Hepatitis C Infection

Hepatitis c infection facts, diagnosis, and interpretation: 

Dr.T.V.Rao MD Hepatitis c infection facts, diagnosis, and interpretation 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) What is Hepatitis?

Hepatitis C: 

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 C Dr.T.V.Rao MD 3

Structure of hepatitis c : 

Structure of hepatitis c Dr.T.V.Rao MD 4

Hepatitis C- A global infection: 

About 3 million Americans infected About 170 million infected worldwide Many do not experience symptoms Hepatitis C- A global infection Dr.T.V.Rao MD 5

Sources of Infection for Persons with Hepatitis C: 

Sources of Infection for Persons with Hepatitis C Sexual 15% Other* 5% Unknown 10% Injecting drug use 60% Transfusion 10% (before screening) *Nosocomial; Health-care work; Perinatal Source: Centers for Disease Control and Prevention Dr.T.V.Rao MD 6

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 What is hepatitis c infection Dr.T.V.Rao MD 7

Hepatitis C - Epidemiology: 

Dr.T.V.Rao MD Hepatitis C - Epidemiology Before 1985 1999 Illegal Drug Use Transfusion Sexual Other Unknown 8

Hepatitis C Infection - Natural History: 

Dr.T.V.Rao MD Hepatitis C Infection - Natural History 9

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Dr.T.V.Rao MD 10

What Happens to People With Hepatitis C Virus?: 

What Happens to People With Hepatitis C Virus? ·········· ·········· ·········· ·········· ·········· ·········· ·········· ·········· ·········· ·········· Infected With Hepatitis C 100 ·········· ····· 15 No Chronic Disease ·········· ·········· ·········· ·········· ·········· ·········· ·········· ·········· ····· Chronic Disease 85 ·········· ······· Cirrhosis 17 ·· 2 Liver Cancer Dr.T.V.Rao MD 11

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) Chronic Hepatitis C Factors Promoting Progression or Severity Dr.T.V.Rao MD 12

Alcohol major contributor for progress of disease: 

Alcohol major contributor for progress of disease Drinker Without Hepatitis C Drinker With Hepatitis C Hepatitis C Non-Drinker Chance Of Getting Cirrhosis Non-Drinker Dr.T.V.Rao MD 13

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 de ath. Hepatitis c can present as acute or chronic infection Dr.T.V.Rao MD 14

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 15

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 viru s Less commonly transmitted through … Dr.T.V.Rao MD 16

Who Should Be Tested for Hepatitis C?: 

Who Should Be Tested for Hepatitis C? People with risk factors for hepatitis C Those who wish to be tested Dr.T.V.Rao MD 17

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 18

HCV Testing Routinely Recommended: 

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 Based on increased risk for infection Dr.T.V.Rao MD 19

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 Routine HCV Testing Not Recommended (Unless Risk Factor Identified) Dr.T.V.Rao MD 20

HCV Infection Testing Algorithm for Diagnosis of Asymptomatic Persons: 

HCV Infection Testing Algorithm for Diagnosis of Asymptomatic Persons EIA for Anti-HCV Negative (non-reactive) STOP Positive (repeat reactive) OR RIBA for Anti-HCV RT-PCR for HCV RNA Negative STOP Additional Laboratory Evaluation (e.g. PCR, ALT) Negative Positive Indeterminate Medical Evaluation Positive Negative PCR, Normal ALT Positive PCR, Abnormal ALT Source: MMWR 1998;47 (No. RR 19) Dr.T.V.Rao MD 21

How is Hepatitis C Diagnosed?: 

Blood testing Hepatitis C antibody test Hepatitis C PCR test to find virus in blood Liver function tests How is Hepatitis C Diagnosed? Dr.T.V.Rao MD 22

LABORATORY DIAGNOSIS: 

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. Dr.T.V.Rao MD 23

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. Currently performed testes for hepatitis c infection Dr.T.V.Rao MD 24

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. Molecular methods in Diagnosis of hepatitis c infection Dr.T.V.Rao MD 25

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 26

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

PowerPoint Presentation: 

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

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. LIVER BIOPSY Dr.T.V.Rao MD 29

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 Liver Histology Dr.T.V.Rao MD 30

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. Diagnostic assessment of infected patients Dr.T.V.Rao MD 31

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 us e. Can we prevent hepatitis c infection Dr.T.V.Rao MD 32

References: 

References Dr.T.V.Rao MD 33 Centre for Disease Control (CDC) Atlanta USA, guidelines on basis of disease Diagnosis, and consequences of Hepatitis C Infection

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