Hepatitis C (Hep C) By Joshua Rollins Etiological Agent: Hepatitis C virus (HCV) Transmission/Reservoirs Reservoir: Human The infection stems from the Hepatitis C virus (HCV), which is Blood borne pathogen that infects an individual by the following means: Sharing needles, syringes, or other equipment to inject drugs Needle stick injuries in health care settings Being born to a mother who has Hepatitis C Less commonly, infection can be transmitted in the following way Sharing personal care items that may have come in contact with another person s blood, such as razors or toothbrushes Having sexual contact with a person infected with the Hepatitis C virus General characteristics of MO Hepatitis C is a viral disease that can affect individual in two ways. Severity can range from a mild illness lasting a few weeks (Acute) to a serious, lifelong illness that attacks the liver (Chronic). Acute Hepatitis C virus infection: is a short-term illness that occurs within the first 6 months after someone is exposed to the Hepatitis C virus. For most people, acute infection leads to chronic infection. Chronic Hepatitis C virus infection: is a long-term illness that occurs when the Hepatitis C virus remains in a person s body. Hepatitis C virus infection can last a lifetime and lead to serious liver problems, including cirrhosis (scarring of the liver) or liver cancer. Key tests for identification The following blood tests can identify if an individual is infected by Hepatitis C virus
Anti-HCV test (EIA): Consists of a blood test for hepatitis antibodies. A positive antibody result means that, at some point in the individual is exposed to the hepatitis C virus, and you developed antibodies to fight off the virus. This test cannot determine if the individual is currently infected. Hepatitis C viral load test (RNA test): After a positive EIA, this test will be run to determine if an individual has chronic Hepatitis C. Signs and symptoms The incubation period for hepatitis C is 2 weeks to 6 months. Following initial infection, approximately 80% of people do not exhibit any symptoms. Those who are acutely symptomatic may exhibit the following: Fever Fatigue decreased appetite nausea vomiting abdominal pain dark urine grey-colored feces joint pain jaundice (yellowing of skin and the whites of the eyes) Due to the fact that acute HCV infection is usually asymptomatic, few people are diagnosed during the acute phase. In those people who go on to develop chronic HCV infection, the infection is also often undiagnosed because the infection remains asymptomatic until decades after infection when symptoms develop secondary to serious liver damage. Historical information Transmission: Present day spread of Hepatitis C virus is mostly caused by sharing needles or other equipment to inject drugs. Before 1992, when widespread screening of the blood supply began in the United States, Hepatitis C was also commonly spread through blood transfusions and organ transplants. Treatment:
Antiviral medications were not the original treatment for hepatitis C. Before 2014, the only treatment for hepatitis C was called interferon and ribavirin, taken as weekly injections under the skin, plus pills. Interferon treatment caused many unpleasant side effects and was not usually successful. Today's antiviral treatments are extremely successful at curing the virus and have very minimal side effects. Virulence factors The natural targets of HCV are hepatocytes and, possibly, B lymphocytes. The primary immune response is mounted by cytotoxic T lymphocytes, which fails to eradicate infection in most people. It may contribute to liver inflammation and tissue necrosis. Viral clearance is associated with the development and persistence of strong virusspecific responses by cytotoxic T lymphocytes and helper T cells. The presence of lymphocytes within the hepatic parenchyma has been interpreted as evidence of immune mediated damage. Seroconversion occurs in 8-9 weeks. Once persons seroconvert they usually remain positive. Although neutralizing antibodies to HCV have been detected in the serum of infected patients, these are short-lived. HCV infection does not induce lasting immunity against re-infection with different virus isolates, or even the same isolate. Control/Treatment Hepatitis C virus is treated with the following all-oral medications: Daclatasvir (Daklinza) + Sofosbuvir (Solvaldi) Elbasvir/Grazoprevir (Zepatier) Ombitasvir/paritaprevir/ritonavir + Dasabuvir (Viekira is the name of the entire combination) Sofosbuvir (Solvaldi) + ribavirin Sofosbuvir/Ledipasvir (Harvoni) Sofosbuvir/Velpatasvir (Epclusa) Sofosbuvir (Solvaldi) + Simeprevir (Olysio) Most of the time, treatment is 12 weeks long. Sometimes treatment can be 8 weeks long, and occasionally it needs to be either 16 or 24 weeks long. In general, hepatitis C treatment regimens have extremely high success rates. Many of the regimens are successful in curing more than 90 percent of people and some of the regimens are successful in 95 to 99 percent of people. Some of the following factor may reduce an individual probability for success Having genotype 3 infection treated previously but not cured, which is called "treatment experienced" Having cirrhosis
Having changes in their virus, called "mutations," that cause the virus to be resistant to medications. Mutations can prevent the medications from working as well. Prevention/ Vaccine There is no vaccine for the Hepatitis C Virus The following prevention lower the risk of Hepatitis C virus: Illegal drug user should not share syringes or needles Safe sexual practices Precautions in a healthcare setting should be taken: exclude blood, plasma, organ, tissue, or semen donors determined to be at increased risk for HCV by history or who have serologic markers for HCV infection must be maintained to prevent HCV transmission from transfusions and transplants. Health-care, emergency medical, and public safety workers should be educated regarding risk for and prevention of blood borne infections, including the need to be vaccinated against hepatitis B (154 156 ). Standard barrier precautions and engineering controls should be implemented to prevent exposure to blood. Health-care workers, those who are HCV-positive should follow strict aseptic technique and standard precautions, including appropriate use of hand washing, protective barriers, and care in the use and disposal of needles and other sharp instruments Statistics/Cases In the United States: In 2011, the number of estimated new HCV infections increased (16,500) to 2014 (30,500). Based on CDC estimates, 3.5 million persons are living with HCV infection in the United States. An estimated three-fourths of persons living with HCV were born during 1945 to 1965. Approximately 50% of persons with HCV infection are unaware of their HCV status. Injection drug use is the most common risk factor for HCV acquisition. Sexual transmission of HCV can occur, but this most often involves men who have sex with men. The number of annual HCV-related deaths is approximately 19,000 persons and this now exceeds the number of annual HIV-related deaths.
The CDC has established a clear definition of acute and chronic HCV infection for reporting purposes as well as reporting guidelines. Globally: Hepatitis C is found worldwide. The most affected regions are World Health Organization (WHO) Eastern Mediterranean and European Regions, with the prevalence of 2.3% and 1.5% respectively. Prevalence of HCV infection in other WHO regions varies from 0.5% to 1.0%. Depending on the country, hepatitis C virus infection can be concentrated in certain populations and/or in general populations. There are multiple strains (or genotypes) of the HCV virus and their distribution varies by region. Work Cited 1. Viral Hepatitis Center for Disease Control and Prevention October 17, 2016 https://www.cdc.gov/hepatitis/hcv/cfaq.htm (May 02, 2017) 2. Hepatitis C Mayo Clinic Staff July 26, 2016 http://www.mayoclinic.org/diseasesconditions/hepatitis-c/symptoms-causes/dxc-20207369 (May 02, 2017) 3. What is Hepatitis C? Dr. Nancy Reau October 2016 http://hepc.liverfoundation.org/what-is-hepatitis-c/ (May 02,2017) 4. Emerging Microbes & Infections Stephanie Pfaender, Richard JP Brown, Thomas Pietschmann and Eike Steinmann 26 March 2014 http://www.nature.com/emi/journal/v3/n3/full/emi201419a.html (May 02, 2017) 5. Viral Hepatitis U.S. Department of Affairs August 25, 2016 https://www.hepatitis.va.gov/patient/hcv/testing/tests-needed.asp (May 05, 2017) 6. Morbidity and mortality Weekly Report Center for Disease Control and Prevention October 16, 1998 https://www.cdc.gov/mmwr/pdf/rr/rr4719.pdf (May 05, 2017) 7. HCV Epidemiology in the United States David H. Spach, MD September 05, 2016 http://www.hepatitisc.uw.edu/go/screening-diagnosis/diagnostictesting/core-concept/all#hcv-diagnostic-tests (May 05, 2017) 8. Hepatitis C fact sheet World Health Organization April 2017 http://www.who.int/mediacentre/factsheets/fs164/en/ (May 05, 2017)