214.2 📚 國考版

214.2.0.1 必背 — HCV Features

  • ssRNA Flaviviridae (hepacivirus)
  • 6 genotypes (1 + 3 most common)
  • ~ 58M chronic infections globally
  • WHO 2030 elimination goal

214.2.0.2 必背 — Transmission

  • IDU #1 in developed countries
  • Pre-1992 transfusion (historical)
  • Egypt iatrogenic (highest prevalence)
  • MSM + HIV+
  • Vertical 5-10% (20% if HIV co-infection)

214.2.0.3 必背 — Course

  • Acute: 75-85% asymptomatic
  • 15-20% spontaneous clear
  • 80% chronic
  • Chronic: largely asymptomatic until cirrhosis (20% in 20-30 yr)

214.2.0.4 必背 — Extrahepatic

  • Mixed cryoglobulinemia (5-25%)
  • MPGN, vasculitis
  • B-cell lymphoma (splenic marginal zone)
  • Porphyria cutanea tarda
  • Lichen planus
  • Type 2 diabetes insulin resistance

214.2.0.5 必背 — Diagnosis

  • Anti-HCV Ab (screen)
  • HCV RNA PCR (active)
  • FibroScan / FIB-4 for fibrosis

214.2.0.6 必背 — Treatment — DAA Era

Drug Indication
Sofosbuvir/Velpatasvir (Epclusa) Pan-genotypic 12 wk
Glecaprevir/Pibrentasvir (Mavyret) Pan-genotypic 8 wk (12 wk cirrhotic)
Sofosbuvir/Velpatasvir/Voxilaprevir (Vosevi) Salvage 12 wk

95% SVR12 = cure

214.2.0.7 必背 — Universal Adult Screening (USA 2020+)

  • All adults ≥ 18 yr at least once
  • Pregnant women
  • High-risk groups

214.2.0.8 必背 — No Vaccine

  • Development challenges
  • Vaccines in Phase 2 trials

214.2.0.9 必背 — Special Populations

  • Pregnancy: DAAs not yet approved (treat post-pregnancy)
  • HIV co-infection: same DAA regimens, drug interactions
  • Cirrhotic decompensated: adjust regimen, avoid PIs in severe
  • Renal failure: glecaprevir/pibrentasvir preferred any eGFR