Hepatitis C Virus

• Flaviviridae family
• genome is a positive-sense RNA molecule
• enveloped
• six genotypes and numerous subtypes of HCV.

• Hepatitis” means inflammation of the liver.

• caused by;

 Toxins,
 certain drugs,
 some diseases,
 heavy alcohol use,
 Bacterial and viral infections

• contagious liver disease

• Ranges in severity from a mild illness to a serious
• Results from infection with the Hepatitis C virus (HCV)
• Spread primarily through contact with the blood of an infected person
• can be either acute and chronic.

Acute HCV:

• Short-term illness
• occurs within the first 6 months after someone is exposed to the HCV.
• sometimes,acute infection leads to chronic infection.

Chronic HCV:

• a long-term illness
• occurs when the Hepatitis C virus remains in a person’s body.
• lasts a lifetime
 • lead to serious liver problems,

 including cirrhosis (scarring of the liver) or liver cancer.

 Approximately 75%–85% of people who become infected with hepatitis C virus will
develop a chronic infection.

Route of transmission

• 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
• 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.

Epidemiology of HCV:-

About 15–45% of infected persons spontaneously clear the virus within 6 months of infection.The
remaining 60–80% of persons will develop chronic HCV infection. Of those with chronic HCV
infection, the risk of cirrhosis of the liver is between 15–30%.

HCV is a major causative agent for chronic hepatitis causes hepatocellular carcinoma. It is a small
hepatotropic virus infecting and also 200 million people globally. The World Health Organization
(WHO) report states that 3% of the world population is infected with HCV, and every year, 3–4
million new cases of HCV infection occur globally.

Geographical distribution

Hepatitis C is found worldwide. The most affected regions are 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%.
HCV seroprevalence in Pakistan:-
Pakistan ranked second in the world in terms of HCV burden, HCV cause 11 million infections all
over the Pakistan. Due to poor socioeconomic situation and lack of awareness in different parts of
Pakistan this viral infection is increasing day by day.

A comprehensive review of previous data (2010–2016) about HCV prevalence in the general
population showed that the prevalence of HCV in the general population ranged from 3.13% to
23.83%.The prevalence range of HCV in these high-risk groups ranged from 2.9% to 66%.

• HCV genotype 3a prevalence was found to be 63.45%, the highest of all genotypes.

population prevalence

Adult population 11.55%

Blood donors 10.10%

Pregnant women 4.65%

Children 1.6%

Patients with different diseases 24.97%

Injecting drug users 51.0%

Provinces Prevalence

Punjab 5.46%
 Sindh 2.55%

Khyber Pakhtoonkhaw 6.07%

Balochistan 25.77%

Fedrally administered tribal areas 3.37%

Symptoms:

• Fever
• Fatigue
• Loss of appetite
• Nausea
• Vomiting
• Abdominal pain
• Dark urine
• Clay-colored bowel movements
• Joint pain
• Jaundice (yellow color in the skin or eyes)

Diagonosis:

• screening
• pcr
• estimation of liver fibrosis
• include FIB-4, FibroSure, Fibrotest, and aspartate aminotransferase-to-platelet ratio index
(APRI).

Treatment:
 • Hepatitis C does not always require treatment as the immune response in some people will
clear the infection,
• Some people with chronic infection do not develop liver damage.
• The cure rate depends on several factors including the strain of the virus and the type of
treatment given.

WHO guidelines:

• Sofosbuvir, daclatasvir and the sofosbuvir/ledipasvir combination can achieve cure rates
above 95%.
• These medicines are much more effective, safer and better-tolerated than the older
therapies.
• Therapy with DAAs can cure most persons with HCV infection and treatment is shorter
(usually 12 weeks).
• WHO is currently updating its treatment guidelines to include pangenotypic DAA
regimens and simplified laboratory monitoring.
• Meanwhile, there remains a very limited role for pegylated interferon and ribavirin in
certain scenarios.
• Although the production cost of DAAs is low, these medicines remain very expensive in
many high- and upper middle-income countries.
• Prices have dropped dramatically in some countries (primarily low-income) due to the
introduction of generic versions of these medicines.

Vaccination:

• There is no vaccine for hepatitis c. Vaccines are available only for Hepatitis A and Hepatitis
B. Research into the development of a vaccine is under way.

Primary prevention:

• It can be prevented by:

• not sharing drug needles
• not sharing razors
 • not using someone else’s toothbrush
• not touching spilled blood

Secondary prevention:

• Education and counselling on options for care and treatment;

• Immunization with the hepatitis A and B vaccines to prevent coinfection from these
hepatitis viruses and to protect their liver
• Early and appropriate medical management including antiviral therapy
• Regular monitoring for early diagnosis of chronic liver disease.