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Gastroenterology and Hepatology Hepatitis C Screening All adults aged 18 to 79 years should be screened at least once for HCV. Other high risk groups include persons who use injection drugs, recipients of blood transfusions before 1992, and those with HIV or an STI. Diagnosis HCV manifests as chronic liver disease because the acute infection is usually asymptomatic. Chronic HCV infection can cause cirrhosis and is a risk factor for HCC. Test for HC\z infection in the presence of non Hodgkin lymphoma, membranoproliferative glomerulonephritis, mixed crl,oglo bulinemia, and porphyria cutanea tarda. Testing Measurement of anti-HCV antibody is the initial diagnostic study. If positive, test for HCV RNA to determine the presence of active infection. Patients with spontaneous resolution of acute HCV or who have been treated successfully for HCV will have clearance of HCV RNA but usually remain positive for antibody to HC\il HCV genotyping should be performed at the time of diagnosis to help in choosing a treatment regimen. DON'T BE TRICKED . Because up to 40% of patients with chronic HCV have normal aminotransferase levels, normal levels cannot exclude a diagnosis of HCV. o Reactivation ofhepatitis B can occur during antiviral therapy for HCV. Test for hepatitis B before initiating direct antiviral therapy for HCV. Treatment Treatment regimens include a combination of direct acting antiviral drugs. Regimens are chosen based on genotype, previous treatment experience and response, and fibrosis status. Treatment of patients with HIV coinfection is similar to that fbr patients with HCV alone. Patients with HCV who have decompensated disease or localized HCC are candidates for liver transplantation. Follow-up Surveillance Patients with cirrhosis should undergo sonography surveillance fbr tlCC every 6 months. TEST YOURSETF A 45 year old man who uses injection drugs has a 3-month his tory of recurrent purpuric lesions on his legs. Skin biopsy shows leukocytoclastic vasculitis. H BsAg is negative. ANSWER: Select testing for HCV infection and cryoglobulins. leukocporlastic Vasculitis: Leukocytoclastic vasculitis consistent with HCV- associated mixed cryoglobulinemia manifesting as palpable purpura. 102