diease

Hepatitis - C


OVERVIEW OF Hepatitis - C :

     Hepatitis C virus causes inflammation of the liver{hepat-liver,it is-inflammation}.It is carried through the blood and other body fluids. It causes both acute and chronic infection.IT belongs to the genus Hepaciviraceae and Family

      Flavi viridiae.It is an Encapsulated(enveloped -has glycoprotein coat) RNA single stranded virus founded in 1988’ by choo et al and kuo et al.

      Previously it was called as blood transmitted non A ,non B infection.

     Size of the virus ranges from 50-60nm and the incubation period of the disease ranges from 15-160 days


STRUCTURE of Hepatitis - C :

The hepatitis c virus particle consists of lipid membrane envelope.Two glycoprotein ,E1 and E2 are embedded in lipid envelope.Thia glycoproteins plays an important role in the entry of virus particle to the immune system.

 Hypervariability region:It helps the E2 to mask the HCV from immune system.


EPIDEMIOLOGY :

The disease is most common in European countries.It is noted that nearly 2.4 million of the American populations are living with hepatitis C virus.

      Genotype 1 was common in Australia,china and Taiwan,while Genotype 6 was found in  Vietnam,southeast Asian countries.


ROUTES OF TRANSMISSION :

The main route of transmission is by body fluids and blood.


COMMON CLINICAL SIGNS AND SYMPTOMS :

  • Bleeding easily

  • Bruising easily

  • Fatigue

  • Poor appetite

  • Swelling in your legs

  • Weight loss


DIAGNOSTIC :

DIAGNOSIS :

Active infection is confirmed by the presence of serum hepatitis C RNA in anyone is antibody positive.Anti HCV antibodies persist in serum even after viral clearance whether spontaneous or post treatment.

  THE LABORATORY DIAGNOSIS :

  • Lab diagnosis is done by ELISA
  • Antigens are obtained from proteins which are both structural and non structural cloned in E.coli.
  • Identification of the virus in blood provides more sensitive and specific test within a few days of exposure to the virus. Nowadays PCR is alone helpful in detecting the virus.

CONFIRMATORY TEST:

If the test confirms positive for anti HCV antibodies, a nucleic acid test for HCV ribonucleic acid is needed to confirm the infection

METHOD (Qualitative HCV RNA Detection):

      HCV RNA is extracted and converted into complementary DNA using reverse transcriptase. The c DNA is subsequently processed vis cyclic enzymatic reactions leading to large  number of double stranded DNAs in PCR. Detection of these amplified products is achieved by hybridizing the produced amplicons onto specific probes.The highly conserved 5’UTR region is the choice for HCV genomic RNA detection across different genotype.

Tests to check for liver damage:

  • Elastography. Doctors use a special ultrasound machine to feel how stiff your liver is.
  • Liver Biopsy. The doctor inserts a needle into your liver to take a tiny piece to examine in the lab.
  • Imaging tests. These use various methods to take pictures or show images of your insides. They include:
    • CT scan and Magnetic resonance imaging (MRI) and Magnectic resonance elastogram

Magnetic resonance imaging (MRI) and Magnectic resonance elastography.

LIVER FUNCTION TEST: LFT may be normal or showfluctuating serum transaminases between 50 and 200U/L.Juandice is rare and it is indicated in end stage cirrhosis.


TREATMENT AND PROGNOSIS :

           Medications used:Antiviral Drugs

           Liver transplantation is indicated when the disease gets worsen.

          Avoid using alcohols.


PROGNOSIS :

The disease is self limited in the affected population of 15-50%.HBV co infection,Iron overload,alpha 1 antitrypsin deficiency may progress the disease.


PREVENTION :

  • Educate the patient.

  • Screening of blood in healthcare environments.

  • Safe and appropriate use of healthcare injections with sterile equipments.

  • Aim for 7-9 hours of sleep every night and rest when tired.

  • Avoid alcohol and drugs.  If you cannot quit, seek help.

  • Maintain a healthy weight.

  • Eat healthy meals: Strive for a diet low in fat and high in fiber.Include fruit, vegetables, and whole grains.

  • Avoid trans fatty acids and saturated fats.

  • Avoid dietary supplements that may harm the liver, such as iron or vitamin A, kava, and valerian. 

  • Take only the medications recommended by your doctor.

  • Drink 6-8 glasses of water per day.

  • Exercise: Be as physically active as possible on a regular basis, balancing rest and activity.

  • Avoid or reduce stress.  Some people find meditation, prayer, or simply a quiet walk to be helpful.

  • Engage in activities that give you pleasure and make you laugh.

  • Discuss your feelings with family and close friends.

  • Join a Hepatitis C support group.


Recovery Period :

Virological relapse can occur in the first 3 months after stopping the treatment  and cure is termed as the absence of virus from serum 6 months after the completion of the therapy.

The recent availability of triple therapy with the addition of protease inhibitor such as telaprevir and bocepavir to standard pegyated interferon/ribavirin has provided a significant advance in therapy


Medicines used in the Treatment :

  1. Treatment with alpha interferons combined with antivirals such as ribavirin or sofosbuvir has been found useful.But the main complication of ribavirin include haemolytic anaemia and teratogenicity.

  2. WHO 2018 guidelines shows pan genotypic direct acting antivirus(DAAs) has good benefits in treating the patients with HCV.

  3. DAAs used to treat HCV include:

  4. Elbasvir, Glecaprevir, Ledipasavir ,peginterferon alfa 2a and sofosbuvir,Boceprevir.

     Virological relapse can occur in the first 3 months after stopping the treatment  and cure is termed as the absence of virus from serum 6 months after the completion of the therapy.

      The recent availability of triple therapy with the addition of protease inhibitor such as telaprevir and bocepavir to standard pegyated interferon/ribavirin has provided a significant advance in therapy.


REFERENCE :

Davidson Principle and practice of General Medicine-22nd edition

www.who.int

http://www.medicalnewstoday.com

http://www.pubmed.gov.in