BOF: 2.4
A 47-year-old male has been referred by his GP for
investigation of abnormal liver function tests. He uses approximately 50 units
of alcohol per week and is an intravenous drug abuser having picked up the
habit when he was in prison for two years. He had just been released from
prison. There were no past illnesses of note; in particular he had never
received a blood transfusion or any blood products. On examination there were
no stigmata of chronic liver disease and there was no hepatomegaly.
Investigations revealed raised aminotransferases and he was anti-HCV antibody
positive and HCV-RNA positive genotype 1.
In this patient the risk of progression of liver disease
is not increased by:
a)
Age at which he acquired infection
b)
Alcohol consumption
c)
Male sex
d)
Continuing drug abuse
e)
Genotype 1
Answer:
d)
The patient is hepatitis C
positive. In patients with hepatitis C the risk of progression
of liver disease is increased by acquiring the illness after the age of 40. In
this patient the history suggests he acquired the infection whilst in prison
when he began intravenous drug abuse.
Alcohol consumption affects the course of the illness
adversely. The patient should be advised to abstain.
Male patients are at greater risk of more rapid
development of fibrosis.
Genotype 1 and 4 are also associated with more rapid
development of fibrosis.
The rate of progress of liver disease has not been shown
to be adversely affected by continuing drug abuse although this will affect
his overall health.
Hepatitis C
