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what is hepatitis
What is Hepatitis?
  • “Hepatitis” means inflammation of the liver
  • Can be caused by:
    • Genetic diseases
    • Medications (including over-the-counter)
    • Alcohol
    • Hepatitis viruses (A,B,C,D,E)
hepatitis c
Identified in 1989

Blood test became available in 1992

Used to be known as “non-A, non-B” hepatitis

Spread through blood-to- blood contact

No vaccine available to prevent hepatitis C

Hepatitis C

C

Dr.T.V.Rao MD

hepatitis c a global infection
Hepatitis C- A global infection
  • About 3 million Americans infected
  • About 170 million infected worldwide
  • Many do not experience symptoms

Dr.T.V.Rao MD

sources of infection for persons with hepatitis c
Sources of Infection forPersons with Hepatitis C

Injecting drug use 60%

Sexual 15%

Transfusion 10%

(before screening)

Other* 5%

Unknown 10%

*Nosocomial; Health-care work; Perinatal

Dr.T.V.Rao MD

Source: Centers for Disease Control and Prevention

what is hepatitis c infection
What is hepatitis c infection
  • Hepatitis C is a contagious liver disease that results from infection with the Hepatitis C virus. It can range in severity from a mild illness lasting a few weeks to a serious, lifelong illness. Hepatitis C is usually spread when blood from a person infected with the Hepatitis C virus enters the body of someone who is not infected

Dr.T.V.Rao MD

hepatitis c epidemiology
Hepatitis C - Epidemiology

1999

Before 1985

Illegal Drug Use

Transfusion

Sexual

Other

Unknown

Dr.T.V.Rao MD

what happens to people with hepatitis c virus

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100

15

Infected With Hepatitis C

No Chronic Disease

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··

17

2

85

Chronic Disease

Cirrhosis

Liver Cancer

What Happens to People With Hepatitis C Virus?

Dr.T.V.Rao MD

chronic hepatitis c factors promoting progression or severity
Chronic Hepatitis C Factors Promoting Progression or Severity
  • Increased alcohol intake
  • Age > 40 years at time of infection
  • HIV co-infection ? Other
    • Male gender
    • Other co-infections (e.g., HBV)

Dr.T.V.Rao MD

alcohol major contributor for progress of disease

Non-Drinker

Hepatitis C Non-Drinker

Drinker Without Hepatitis C

Drinker With Hepatitis C

Alcohol major contributor for progress of disease

Chance Of Getting Cirrhosis

Dr.T.V.Rao MD

hepatitis c can present as acute or chronic infection
Hepatitis c can present as acute or chronic infection
  • Hepatitis C can be either “acute” or “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 is a serious disease than can result in long-term health problems, or even death.

Dr.T.V.Rao MD

transmission exposure
Transmission / Exposure
  • Hepatitis C is spread when blood from a person infected with the Hepatitis C virus enters the body of someone who is not infected. Today, most people become infected with the Hepatitis C virus 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.
  • People can become infected with the Hepatitis C virus during such activities as 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

Dr.T.V.Rao MD

less commonly transmitted through
Less commonly transmitted through …
  • Less commonly, a person can also get Hepatitis C virus infection through 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

Dr.T.V.Rao MD

who should get tested for hepatitis c
Who should get tested for Hepatitis C?
  • You are a current or former injection drug user, even if you injected only one time or many years ago.
  • You were treated for a blood clotting problem before 1987.
  • You received a blood transfusion or organ transplant before July 1992.
  • You are on long-term hemodialysis treatment.
  • You have abnormal liver tests or liver disease.
  • You work in health care or public safety and were exposed to blood through a needle stick or other sharp object injury.
  • You are infected with HIV.

Dr.T.V.Rao MD

hcv testing routinely recommended
Ever injected illegal drugs

Received clotting factors made before 1987

Received blood/organs before July 1992

Ever on chronic hemodialysis

Evidence of liver disease

Healthcare, emergency, public safety workers after needle stick/mucosal exposures to HCV-positive blood

Children born to HCV-positive women

HCV Testing Routinely Recommended

Based on increased risk for infection

Dr.T.V.Rao MD

routine hcv testing not recommended unless risk factor identified
Routine HCV Testing Not Recommended(Unless Risk Factor Identified)
  • Health-care, emergency medical, and public safety workers
  • Pregnant women
  • Household (non-sexual) contacts of HCV-positive persons
  • General population

Dr.T.V.Rao MD

hcv infection testing algorithm for diagnosis of asymptomatic persons
HCV Infection Testing Algorithmfor Diagnosis of Asymptomatic Persons

Negative

(non-reactive)

STOP

EIA for Anti-HCV

Positive (repeat reactive)

OR

Negative

RT-PCR for HCV RNA

RIBA for Anti-HCV

Positive

Positive

Negative

Indeterminate

STOP

Additional Laboratory Evaluation (e.g. PCR, ALT)

Medical Evaluation

Negative PCR,

Normal ALT

Positive PCR,

Abnormal ALT

Source: MMWR 1998;47 (No. RR 19)

Dr.T.V.Rao MD

how is hepatitis c diagnosed
How is Hepatitis C Diagnosed?
  • Blood testing
    • Hepatitis C antibody test
    • Hepatitis C PCR test to find virus in blood
  • Liver function tests

Dr.T.V.Rao MD

laboratory diagnosis
Serologic tests to detect HCV antibodies: - enzyme immunoassay (EIA). False negative in pts on HD, immunodeficiency; false positive in autoimmune disorder. - recombinant immunoblot assay (RIBA)

Target amplification technique to detect HCV RNA (molecular assay) - polymerase chain reaction (PCR). A positive test confirms HCV infection.

LABORATORY DIAGNOSIS

Dr.T.V.Rao MD

currently performed testes for hepatitis c infection
Currently performed testes for hepatitis c infection
  • Currently, the second-generation enzyme immunoassay (EIA-2) for antibodies to HCV (anti-HCV) is the most practical screening test for HCV infection. The diagnosis of HCV infection can be supported or confirmed by the recombinant immunoblots assay (RIBA) or tests for HCV RNA. RIBA detects antibodies to individual HCV antigens and confers increased specificity compared to EIA-2.

Dr.T.V.Rao MD

molecular methods in diagnosis of hepatitis c infection
Molecular methods in Diagnosis of hepatitis c infection
  • Qualitative reverse transcription- polymerase chain reaction (RT-PCR) assays for HCV RNA are simpler than quantitative tests and sufficient for confirmation of the diagnosis of HCV infection.

Dr.T.V.Rao MD

alanine aminotransferase
Alanine Aminotransferase
  • Serum ALT testing is inexpensive and noninvasive.
  • Insensitive means of monitoring disease activity.
  • A single determination gives limited information, and serial measurements recommended.
  • Weak association between the degree of ALT elevation and severity of histopathological findings on liver biopsy.
  • Resolution of ALT elevation with antiviral therapy appears to indicate disease response.

Dr.T.V.Rao MD

slide27

Serologic Pattern of Acute HCV Infection

with Recovery

anti-HCV

Symptoms +/-

HCV RNA

Titer

ALT

Normal

6

1

2

3

4

0

1

2

3

4

5

Years

Months

Time after Exposure

Dr.T.V.Rao MD

slide28

Serologic Pattern of Acute HCV Infection with Progression to Chronic Infection

anti-HCV

Symptoms +/-

HCV RNA

Titer

ALT

Normal

6

1

2

3

4

0

1

2

3

4

5

Years

Months

Time after Exposure

Dr.T.V.Rao MD

liver biopsy
LIVER BIOPSY
  • Provides useful information about the degree of fibrosis in HCV infected patients. This information is important in management decisions.
  • Is not used for diagnosis of HCV infection.
  • Used for assessment of severity of inflammation, presence of fibrosis, evaluate possible concomitant disease processes, assess therapeutic intervention.

Dr.T.V.Rao MD

liver histology
Liver Histology
  • Activity (necro-inflammation) – severity and progress. May fluctuate with disease activity or therapeutic intervention.
  • Fibrosis implies possible progression to cirrhosis. In mild cases, is limited to portal and periportal area. More advanced changes defined by ‘bridging fibrosis’.
  • Cirrhosis

Dr.T.V.Rao MD

diagnostic assessment of infected patients
Diagnostic assessment of infected patients
  • In summary, the diagnostic algorithm of Hepatitis C depends on the clinical context. In asymptomatic, low-risk subjects, who are found to be anti-HCV- positive by EIA-2, the diagnosis of HCV infection needs to be confirmed, especially if the initial biochemical tests reveal normal ALT levels.

Dr.T.V.Rao MD

can we prevent hepatitis c infection
Can we prevent hepatitis c infection
  • There is no vaccine for Hepatitis C. The best way to prevent Hepatitis C is by avoiding behaviors that can spread the disease, especially injection drug use.

Dr.T.V.Rao MD

references
References
  • Centre for Disease Control (CDC) Atlanta USA, guidelines on basis of disease Diagnosis, and consequences of Hepatitis C Infection

Dr.T.V.Rao MD

slide34

Created by Dr.T.V.Rao MD for Medical and Health Care workers in the Developing world

  • Email
  • doctortvrao@gmail.com

Dr.T.V.Rao MD