<prompt> True statement regarding hepatitis C infection:Most patients have severe symptoms when infected for first timeHighly likely to cause chronic ongoing infectionTransmitted by eating raw oystersIt is DNA virus  <response>: Ans: b Highly likely to cause chronic ongoing infectionRef: Harrisons Principles of Internal Medicine, 19th edition, Page 2040; Sleisenger and Fordtrans Gastrointestinal and Liver Disease, Page 1332Acute hepatitis C is rarely seen in clinical practice, because nearly all cases are asymptomatic.Chronic hepatitis C follows acute hepatitis C in 50-70 of cases20-25 of patients with chronic hepatitis C progress to cirrhosisProgression of liver disease depends on:AgeLonger duration of infection - most important factorConcomitant other liver diseaseObesityHIV infectionLong-term prognosis for chronic hepatitis C in a majority of patients is relatively benign o The best prognostic indicator in chronic hepatitis C is liver histologyAminotransferase levels tend to fluctuate more the characteristic episodic pattern of aminotransferase activityInteresting and occasionally confusing finding in patients with chronic hepatitis C is the presence of autoantibodies Anti LKMDrugs used in the treatment of hepatitis C infection: PEG IFN-a plus ribavirinAgentGenotypesDoseCommentProtease InhibitorsBoceprevir1800 mg three times dailyUsed in combination with pegylated interferon and ribavirin; no longer recommendedTelaprevir11125 mg twice dailyUsed in combination with pegylated interferon and ribavirin; no longer recommendedSimeprevir1 and 4150 mg once dailyUsed in combination with pegylated interferon and ribavirin or with sofosbuvirParitaprevir1 and 4150 mg once dailyUsed in combination with ombitasvir and dasabuvir; ritonavir boostedAsunaprevir1 and 4200 mg twice dailyUsed in combination with daclatasvir or with daclatasvir and BMS-791324Grazoprevir1,2, 4-6100 mg once dailyUsed in combination with eibasvirNon-nucleostide Polymerase InhibitorsDasabuvir1 and 4250 mg twice dailyUsed in combination with paritaprevir and ombitasvirBMS-791325175 mg twice dailyUsed in combination with daclatasvir and asunaprevirNucleostide Polymerase InhibitorSofosbuvir1-6400 mg once dailyUsed in combination with pegylated interferon and ribavirin all genotypes or with ribavirin alone genotypes 2 and 3 or with simeprevir genotypes 1 and 4 or with declatasvir all genotypes or with ledipasvir genotypes 1,3 and 4 or with GS-5861 under studyNS5A InhibitorsDaclatasvir1-660 mg once dailyUsed in combination with sofosbuvir genotypes 1-6 or with pegylated interferon and ribavirin genotype 4 or with asunaprevir with or without BMS-791325; under studyLedipasvir1,3 and 490 mg once dailyUsed in combination with sofosbuvirOmbitasvir1 and 425 mg once dailyUsed in combination with paritaprevir and dasabuvirEibasvir1-650 mg once dailyUsed in combination with grazoprevirGS-58161-6100 mg once dailyUsed in combination with sofosbuvir 