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Definition and Mode of Transmission

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According to the Centers for Disease Control and Prevention (CDC, 2009), hepatitis C is defined as a contagious hepatic disease resulting from hepatitis C virus (HCV) infection. HCV is the leading etiological agent for chronic hepatitis, hepatocellular carcinoma, and liver cirrhosis (Drexler, et al (2009, p.210). Contamination with infected blood is the leading mode by which the disease is spread to healthy individuals. Sharing of needles or other equipment used by intravenous drug users also is known to be a way of transmitting the disease. The virus also can be transmitted through semen, vaginal fluid, or saliva of an infected individual, although in rare cases. Prior to 1992, hepatitis C was transmitted mainly through organ transplant and blood transfusions (CDC, 2009). It might take years to decades for hepatitis C symptoms to appear. For this reason, a number of individuals with the disease become aware of their infection only after considerable damages to the hepatic cells (Hicks, 2012). Early diagnosis therefore is recommended for the prevention of these damages and to avoid infecting healthy individuals.

Epidemiology

Target population for hepatitis C is mainly the intravenous drug users who share needles and other equipment for administering their drugs. According to the World Health Organization, it is estimated that about 170 million people around the world are infected with the virus, which is the leading cause of chronic hepatitis C. Today, approximately 3.2 million Americans suffer from hepatitis C and 75 percent of the patients develop acute hepatitis C. This makes about 3 percent of the population globally (Norton, 2012). An additional four million new infections are reported annually around the globe, making the disease to be of public health concern (Hicks, 2012).

Symptoms, Co-morbidities, and Complications

In the event of acute infection, hepatitis C results in a host of symptoms, including fatigue, loss of appetite, muscle pains, loss of weight, and nausea and jaundice (Nelson, et al., 2011). In some patients, hepatitis C infections have been found to occur spontaneously, especially among children and female patients. In the case of chronic infection, it has been reported that about 80 percent of those exposed to hepatitis virus develop hepatitis C (Nelson, et al., 2011). In addition, during the initial stages of the infection, most patients experience very minimal clinically important symptoms.

Frequently, a number of chronic hepatitis C infections lead to hepatomas and liver cirrhosis. It is approximated that 10-30 percent of patients end up developing cirrhosis in their early thirties (Nelson, et al., 2011). Liver cirrhosis is commonly associated with patients already infected with HIV and hepatitis B. It is also a common problem among alcoholics with reduced liver functions. In addition, patients who develop cirrhosis are more prone to hepatocellular carcinoma. The risk is even increased 100 fold for excessive alcohol users. Other resultant effects of liver cirrhosis include varicoses, portal hypertension, and jaundice, bleeding and cognitive impairment syndrome, commonly known as hepatic encephalopathy. At this stage, liver transplant is very necessary.

At the extra-hepatic stage, there is a rare association between hepatitis C with Sjogren’s syndrome, diabetes mellitus, thrombocytopenia, disorders linked with B-cell lymphoproliferative, and lichen planus (Louie, et al., 2011). For example, in the case of thrombocytopenia, it is estimated the condition reaches 0.16% to 45.4% for patients with chronic hepatitis C (Nelson, et al., 2011).  A condition known as membranoproliferatative glomerulonephritis has also been reported in some of the patients with hepatitis C. Also common complication is Hyde’s prurigo nodularis, an unusual disorder whose etiology is unknown and is characterized by extreme pruritic nodules.

Diagnosis

A number of diagnostic tests have been developed with the aim of timely detection of the disease. These tests include the recombinant immunoblot assay; ELISA test, which also is known as the HCV antibody enzyme immunoassay; and the quantitative HCV RNA polymerase chain reaction (PCR) (Ghany et al, 2009, p.1344).Typical detection of HCV Ribonucleic acid has been made possible using the polymerase chain reactions. This takes place in a period of between 1-2 weeks after the infection. In the case of chronic infections that occur without symptoms, it is thus discovered in the event of routine screening and during elevated liver enzyme levels investigations. Testing of hepatitis C starts with blood testing or serology in detecting antibody presence in HCV.  Other tests include liver biopsies in determining the level of liver damage; in addition, screening also is conducted.

Treatment and Medical Management

In very rare cases, hepatitis C infection will clear without any medical interventions. It is recommended, however, that patients avoid alcohol and any hepatotoxic medications (Mueller, Millonig, & Seitz, 2009). Other interventions that have been put in place include ultrasound surveillance for cases of hepatocellular carcinoma and timely vaccination against other forms of hepatitis. HCV treatment is generally recommended for those patients whose HCV infection and liver abnormalities have been proven. Currently, treatment combines both antiviral drug ribavirin and pegylated interferon alpha. Depending on the genotype of HVC, this treatment is administered for a period ranging between 24 to 48 weeks.

The use of this combined treatment approach has shown positive results among 50–60% of the patients receiving treatments (Nelson, et al., 2011).  However, this approach has some adverse effects in which half of the patients experience flu related problems while a third of them experience emotional problems. Effective treatment is seen at the first six months of chronic hepatitis C. There is no vaccine against the protection of contracting hepatitis, this is as of 2011. Despite this, a number of positive developments have been realized,which include the harm reduction strategies like new syringe and needle provision or substance use treatments that have proved beneficial in reducing hepatitis C risk in IDU cases (Ghany et al, 2009, p.1378). In developing nations without a sufficient supply of medical equipment, oral medications is the better option as opposed to injection.

Prognosis and Treatment Failure Relative to Genotype

The success rates for hepatitis C treatment for patients on ribavirin and pegylated interferon for up to 24-48 weeks has been determined to be 50 percent. With the new approaches of adding novel oral agents to the interferon and ribavirin, the cure rates have increased to about 85-90 percent (Holmberg, 2011). Failure to attain sustained viral responses (SVR) following a course of pegylated interferon and ribavirin among some patients has been attributed to non-response, relapses, or virological break through and this is only in minor cases (Ghany et al, 2009, p.1348).  According to Ghany, et al (2009, p.1348), individuals with genotype non-1 infections, with lesser fibrosis, and lower baseline HCV RNA levels or those with Caucasians origin, have high SVR rates. It has also been observed that patients treated with interferon monotherapy have higher SVR than those with combo treatment (Ghany et al, 2009, p.1348).

Conclusion

Hepatitis C has become an important public health issue posing challenges because of its nature of incubation period. Individuals with the disease may stay healthy for decades without knowing that they are infected. The difference in genotypes in relation to prognosis also presents another challenge to healthcare providers. However, with improved techniques of disease diagnosis, it will be easier to detect the disease in its early stages of development. This will prevent extreme damage to the liver that only is presented when the disease has progressed to worse states. Liver cirrhosis and hepatomas are common problems that occur in patients when the diagnosis is confirmed at late stages. The use of antibody based tests has been important in diagnosing complications, but has, however, not been able to detect diseases at their early stages. This is because it takes time for the antigens to cause a production of antibodies that will be present during testing. Newer and more rapid techniques are required, therefore, to combat the problem of hepatitis C. In terms of treatment, new fields of pharmacogenomics finally will lead to improved medicines for patients with hepatitis C. Combined with nanomedicine, these areas promise a pipeline of drugs that not only are effective, but also specific to individuals of different genetic profiles.


References:

CDC (2009). Hepatitis C information for the public. Retrieved 12th February, 2012, from: http://www.cdc.gov/hepatitis/c/

Delirious, J (2009). Hepatitis C cured. Bloomington, Indiana: AuthorHouse

Drexler, J.F et al (2009). A Novel Diagnostic Target in the Hepatitis C Virus Genome, PLos Medicine, 6(2)210-220

Ghany, M.G et al (2009). Diagnosis, management, and treatment of hepatitis C: An update. Hepatology, 49(4):1335-1374

Holmberg, S (2011). Chapter 3: Infectious disease related to travel. Retrieved 14th February, 2012, from: http://wwwnc.cdc.gov/travel/yellowbook/2012/chapter-3-infectious-diseases-related-to-travel/hepatitis-c.htm

Louie, K.S. et al (2011). Prevalence of thrombocytopenia among patients with chronic hepatitis C: a systematic review. Journal of viral hepatitis 18 (1): 1–7.

Mueller, S, Millonig, G & Seitz, HK (2009). “Alcoholic liver disease and hepatitis C: a frequently underestimated combination.” World journal of gastroenterology: WJG 15 (28): 3462–71.

Nelson, P.K et al (2011). “Global epidemiology of hepatitis B and hepatitis C in people who inject drugs: results of systematic reviews.” Lancet 378 (9791): 571–83.

Norton, A (2012). Amateur tattoos carry hepatitis C risk: CDC. Retrieved 14th February, 2012, from: http://www.reuters.com/article/2012/02/07/us-amateur-tattoos-idUSTRE81623W20120207