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.
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.
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.
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:
- 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)
MULTIPLE CHOICE QUESTIONS (MCQs) :-
1.] Hepatitis – C causes an infection of the ?
2.] Is hepatitis – C contagious ?
3.] In most people, what are the symptoms of hepatitis – C when they are initially infected ?
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 ?
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
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
1.] (b) liver
3.] (d) most people do not experience symptoms
4.] (a) scarring of the liver
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
1.] Textbook Of Pathology By Harsh Mohan; 7th edition; Page no. 593 – 594.
2.] Robbin’s Basic Pathology; 5th edition; Page no. 846 – 848.