Hepatitis C Infection - Essay Example

Topic:  Hepatitis C Introduction Hepatitis C is an inflammation of the liver, which is caused by hepatitis C virus (Shoenfield It is formerly known as non - A/non - B hepatitis, and became a significant burden in the public health. It is estimated that hepatitis C infects about 150 – 200 million people worldwide (Hepatitis C). Causes About 90 - 95% of Hepatitis C is transfusion – associated. Hepatitis C carries a risk of chronic progressive hepatitis by 50% and poses a risk of cirrhosis by 25%. It was reported that 50% of cases of hepatitis C are sporadic with no apparent exposure risk. The hallmarks of hepatitis C infection are persistent infection and chronic hepatitis. The following are the primary risk groups for hepatitis C: (1) hemophiliacs, (2) intravenous drug abusers, (3) patients with kidney failure treated with hemodialysis, (4) homosexuals, (5) born from a Hepatitis C positive mother, (6) health care workers, (7) sharing personal items with a hepatitis C positive individuals (Robbins, et al. 846; Seaton). Molecular Biology Hepatitis C virus is a small, enveloped, single - stranded RNA virus that belongs to flavi/pesti virus family, and measures 30 - 60 nm in diameter. The virus is a single, ~ 3010 amino acid polypeptide processed into nucleo - capsid, enveloped, and five nonstructural proteins, respectively. (Source: Caskey, 2005) (Source: Wood, 2006) Incubation Period and Serum Markers The incubation period for a hepatitis C virus infection ranges from 2 - 26 weeks. Hepatitis C RNA can be detected in the blood for 1 to 3 weeks during active infection. This virus persists in many patients regardless of neutralizing antibodies that are present. In chronic disease states, episodic elevations in serum transaminases are perceived (Robbins et al 846). Course of the Disease Hepatitis C infection is divided into acute and chronic phase. The initial period after the infection is called the acute phase. During this phase, most people are usually asymptomatic; however, about 25 - 35% may experience loss of appetite, jaundice, fatigue, nausea, and enlargement of the liver or pain in the abdomen. About 85% of these infected people are unable to clear the virus from their body for more than 6 months and consequently develop into a long term or chronic disease. For a time, chronic hepatitis C virus may be asymptomatic; yet, chronic form is more serious than the acute because this would eventually result to liver scarring (cirrhosis), liver failure, liver cancer, and death. Hence, chronic hepatitis C must be treated aggressively. Symptoms of Hepatitis C The following are the symptoms for acute hepatitis C infection: (1) tiredness, (2) pain in the joint and belly, (3) skin itchiness, (4) soreness in the muscles, (5) dark urine, (6) yellowish eyes and skin, (7) poor appetite, and (8) low grade fever (Essig; Shoenfield 4). Symptoms for chronic hepatitis C infections include: (1) intermittent fatigue, (2) wasting of the muscle, (3) generalized weakness, and (4) easy bruising. In more advanced case, the symptoms include: (1) edema, (2) internal bleeding, and (3) mental confusion (Shoenfield 4). Diagnosis Patients with hepatitis C virus are diagnosed by accident during blood tests for blood donation or accidentally diagnosed during regular check - up. Frequently, a person with hepatitis C infection has high levels of blood liver enzymes. A liver biopsy is suggested to identify whether the virus has caused liver scarring (Essig). To determine the existence of hepatitis C virus antibodies in the blood, a screening test must be done. Moreover, to diagnose hepatitis C infection, a conventional, initial screening test called enzyme immunosorbent assay must be done. The aforementioned test is referred to as the anti-hepatitis C virus antibody test. Screening tests are done to determine the presence of antibodies to hepatitis C virus in the blood. The enzyme immunosorbent assay (EIA) is the conventional, initial screening test to diagnose hepatitis C infection. The EIA measures specific antibodies to small pieces of the hepatitis C virus proteins (antigens). This test, therefore, is referred to as the anti-hepatitis C virus antibody test. A confirmatory test called Recombinant Immunoblot Assay (RIBA) should be performed to individuals who are positive for hepatitis C virus proteins (Shoenfield 6). There are two most common molecular assays available to measure the hepatitis C virus RNA in the blood. These assays examine the virus at the molecular level: (1) reverse transcription polymerase chain reaction (RT-PCR) assay, and (2) branched chain DNA (bDNA) assay. A third type of assay called transcription-mediated amplification (TMA) has been released recently (Shoenfield 6). Treatment Ultimate goals of antiviral therapy includes: (1) viral infection elimination, (2) normalize the liver tests and microscopic appearance, (3) prevent progression to liver cirrhosis and hepatocarcinoma, (4) prolong survival, and (5) improvement of quality of life (Shoenfield 8). Treatment options for hepatitis C are the following: (1) conventional interferon, (2) combined conventional interferon and ribavirin, (3) pegylated interferon, and (4) combined pegylated interferon and ribavirin (Shoenfield 9). Conventional interferon The mainstay of treatment in the past, but is now outdated. Combined Conventional Interferon and Ribavirin Ribavirin, a nucleoside analogue is taken orally that closely resemble the biochemical units that make up genetic material (RNA and DNA). This medication functions to trick the genetic material of the virus and slows down the reproduction of the virus; however, Ribavirin is not effective in hepatitis C treatment when used alone but should me combined with conventional interferon. Pegylated Interferon The conventional interferon alpha is absorbed and cleared rapidly by the kidneys from the body. As a result, a chemical process called pegylation of interferon that forms pegylated interferon was found to slow interferon clearance. The following are the two types of pegylated interferon: (1) pegylated interferon alpha 2b (Peg-Intron A), and (2) pegylated interferon alpha 2a (Pegasys). Both are administered once per week and eliminate the need for daily dosing with conventional interferon (Shoenfield 9). Combined Pegylated Interferon and Ribavirin The combination of pegylated interferon and ribavirin appeared to be more effective, especially in patients being infected with genotype 1. Liver Transplantation In the United States, the leading cause for transplantation of the liver is the end stage disease of the liver that is associated with chronic hepatitis C infection (Shoenfield 9). References Caskey, D. Bloodborne Pathogen Training. 01 Dec 2005. UK Workers’ Care. 24 March 2008 Essig, Maria. Hepatitis C. 27 Aug. 2007. Yahoo Health. 24 March 2008 Seaton, Richard. Hepatitis C and HIV Co-Infection: An Update. 20 Apr. 2007. HRSA Care Action. 24 March 2008 What I need to know about Hepatitis C. 21 Aug. 2002. National Institute of Diabetes and Digestive Kidney Diseases, National Institutes of Health. 24 March 2008 http://digestive.niddk.nih.gov/ddiseases/pubs/hepc_ez/ Wood, Suno. Hepatitis C: A Viral Time Thrombi. Oct 2006. Moscow Institute of Cybernetic Medicine. 24 March 2008 Read More