes and needles after one use in a safe, puncture-proof container
* HCV-infected persons should be advised to not donate blood, body organs, other tissue or semen
* HCV-infected persons should be counseled that the risk of sexual transmission is low, and that the infection itself is not a reason to change sexual practices ( i.e., those in long term relationships need not start using barrier precautions and others should always practice "safer" sex)}}
 
==Recommendation for Secondary Prevention: AASLD Practice Guidelines 2009<ref name="pmid19554546">{{cite journal |author=Swan T, Curry J |title=Comment on the updated AASLD practice guidelines for the diagnosis, management, and treatment of hepatitis C: treating active drug users |journal=[[Hepatology (Baltimore, Md.)]] |volume=50 |issue=1 |pages=323–4; author reply 324–5 |year=2009 |month=July |pmid=19554546 |doi=10.1002/hep.23077 |url=http://dx.doi.org/10.1002/hep.23077 |accessdate=2012-02-21}}</ref>==
{{cquote|
'''1.''' All persons with chronic HCV infection who lack antibodies to hepatitis A and B should be offered vaccination against these two viral infections ''(Class IIa, Level C)''.


'''2.''' Persons with chronic HCV infection should be advised to abstain from alcohol consumption ''(Class IIb, Level C)''.
===Precautions to prevent transmission to other individuals include:<ref name="who">World Health Organization (WHO) 2014. Guidelines for the screening, care and treatment of persons with hepatitis C infection.http://www.who.int/hiv/pub/hepatitis/hepatitis-c-guidelines/en/. Accessed online on July 24,2014.</ref>===
 
* Covering completely any cut or wound with a waterproof dressing would help in reduction of transmission of the virus
'''3.''' No recommendation can be made for the use of herbal products. There is no current evidence that herbal products have a role in the treatment of patients with acute or chronic HCV infection, ''(Class III, level C)''.}}
* Ensuring that the injecting equipment is not shared
* Avoiding blood or organ donation
* Not sharing personal items such as toothbrushes or razors
* Engaging in protected intercourse whenever possible


There are currently no CDC recommendations to restrict a healthcare worker who is infected with HCV. The risk of transmission from an infected healthcare worker to a patient appears to be very low.<ref name="aasld2014">AASLD/IDSA/IAS–USA. Recommendations for testing, managing, and treating hepatitis C. http://www.hcvguidelines.org. Accessed July 27, 2014.</ref> All healthcare personnel, including those who are HCV positive, should follow strict aseptic technique and standard precautions, including appropriate hand hygiene, use of protective barriers, and safe injection practices.<ref name="aasld2014">AASLD/IDSA/IAS–USA. Recommendations for testing, managing, and treating hepatitis C. http://www.hcvguidelines.org. Accessed July 27, 2014.</ref>
==References==
==References==
{{Reflist|2}}
{{Reflist|2}}


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Latest revision as of 23:11, 12 June 2021

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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1] ; Associate Editor(s)-In-Chief: Javaria Anwer M.D.[2]

Overview

Patients who are diagnosed with chronic hepatitis C require vaccination against other hepatitis viruses, limiting of alcohol intake, and evaluation for other comorbid conditions in order to limit further hepatic damage. Patients should be instructed on how to avoid HCV transmission to others.

Secondary Prevention

Patients who are diagnosed with chronic hepatitis C require specific measures to limit further hepatic damage and to avoid progression to cirrhosis.

Important measures to avoid reduce the risk of further hepatic injury include:

Precautions to prevent transmission to other individuals include:[6]

  • Covering completely any cut or wound with a waterproof dressing would help in reduction of transmission of the virus
  • Ensuring that the injecting equipment is not shared
  • Avoiding blood or organ donation
  • Not sharing personal items such as toothbrushes or razors
  • Engaging in protected intercourse whenever possible

There are currently no CDC recommendations to restrict a healthcare worker who is infected with HCV. The risk of transmission from an infected healthcare worker to a patient appears to be very low.[1] All healthcare personnel, including those who are HCV positive, should follow strict aseptic technique and standard precautions, including appropriate hand hygiene, use of protective barriers, and safe injection practices.[1]

References

  1. 1.0 1.1 1.2 AASLD/IDSA/IAS–USA. Recommendations for testing, managing, and treating hepatitis C. http://www.hcvguidelines.org. Accessed July 27, 2014.
  2. Hsu YC, Ho HJ, Huang YT, Wang HH, Wu MS, Lin JT, Wu CY (March 2015). "Association between antiviral treatment and extrahepatic outcomes in patients with hepatitis C virus infection". Gut. 64 (3): 495–503. doi:10.1136/gutjnl-2014-308163. PMID 25398770.
  3. Innes HA, McDonald SA, Dillon JF, Allen S, Hayes PC, Goldberg D, Mills PR, Barclay ST, Wilks D, Valerio H, Fox R, Bhattacharyya D, Kennedy N, Morris J, Fraser A, Stanley AJ, Bramley P, Hutchinson SJ (August 2015). "Toward a more complete understanding of the association between a hepatitis C sustained viral response and cause-specific outcomes". Hepatology. 62 (2): 355–64. doi:10.1002/hep.27766. PMID 25716707.
  4. Cacoub P, Desbois AC, Comarmond C, Saadoun D (November 2018). "Impact of sustained virological response on the extrahepatic manifestations of chronic hepatitis C: a meta-analysis". Gut. 67 (11): 2025–2034. doi:10.1136/gutjnl-2018-316234. PMID 29703790.
  5. Cacoub, Patrice; Longo, Dan L.; Saadoun, David (2021). "Extrahepatic Manifestations of Chronic HCV Infection". New England Journal of Medicine. 384 (11): 1038–1052. doi:10.1056/NEJMra2033539. ISSN 0028-4793.
  6. World Health Organization (WHO) 2014. Guidelines for the screening, care and treatment of persons with hepatitis C infection.http://www.who.int/hiv/pub/hepatitis/hepatitis-c-guidelines/en/. Accessed online on July 24,2014.

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