HEPATITIS

C INFECTION

FACTS, DIAGNOSIS, AND INTERPRETATION
Dr.T.V.Rao MD

DR.T.V.RAO MD

1

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 “nonA, non-B” hepatitis • Spread through blood-toblood contact

• No vaccine available to prevent hepatitis C
DR.T.V.RAO MD

3

T.STRUCTURE OF HEPATITIS C DR.V.RAO MD 4 .

T.RAO MD 5 .V.HEPATITIS CA GLOBAL INFECTION • About 3 million Americans infected • About 170 million infected worldwide • Many do not experience symptoms DR.

Perinatal DR.RAO MD Source: Centers for Disease Control and Prevention 6 .SOURCES OF INFECTION FOR PERSONS WITH HEPATITIS C Injecting drug use 60% Sexual 15% Transfusion 10% (before screening) Other* 5% Unknown 10% *Nosocomial.T.V. Health-care work.

lifelong illness. Hepatitis C is usually spread when blood from a person infected with the Hepatitis C virus enters DR.RAO MD the body of someone who is not infected 7 .T. It can range in severity from a mild illness lasting a few weeks to a serious.V.WHAT IS HEPATITIS C INFECTION • Hepatitis C is a contagious liver disease that results from infection with the Hepatitis C virus.

EPIDEMIOLOGY Before 1985 Illegal Drug Use Transfusion Sexual Other Unknown 1999 DR.HEPATITIS C .T.V.RAO MD 8 .

T.HEPATITIS C INFECTION NATURAL HISTORY Acute infection Resolve 15% Chronic infection 85% Stable 80% Cirrhosis 20% Stable 75% 9 Mortality 25% DR.V.RAO MD .

T.V.RAO MD .10 DR.

RAO MD .V.T.WHAT HAPPENS TO PEOPLE WITH HEPATITIS C VIRUS?             100 Infected With Hepatitis C          15 No Chronic Disease    85 17 Cirrhosis 2 Liver Cancer 11 Chronic Disease DR.

RAO MD 12 .T.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 coinfections (e. HBV) DR.g.V..

RAO MD 13 .V.ALCOHOL MAJOR CONTRIBUTOR FOR PROGRESS OF DISEASE Chance Of Getting Cirrhosis Non-Drinker Hepatitis C Non-Drinker Drinker Without Hepatitis C Drinker With Hepatitis C DR.T.

For most people. or even death.” 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.HEPATITIS C CAN PRESENT AS ACUTE OR CHRONIC INFECTION • Hepatitis C can be either “acute” or “chronic.RAO MD 14 . Chronic Hepatitis C is a serious disease than can result in longterm health problems. acute infection leads to chronic infection.V.T. DR.

or other equipment to inject drugs Needle stick injuries in health care settings • Being born to a mother who has Hepatitis C DR. Hepatitis C was also commonly spread through blood transfusions and organ transplants. most people become infected with the Hepatitis C virus by sharing needles or other equipment to inject drugs.RAO MD 15 .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. when widespread screening of the blood supply began in the United States. • People can become infected with the Hepatitis C virus during such activities as Sharing needles. Before 1992.V. Today. syringes.T.

V.T. such as razors or toothbrushes • Having sexual contact with a person infected with the Hepatitis C viru s DR.RAO MD 16 .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.

V.WHO SHOULD BE TESTED FOR HEPATITIS C? • • People with risk factors for hepatitis C Those who wish to be tested DR.RAO MD 17 .T.

V. • You work in health care or public safety and were exposed to blood through a needle stick or other sharp object injury.WHO SHOULD GET TESTED FOR HEPATITIS C? • You are a current or former injection drug user. DR. • You are on long-term hemodialysis treatment.T. • You are infected with HIV. • You were treated for a blood clotting problem before 1987. • You have abnormal liver tests or liver disease.RAO MD 18 . • You received a blood transfusion or organ transplant before July 1992. even if you injected only one time or many years ago.

RAO MD 19 .V.T. public safety workers after needle stick/mucosal exposures to HCV-positive blood • Children born to HCV-positive women DR. emergency.• • • • • Based on increased risk for infection 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.

T. and public safety workers • Pregnant women • Household (non-sexual) contacts of HCVpositive persons • General population DR.V.RAO MD 20 .ROUTINE HCV TESTING NOT RECOMMENDED (UNLESS RISK FACTOR IDENTIFIED) • Health-care. emergency medical.

T. PCR.V. Normal ALT Positive PCR.HCV INFECTION TESTING ALGORITHM FOR DIAGNOSIS OF ASYMPTOMATIC PERSONS EIA for Anti-HCV Positive (repeat reactive) Negative (non-reactive) STOP OR RIBA for Anti-HCV Negative STOP Negative RT-PCR for HCV RNA Positive Positive Indeterminate Additional Laboratory Evaluation (e.47 (No.g. ALT) Negative PCR. RR 19) 21 .RAO MD Source: MMWR 1998. Abnormal ALT Medical Evaluation DR.

T. Hepatitis C PCR test to find virus in blood • Liver function tests DR.HOW IS HEPATITIS C DIAGNOSED? • Blood testing 1.RAO MD 22 . Hepatitis C antibody test 2.V.

RAO MD 23 .V. DR.LABORATORY DIAGNOSIS • Serologic tests to detect HCV antibodies: enzyme immunoassay (EIA). False negative in pts on HD. immunodeficiency. false positive in autoimmune disorder. A positive test confirms HCV infection.T. recombinant immunoblot assay (RIBA) • Target amplification technique to detect HCV RNA (molecular assay) - polymerase chain reaction (PCR).

RIBA detects antibodies to individual HCV antigens and confers increased specificity compared to EIA-2. The diagnosis of HCV infection can be supported or confirmed by the recombinant immunoblots assay (RIBA) or tests for HCV RNA.RAO MD 24 .T. DR. the secondgeneration enzyme immunoassay (EIA-2) for antibodies to HCV (anti-HCV) is the most practical screening test for HCV infection.V.CURRENTLY PERFORMED TESTES FOR HEPATITIS C INFECTION • Currently.

MOLECULAR METHODS IN DIAGNOSIS OF HEPATITIS C INFECTION • Qualitative reverse transcriptionpolymerase chain reaction (RT-PCR) assays for HCV RNA are simpler than quantitative tests and sufficient for confirmation of the diagnosis of HCV infection.V.RAO MD 25 . DR.T.

• A single determination gives limited information. • Weak association between the degree of ALT elevation and severity of histopathological findings on liver biopsy. and serial measurements recommended.ALANINE AMINOTRANSFERASE • Serum ALT testing is inexpensive and noninvasive. DR.T.V. • Resolution of ALT elevation with antiviral therapy appears to indicate disease response.RAO MD 26 . • Insensitive means of monitoring disease activity.

Serologic Pattern of Acute HCV Infection with Recovery anti-HCV Symptoms +/HCV RNA Titer ALT Normal 0 DR.RAO MD 1 2 3 4 Months 5 6 1 2 3 Years 4 27 Time after Exposure .V.T.

T.Serologic Pattern of Acute HCV Infection with Progression to Chronic Infection anti-HCV Symptoms +/HCV RNA Titer ALT Normal 0 DR.V.RAO MD 1 2 3 4 Months 5 6 1 2 3 Years 4 28 Time after Exposure .

T. This information is important in management decisions. evaluate possible concomitant disease processes. DR. assess therapeutic intervention. presence of fibrosis. • Is not used for diagnosis of HCV infection.LIVER BIOPSY • Provides useful information about the degree of fibrosis in HCV infected patients. • Used for assessment of severity of inflammation.RAO MD 29 .V.

More advanced changes defined by „bridging fibrosis‟.T.V.RAO MD 30 . is limited to portal and periportal area. • Fibrosis implies possible progression to cirrhosis.LIVER HISTOLOGY • Activity (necro-inflammation) – severity and progress. May fluctuate with disease activity or therapeutic intervention. • Cirrhosis DR. In mild cases.

T. the diagnostic algorithm of Hepatitis C depends on the clinical context.RAO MD 31 . low-risk subjects. In asymptomatic.V. especially if the initial biochemical tests reveal normal ALT levels. DR. who are found to be anti-HCVpositive by EIA-2. the diagnosis of HCV infection needs to be confirmed.DIAGNOSTIC ASSESSMENT OF INFECTED PATIENTS • In summary.

V.T. The best way to prevent Hepatitis C is by avoiding behaviors that can spread the disease. DR. especially injection drug use.RAO MD 32 .CAN WE PREVENT HEPATITIS C INFECTION • There is no vaccine for Hepatitis C.

and consequences of Hepatitis C Infection DR.RAO MD 33 .REFERENCES • Centre for Disease Control (CDC) Atlanta USA. guidelines on basis of disease Diagnosis.T.V.

com DR.RAO MD 34 .V.T.V.Rao MD for Medical and Health Care workers in the Developing world • Email • doctortvrao@gmail.• Created by Dr.T.

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