Regarding the prevention and treatment of hepatitis C?

Which one of the following statements best describes the prevention and treatment of hepatitis C?

A. No vaccine is available and treatment is only successful in around 10-15% of patients
B. No vaccine and no treatment is available
C. A vaccine is available and treatment is successful in around 50% of patients
D. A vaccine is available but no treatment has been shown to be effective
E. No vaccine is available but treatment is successful in around 50% of patients

Answer:
E. No vaccine is available but treatment is successful in around 50% of patients

Discussion: Hepatitis C is likely to become a significant public health problem in the UK in the next decade. It is thought around 200,000 people are chronically infected with the virus. At risk groups include intravenous drug users and patients who received a blood transfusion prior to 1991 (e.g. haemophiliacs).

Pathophysiology 
 hepatitis C is a RNA flavivirus
 incubation period: 6-9 weeks

Transmission
 the risk of transmission during a needle stick injury is about 2%
 the vertical transmission rate from mother to child is about 6%
 breast feeding is not contraindicated in mothers with hepatitis C
 the risk of transmitting the virus during sexual intercourse is probably less than 5%

Clinical Features 
 after exposure to the hepatitis C virus less than 20% of patients develop an acute hepatitis

Complications
 chronic infection (80-85%) - only 15-20% of patients will clear the virus after an acute infection and hence the majority will develop chronic hepatitis C
 cirrhosis (20-30% of those with chronic disease)
 hepatocellular cancer
 cryoglobulinaemia
 porphyria cutanea tarda (PCT): it is increasingly recognised that PCT may develop in patients with hepatitis C, especially if there are other factors such as alcohol abuse

Management of chronic infection
 currently a combination of pegylated interferon-alpha and ribavirin are used
 up to 55% of patients successfully clear the virus, with success rates of around 80% for some strains
 the aim of treatment is sustained virological response (SVR), defined as undetectable serum HCV RNA six months after the end of therapy

Complications of treatment 
 ribavirin - side-effects: haemolytic anaemia, cough. Women should not become pregnant within 6 months of stopping ribavirin as it is teratogenic
 interferon alpha - side-effects: flu-like symptoms, depression, fatigue, leukopenia, thrombocytopenia