Hepatitis C

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Hepatitis C:

Hepatitis C Dr . Nishant Kumar

Problem Statement:

Problem Statement Contagious liver disease that result from infection from Hepatitis C virus Severity ranges from mild illness lasting few weeks to a serious life long infection Each year nearly 3-4 million people are infected worldwide 130- 150 million people are chronically infected and are at risk for developing liver cirrhosis . Nearly 500,000 people die from hepatitis C related liver disease every year In India HCV prevalence is around 1% and occur mostly through blood transfusion and use of unsterile glass syringe.

Agent Factors:

Agent Factors HCV is a single stranded RNA virus Genus – Hepa-civirus ,(HCV) Family – Flavi - viridae Characterized by high spontaneous mutation rate 11 genotype and ( 90 subtype) (1a,1b,2a,3b etc ) In India HCV genotype 2 and 3 are prevalent in 60 -80% of the infected population

Host factors:

Host factors Population are risk are – IV drug users Contaminated blood transfusion Tattoos done with non sterile instruments Recipient of blood or organs form donor from infected HCV patients HIV infected persons Children born to mother infected with HCV

Environmental Factors:

Environmental Factors Progression of Chronic hepatitis is highly variable among individual's A complex interaction between host viral and environmental factors are at interplay Studies shows a combination of HCV infections and high level of alcohol abuse results in synergistic acceleration of liver fibrogenesis Other suggested aggravation include cigarette smoking Possible association with Cannabis smoking

Transmission:

Transmission Mainly blood –borne ( transfusion, IV drug abuse) Low risk : Snorting cocaine or other drugs Occupational exposure needle stick , health workers-1.8% Body piercing and acupuncture with unsterile needles Tattooing Mother to Child Razor and toothbrushes sharing Sexual Transmission

Incubation Period:

Incubation Period 2 weeks to 6 months

Course of Illness:

Course of Illness Asymptomatic – 30% Moderate to Severe hepatitis in 30 % 70 -80 % develop chronic infection ( Presence of Viral RNA for 6 months, evidence of viral replication) 10-30 % develop cirrhosis Alcohol use Male sex, Age over 40 Co-infection with HIV /HBV 5 Year mortality with compensated cirrhosis is 9%, while Decompensated cirrhosis is 50%

Sign and Symptoms:

Sign and Symptoms Acute infection – majority are asymptomatic Symptoms include- Fever , fatigue, decrease appetite , nausea , vomiting abdominal pain , dark urine, grey color feces, joint pain Signs - jaundice

Diagnosis:

Diagnosis Investigations Liver enzymes are non specific Serum anti HCV antibodies- 99% sensitivity and specificity Serum HCV RNA : “ Viral Load” Quantitative method for Confirmation of Diagnosis Monitoring response to therapy Qualitative Method for – Diagnosis confirmation Liver biopsy for cirrhosis and prognosis Genotype : treatment duration and response

Treatment:

Treatment 6 genotype of Hepatitis C responds to different treatment Combination of Anti retroviral drugs and interferons Not always well tolerated and costly Treatment with direct-acting antivirals (DAAs) WHO recommends that all patients with hepatitis C be treated with DAA-based Cure rate- 95% No Vaccination for HCV

Prevention:

Prevention

Thank You:

Thank You

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