Hepatitis C Virus
Hepatitis C
- Genus hepacivirus
- Family flavivirus
Morphology
- Small
- Enveloped
- Single stranded RNA virus
Genome
- Approx. 10,000 nucleotides coding for structural and nonstructural proteins.
- HCV has a high rate of mutation and genomic heterogeneity.
- Envelope protein coded by hypervariable region varies from isolate-to-isolate
- Allow the virus to invade host immunity.
Incubation period
- 1-5 months
MEANS OF TRANSMISSION
- Parenteral exposure to infected blood.
- Routes of infection include :
- organ transplantation
- IV drug use
- sexual contact
- exposure to blood
- perinatal transmission
- occupational exposure.
Clinical Manifestations
- MC virus associated with transfusion-related hepatitis.
- Cause fatty change in liver.
Serology and Diagnosis
- Assays of HCV RNA
- Two types of Amplification techniques can be used to detect HCV RNA
- Branched chain complementary DNA (b DNA) assay.
- Reverse Transcriptase PCR or TMA.
Treatment
- Recovery is rare
- Progression to chronic hepatitis is the rule.
- Antiviral therapy with interferon alpha reduces the rate of chronicity.
Chronic Hepatitis
- HCV has the maximum propensity for chronic hepatitis and chronic carrier state. It can also cause cirrhosis and hepatocellular carcinoma.
Clinical features:
- Fatigue is MC symptom jaundice is rare.
Extrahepatic manifestations may be seen:
- Agranulocytosis
- Aplastic anemia
- Corneal ulceration
- Cryoglobulinaemia
- Diabetes mellitus (type I)
- Erythema exsudativum multiforme
- Membrane proliferative Glomerulonephritis
- idiopathic pulmonary fibrosis
- Guillain-Barre syndrome
- Hyperlipidemia
- Lichen planus
- Non-Hodgkin lymphoma
- Polyarteritis nodosa
- Polyarthritis
- Polyneuritis
- Porphyria cutanea tarda
- Sialadenitis
- Sjogren’s syndrome /Sicca syndrome
- Thrombocytopenia
- Thyroiditis
Lab features:
- Aminotransferase fluctuates between high-to-high normal value.
- Both ALT and AST increase with ALT > AST.
- But when cirrhosis develop AST becomes greater than ALT
- LKMT – Antibody may be seen in cases of HCV.
Treatment:
- Combination therapy with pegylated interferon plus Ribavirin is standard therapy.
- Liver transplantation – When cirrhosis develops.
Exam Question
- HCV spread by blood
- HCV is flavivirus.
- Progression to chronicity is seen with hepatitis B and Hepatitis C
- Type I MPGN is commonly associated with persistent hepatitis C infection
- Extrahepatic Manifestations of Hepatitis C include lichen planus, glomerulonephritis, and cryoglobulinemia
- A course of Interferon plus Ribavarin is the recommended treatment of choice for Relapsers after a previous course of standard monotherapy with interferon or combination interferon/ribavarin therapy
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