Role of DAA'S in extrahepatic manfestations of Hepatitis C

1. Gastroenterologist , Hepatologist
Qabbary Specialized Hospital

3. 70-74% of
patients infected with HCV might develop at
least one EHM
during the course of the disease
What do you think about the prevelance of
Extrahepatic manifestations in Hepatitis C patients
?

4. Thes can be present long before the stage of
advanced liver disease
And include non spesfic symptoms(fatigue,nausea,abdominal or
musculoskletal pain,loss of weight)
Neuropsychiatric symptoms including (depression , irritability and
malaise)
And more spesfic biological manifestations such as cryoglobulinania
vasculitis, lymphoprolifrative disorders such as(B CELL non
Hodgkin lymphoma)
Renal disease
Typr II DM
Crebrovascular and Cardiovascular events
Porphyria cautanea tarda and lichen planus

10. Mixed cryoglobulinemia (MC) vasculitis(Cryovas)
 is a small vessel vasculitis involving mainly the skin, the joints, the
peripheral nerve system and the kidneys

HCV infection is the cause of Cryovas in about
80% of cases.
 The disease expression is variable,ranging from mild symptoms
(purpura, arthralgia) to fulminant life-threatening
complications(glomerulonephritis, widespread vasculitis).
Skin is the most frequently involved target
 Palpaple pupra is the most common manifestation

28. Role of Antiviral in treating
HCV patients with extra
hepatic hepatic
manifestations

39. 54 years old female who
developed ulcerations on her
toes and severe toe pain such
that she could not stand or walk
She ask medical advice and not
improved even after
dermatological treatment
the dermatologist consult the
internist and he asked some
investigations and the results
was

40. CBC …… Normal
FBS , PPBS ,HbA1c …………Normal
TSH………….. Normal
HBsAg HBcAb ……Negative
HCV Ab ……………..positive
Liver enzymes ………. Normal
Renal functions………Normal
The patient refered to the Hepatologist
for HCV Treatment

41. Do you think the complaint related to hepatitis C ?
YES - NO
WHAT is the next step ?
HCV PCR and the result was 1260000
RF & Cryoglobulins and the result was positive
The patient starts treatment of HCV with DAA’S for 12 week
and achived SVR
1 month in to treatment the foot pain was gone and the
patient came walking NOT on a Wheel chair
2 months on treatment,All the toes lesions resolved
comletely

42. Take home messeges
 Chronic HCV is associated with multi systemic
manifestations beyond the liver
 The occurrence of these manifestations is
unpredictable and irrespective to the stage of liver
disease
 Recent development in HCV therapeutics have
established simpler, all oral highly effective DAA’S
agents as the first line of treatment