Hepatitis C Management

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Question:

Two questions: What procedure should be followed after a needlestick while treating an patient infected with HCV? Also, can HCV be transmitted to a doctor who has naked eye contact with blood droplets from an HCV-positive patient during surgery?

The rate of HCV infection after a single needlestick with a sample of blood known to harbor HCV is approximately 5%. Universal Precautions will reduce but not eliminate the risk of transmission. In the event of a needlestick, the HCV status of the individual from whom the blood came should be determined. If that person is positive for anti-HCV antibodies, a Qualitative HCV RNA PCR should be done.

Simultaneously, the HCV status of the person who received the accidental needlestick should be determined. The purpose of this baseline antibody test is to determine if the victim has already been infected with HCV. Anti-HCV antibody determination is sufficient for the first screen. For the victim, no other immediate intervention is needed. Neither pre- nor postexposure administration of a gamma globulin will prevent transmission of HCV.

Though the optimal timing of treatment is still undefined, the general consensus is that it is reasonable to initiate treatment of persistent infection 12 weeks after acute infection is documented. Treatment initiated during the acute phase of infection shows an SVR rate of close to 100%.

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