Hepatitis-C HCV, Symptoms, Causes, Pathogenesis, Treatment and MCQs for NEET, GPAT, NET JRF Exam

INTRODUCTION :-

1.] Initially, in previous times Hepatitis – C was designated as non – A and non – B [ NANB ] hepatitis. But, now it has been characterized and is called Hepatitis – C.

2.] Hepatitis – C infection is acquired by the blood transfusion, blood products, haemodyialysis, parental drug abuse and accidental cuts and Needle pricks in health workers.

3.] About 90% of post – transfusion hepatitis is of hepatitis – C type.

4.] About 1 – 2% of volunteer blood donor and upto 5% of professional blood donors are the carrier of HCV.

5.] It has an incubation period of about 20 – 90 days ( mean 50 days ).

6.] Persistent of infection and chronic hepatitis are the key features of HCV.

7.] Currently, HCV is considered more important cause of chronic liver disease worldwide than HBV.

HEPATITIS – C VIRUS [ HCV ] :-

1.] HCV is a single – stranded, enveloped RNA virus, having a diameter of 30 – 60 nm.

2.] HCV genome has about 3000 amino acids.

3.] The genomic organization of HCV shows a 5’ terminal end, C (caspid) region and the envelope region E1 and E2 in the exons.

4.] The viral protein results in corresponding serologic and virologic markers of HCV infection as under :-

A.) ANTI HCV ANTIBODIES :

  • 1st generation antibodies are against C 100 – 3 region protein and appear 1 – 3 months after infection.
  • 2nd generation antibodies are against C 200 and C 33c protein appear about 1 month earlier than the 1st generation.
  • 3rd generation antibodies are against C22 – 3 and NS – 5 region proteins and are detected even earlier.

B.) HCV RNA : HCV infection is, however confirmed of HCV – RNA employing PCR technique which can be detected within a few days after the exposure of the HCV infection.

PATHOGENESIS :-

HCV induces hepatocellular injury by cell – mediated immune mechanism is supported by the following :-

  • It is possible that the host lymphoid cell are infected by HCV.
  • Natural killer cell [NK] cells also seem to contribute to containment ( the limitation of something harmful ) of HCV infection.
  • HCV activated CD4+ lymphocytes stimulate CD8+ T lymphocytes via cytokines elaborated by CD4+ helper T – cells.
  • The stimulated CD8+T lymphocytes, in turn, elaborate antiviral cytokines against various HCV antigen.
  • This may seriously hamper efforts to develop an effective HCV vaccine, particularly because HCV appears to be a relatively unstable virus, with continued alteration in envelope antigen expression.

TREATMENT :-

Hepatitis C virus (HCV) infection causes liver inflammation that can lead to liver problems, including cancer. People who have chronic hepatitis C need medication to treat it. These drugs can ease symptoms of HCV.

A.] RIBAVIRIN :

Ribavirin works by stopping viruses from replicating and spreading. It’s an oral medication that comes as a capsule, tablet, or solution and is available in several strengths. It’s used in combination with other drugs.

Brand names of ribavirin include:

  • Copegus
  • Moderiba
  • Rebetol
  • Ribasphere
  • Ribasphere RibaPak

Ribavirin may cause birth defects if a woman takes it during pregnancy. It can also cause birth defects if a man fathers a child during his treatment with this drug.

B.] DIRECT – ACTING ANTIVIRALS ( DAAs )

C.] Protease inhibitor antiviral medications (NS3/4A inhibitors)

  • paritaprevir, for genotype 1
  • simeprevir (Olysio), for genotypes 1 and 4
  • grazoprevir, for genotypes 1 and 4

D.] Protease inhibitors (NS5A inhibitors)

Examples of directed inhibitors include:

  • ledipasvir (a component of the combination drug Harvoni)
  • ombitasvir (a component of the combination drug Viekira Pak)
  • elbasvir (a component of the combination drug Zepatier)
  • daclatasvir (Daklinza)

E.] Nucleotide/nucleoside and nonnucleoside polymerase inhibitors (NS5B inhibitors)

Examples of these drugs include:

  • sofosbuvir (Sovaldi)
  • dasabuvir

 

MULTIPLE CHOICE QUESTIONS (MCQs) :-

1.] Hepatitis – C causes an infection of the ?

a. Brain

b. Liver

c. Kidney

d. Blood

2.] Is hepatitis – C contagious ?

a. True

b. False

3.] In most people, what are the symptoms of hepatitis – C when they are initially infected ?

a. Itching

b. Jaundice

c. Back pain

d. Most people do not experience symptom

4.] What are cirrhosis ?

a. Scarring of the liver

b. Liver pain

c. Early – stage liver cancer

d. All of the above

5.] There is a vaccination against Hepatitis – C ?

a. True

b. False

6.] Hepatitis – C virus has how many amino acids ?

a. 1000 amino acids

b. 2000 amino acids

c. 1500 amino acids

d. 3000 amino acids

7.] Hepatitis – C virus is which type of virus ?

a. Single stranded, enveloped, having diameter of 30 – 60nm

b. Double stranded, non – enveloped with a diameter of 30 – 60nm

c. Both the above statements are incorrect

d. None of the above

8.] Incubation period for HCV are ?

a. 10 – 15 days

b. 20 – 90 days

c. 2 days

d. 1 week

9.] Which of the following is the most important goal of treating chronic viral hepatitis – C infection ?

a. Normalize ALT and AST

b. Improve symptoms

c. Reverse cirrhosis

d. Eliminate the HCV RNA from serum

10.] What specific treatment do you recommend for chronic hepatitis – C infection for TAS ?

a. Interferon – α + ribavirin

b. Lamivudine

c. None; he is likely to respond to interferon – α

d. None; the risk of adverse effect of interferon – α is too great in TAS

SOLUTIONS :-

1.] (b) liver

2.] (a)

3.] (d) most people do not experience symptoms

4.] (a) scarring of the liver

5.] (b)

6.] (d) 3000 amino acids

7.] (a) single stranded, enveloped, having diameter of 30 – 60nm

8.] (b) 20 – 90 days

9.] (d) eliminate the HCV RNA from serum

10.] (a) interferon – α + ribavirin

 

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REFERENCES :-

1.] Textbook Of Pathology By Harsh Mohan; 7th edition; Page no. 593 – 594.

2.] Robbin’s Basic Pathology; 5th edition; Page no. 846 – 848.

 

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