Case:

CC: 23-year-old man was referred for abnormal LFT’s

HPI: The patient was admitted for severe depression.  His psychiatrist had obtained blood tests to follow valproate (Depakote) therapy.  Liver chemistries were abnormal (see below).  The patient was asymptomatic and denied any jaundice, fever, abdominal pain, nausea and vomiting.  He has never had blood transfusions.  He denies the use of medications other than those prescribed by his psychiatrist.  Patient admits using illicit drugs IV starting about 8 weeks ago and has continued use to the present.

PMH: Bipolar disorder

Medications:

Depakote 500 mg XR qd,

fluoxetine 40 mg qd,

clonazepam 1 mg prn.

PH and SH: no excessive alcohol and tobacco use, no travel, recent IV drug abuse as above

FH: father suffers from depression

Labs:

Direct bili 1 mg/dL, Alk phos 188 u/L, ALT 1178 u/L, AST 746 u/L (all significantly elevated); Anti-HCV negative on hospital day 1 and positive on day 3, HCV-RNA PCR positive (done only on day 3);

Hep A, B and D markers are negative.

Patient is diagnosed with Acute Hepatitis C

Questions:

1. In this case, what are the some clinical features that are typical for acute HCV?

2. How is the diagnosis of acute hepatitis C made?

3. What is the natural history for HCV infection?

4. What are the treatment strategies for acute HCV infection.

5. When is therapy initiated in chronic HCV patients and what is an example of a treatment regimen?

6. What are some of the limitations of available therapies?

Click here to see the answers