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Hepatities C
- 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