The slides were examined hepatitis from all directions

1. Hepatitis C

3. 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

4. Flaviviridaea
Hepaciviruses
Pestiviruses:
Classical swine
Fever virus
Bovine viral
Diarhoea virus
Flaviviruses:
Yellow fever
Dengue fever
Japanese encephalitis

5. Morphology
 Nucleic acid: ss+RNA
Classification related to pestiviruses
and flaviviruses
In vivo replication: liver and
lymphocytes
Genome size : 9.6 kb

6. morphology

7. 1-structural proteins
.cover protein E1
.cover protein E2
.one peptide in E2
2-non structural proteins
NS2
NS3
NS4A
NS4B
NS5A
NS5B

9. Builds and converts proteins and sugars
Stores vitamins, sugars, fats and other nutrients
Releases chemicals and nutrients into the body
when needed

11. Egypt: 10- 30%
Japan Taiwan Italy: in up to 41 years old persons
45%
Africa, America, Europe, Eastern south Asia: under
2,5%
South era of Aram ocean countries: 2,5- 4,9%
Middle east: 1-12%
Epidemiology

13. Genotype 1: 40-80%
Genotype 2: The most prevalence after genotype 1
Genotype 3: India Pakistan Scotland Australia
Genotype 4: middle east, Africa, Egypt(90%)
Genotype 5: south Africa
Genotype 6: hong-kong
The most subtypes of America: (1a , 1b)
Iran: (1b, 47%) (3a, 36%) (1a, 8%) (4, 7%)

14. 1a, 1b
2a, 2b,
3a
1a, 1b
2a, 2b, 2c,
3a
4
5a
1b
1b,
6
1b,
3a
1b,
3a
3b
4
Fang et al. Clin Liver Dis. 1997.
1a, 1b,
2b, 3a
2a
HCV Infection:
Worldwide Genotype Distribution

16. What About Alcohol?
Drinker Without Hepatitis C
Drinker With Hepatitis C
Hepatitis C Non-Drinker
Chance Of Getting
Cirrhosis
Non-Drinker

17. Disease burden due to HCV is substantial
Kwong et al PLoS One 2012
Human papilloma virus
E. Coli
HIV/AIDS
Staphylococcus aureus
C. Dificile
Rhinovirus
Group B Strep
Group A Strep
Haemophilus influenza
Legionella
Chlamydia
Adenovirus
Gonorrhea
Health Adjusted Life Years (HALYs)
0 2000 4000 6000 8000 1000
Tuberculosis
Influenza
Hepatitis B virus
Hepatitis C virus
Respiratory syncytial virus
Parainfluenza virus
Years of Life Lost
Year-equivalents of reduced functioning
Streptococcal pneumonia

18. High Risk
How Do People Become
Infected With Hepatitis C?
• Blood products
– Blood transfusions before 1992
• Other blood products before 1987
– Current transfusions no longer a major risk factor
• Injection (IV) drug use – 60% of all new
infections

19. Lower Risk:
• Snorting cocaine or other drugs
• Occupational exposure
• Body piercing & acupuncture with
unsterilized needle
• Tattooing

20. Lower Risk:
• From pregnant mother to child
• Non-sexual household contacts (rare)
– Sharing razors and/or toothbrushes
• Sexual transmission
– Low risk in monogamous relationship

21. Hepatitis C is NOT
Spread By:
• Sneezing
• Coughing
• Food or water
• Sharing drinking
glasses or eating
utensils
• Handshakes
• Holding hands
• Hugging
• Kissing on the cheek
• Playing with children
• Donating blood

22. How Will You Know if You
Have Hepatitis C?
• Many people have no symptoms of the virus
• If you do have symptoms:
• The only way to know if you have hepatitis c
is to have a blood test
• Fatigue • Discomfort in the liver area
• Loss of appetite • Aching joints
• Trouble sleeping • Depression

23. How is Hepatitis C
Diagnosed?
• Blood testing
1. Hepatitis C antibody
test
2. Hepatitis C PCR
test to find virus in
blood
• Liver function tests

24. Testing
 Antibody test
 ‘Window period’ – 2 weeks up to 6 months, but on average 6 to 12 weeks.
Indicates a person has been exposed to the virus. Doesn’t determine if
infection is current or what genotype is present
 PCR tests
Qualitative – virus detected/not detected
Quantitative – viral load
Genotype

25. Diagnosis
Serologic ways:
1: ELISA (Enzyme-Linked ImmunoSorbant assay)
2: RIBA (Recombinant immunoblot assay)
3: HCVcAg (HCV Core Antigen)

26. Virologic ways
HCV RNA
RT-PCR tests for HCV RNA
1. Amplicor Hepatitis c Virus Test,Version 2.0
2. Cobas Amplicor Hepatitis C Virus Test,Version 2.0
PCR test:
1: RT-PCR
2: bDNA(Chain DNA Assay Branched)

27. Genotype tests
1- Trugene HCV SNC Genotyping
2- Line-Probe-Assay
and the others way:
1- liver biopsy
2- liver imaging
3- andoscopy
4-phibroscan and …

28. Why Should You Be Concerned
About Hepatitis C?
• Hepatitis C causes serious problems in some
patients
• Fibrosis
• Cirrhosis
• Advanced liver disease
• Hepatocellular carcinoma (liver cancer)

30. Response To Treatment
(Time)
1-RVR (Rapid Virologic Response)
2-EVR (EarlyVirologic Response)
3-ETR (End Of Treatment Virologic Response)
4-SVR (Sustained Virologic Response)
5-LTR (Long-Term Virologic Response)

31. DRUGS for Treatment
1: Interferon
2: Ribavirin
3: (PEG) Interferon
4: Protease Inhibitors:
1: Boceprevir 2: Telaprevir
1: Ribavirin + PEG Interferon + Protease Inhibitors = Genotype 1
2: Sofosbuvir = All genotypes treated
3: Sofosbuvir + Ribavirin = Geno 2 , 3 and Cirrhosis
4: sofo+ riba+ PEG IFN = geno 1,4, 5 ,6 and cirrhosis

32. How Can You Prevent the
Spread of Hepatitis C?
• Cover open wounds
• Tell people not to touch your blood
• Clean blood spills yourself or inform others to
use latex gloves
• Dispose of needles/materials properly
• Do not inject drugs

33. • Avoid sharing contaminated articles
– Razors, toothbrushes, or other personal care
items
• Inform healthcare professionals/others
• Do not donate blood, body organs, tissues or
semen
• Practice safe sex

34. Those With Hepatitis C Should
• Take care not to spread hepatitis C to others
• Be vaccinated for hepatitis A and hepatitis B
• Discuss treatment options with a
knowledgeable medical professional

35. HCV – Natural History
Acute HCV-100 patients
Resolved - 25 Chronic - 75
Stable – 45-55 Cirrhosis – 20-30
Stable – 15-25
Decompensation – 5-8
HCC – 1-3 per year
20 – 30 years
Accelerated by:
alcohol
HIV