Hepatitis C Virus

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
  •  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
Don’t Forget to Solve all the previous Year Question asked on Hepatitis C Virus

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