Methods of Diagnosing Hepatitis C: Blood Testing - Research Paper Example

Introduction

Hepatitis C is a highly infectious diseases that is caused by Hepatitis C virus (HCV), the virus normally affects the liver in the body and leads to inflammation, in some occasions it leads to serious damage of the liver. At the initial stages of the infections the victims experience mild symptoms or no symptoms at all. The virus normally persists in the liver for many victims. With time it leads to liver disease and sometimes cirrhosis (Liang & Ghany, 2013). The virus is primarily spread through blood contact through means such as poorly sterilized medical materials, blood transfusions, intravenous drug use and many others. If a mother is infected, it can be transmitted to the child during birth. Diagnosis is done through blood testing by trying to find the virus RNA or antibodies to the virus (Liang & Ghany, 2013). The diseases does not have vaccine and can be prevented by testing blood during transfusion and being cautious when using clinical equipment’s that come in contact with blood when being used. It is cured with antiviral medications like sofosbuvir.

HCV physiology

HC is caused by a spherical enveloped single-stranded RNA virus that belongs to the Flaviviridae family and Flavivirus genus (Liang & Ghany, 2013). HCV has 7 major types of genotypes which are known as genotypes 1 to 7. Genotypes are further divided into many subtypes and the number of subtypes depends on the genotype. The virus half-life in the serum is about 3 hours and it can be as short as 40 minutes.

The virus natural targets in the body include hepatocytes and likely B lymphocytes. Virus allowance in the body is associated with the development and persistence of strong virus specific responses by cytotoxic T lymphocytes and assisting Tcells (WHO, 2017). In many people that have been infected, viremia persists and accompanied by changing degrees of hepatic inflammation (Mayo Clinic Staff, n.d). RNA-dependent RNA polymerase is an enzyme that is important in HCV replication, but it lacks proofreading capabilities and generates millions of mutant’s viruses called quasispecies. The mutants generated present some molecular variations with up to two percent nucleotide heterogeneity (Mayo Clinic Staff, n.d). Quasispecies has posed a major challenge to immune-mediated control of hepatitis c virus and this explains why it has become difficult to develop the vaccine against the virus.

Transmission

Intravenous drug use and blood transfusions are two main means of HCV transmission. Transfusion of blood contaminated with HC virus was once a major means of transmission. From 1990s onwards in U.S, transmission through this means has significantly reduced because of donated blood screening for HCV antibody before being passed to the recipient. The modern use of better sensitive assays like polymerase chain reaction (PCR) and others have reduced the risk of getting the virus through blood transfusion by 1 in 230,000 donations (HCV advocate, 2017). In developing nations, it is mainly transmitted through intravenous drug abuse (IDU). In this situation, the drugs users inject themselves with nonsterile needles or snort cocaine with shared straws (HCV advocate, 2017).

A group also that is highly at a risk of contracting the virus is healthcare workers. This group of people handle the patients suffering from HCV and some might be there for other medication issues and may be they are carrying the virus in their blood without knowing. Transmission can take place through needle-stick injuries or other occupational exposures (El-Zayadi, 2008). Transmission through medical equipment’s injuries in the healthcare sectors result in 3 percent risk of HCV transmission. Transmission through nosocomial patient to patient can take place by means of contaminated colonoscope during surgery or blood dialysis (El-Zayadi, 2008). Tattooing, acupuncture, and sharing razor blades provide another means of HCV transmission. In U.S, a standard practice of using disposable needles for acupuncture has been developed and this has assisted in stopping transmission via that route. The uncommon routes of transmission that affect less than five percent of individual at risk include sexual transmission, saliva contact, and casual household contact (El-Zayadi, 2008).

Prognosis

HCV infection that is self-limiting is few in infected people. In 70 to 80 percent of the infected population, the infection becomes chronic. When the infection stayed in the body for more than 20 years it end up developing cirrhosis in around 20 percent of the persons with chronic infection (Jirillo, 2008). The onset of chronic HCV infection early in life in many occasions leads to less serious consequences. Infection of HBV, too much iron and lack of alpha 1-antitrypsin promote progression of HCV to cirrhosis. The risk of HCC and cirrhosis doubles in patients who get the infection through blood transfusion. Development towards HCC is common in presence of cirrhosis and alcoholism. A study on Veterans Affairs (VA) HCV clinical data of more than 120,000 patients by McCombs found that those who achieved undetectable HCV virus had low risk of liver disease. Furthermore, patient ethnicity or race plus HCV genotypes has an effect on the risk of future liver happenings (Jirillo, 2008). The risk of liver problems was higher in white patients as compared to black patients. Successful treatment reduces the future risk of hepatocellular carcinoma by approximately 75 percent.

Diagnosis

There are several methods of diagnosing hepatitis C. these methods includes blood testing. Testing is aimed at detecting the presence of antibodies to HCV by use of enzyme immunoassay (Jirillo, 2008). If the test is found to be positive, confirmatory test is then carried out to verify the immunoassay and viral load. In case there is no RNA and immunoblot is positive it means the patient previously had the problem but had cured it by a means such as treatment. Another test is through testing of liver damage. The following methods are used to test liver damage, Magnetic resonance elastography (MRE), Transient elastography, and Liver biopsy. MRE is an alternative method to liver biopsy. This method combines magnetic resonance imaging technology together with patterns developed by sound waves that bounces back from the liver to create a visual map that shows how the surface of the liver behaves (Denise, 2017). If the tissues of the liver are stiff it indicates the presence of fibrosis caused by chronic hepatitis C. Transient elastography is a form of ultrasound that transmits vibrations into the liver and measure the speed of their dispersal across the liver tissues in order to estimate its stiffness (Denise, 2017). Liver biopsy is carried out using ultrasound guidance. The test involves inserting a thin needle through abdominal wall so as to remove a piece of liver that will be taken to the laboratory for test. Many people in U.S and Canada are not aware about their HCV status and it is recommended that screening should be done especially at those at a high risk of contracting the diseases such as those who have received blood through transfusion, those who have completed their jail term, drug users and many others.

Many researches geared towards understanding better Hepatitis C has been ongoing. There are several medications meant for treating HC that are in development. The medications include vaccine for preventing the diseases immunomodulators, and cyclophilin inhibitors, among others (Denise, 2017). Potential better treatments have developed due to better understanding of the diseases virus. There are several vaccines that are being developed and many are showing positive results. A combination of velpatasvir and sofosbuvir is on trial and it has resulted in cure rates of 99 percent.