Hepatitis C and D

Diksha Cheetoo Roll No 10

Table of content
Introduction on HCV Incidence and geographical distribution Transmission Prevetion and treatment HDV

Hepatitis C
It is a liver disease causes by the Hepatitis C virus In 1989, it has been shown to be the major cause of Parenterally Transmitted nonA non-B hepatitis (PT-NANB) Single stranded virus Has no genomic resemblance to HBV or HAV

Incidence
Every year, 3-4 million of people are infected with HCV About 150 million people are chronically infected by HCV and are at risk of developing liver cirrhosis and/ liver cancer More than 350,000 people die from hepatitis c related liver diseases every year

Geographical distribution
HC is found worldwide with some countries having chronic infection rates as high as 5 % or above. The main mode of transmission in these countries is attributed to unsafe injections using contaminated equipments.

Transmission
HC is transmitted through contact of infected blood. This can occur through 1. Receipt of contaminated blood transfusion, blood products, and organ transplant 2. Injections given with contaminated syringes and needle-stick injuries in health care settings. 3. Injection drug use ( 50%) 4. Being born to HC infected mother ( small risk)

 HC may be transmitted through sex with an infected person or sharing personal items contaminated with infectious blood, but these are rare. Hc is not spread through breast milk, food or water or by casual contact such as hugging.

Symptoms
The IP of HC is 2 weeks- 6 months (WHO), Parks ( 6-7 weeks). Initially 80% of people are symptomless 20% - fever, fatigue, decreases appetite,N, V, Abdo pain,jaundice, grey coloured faeces.

 75-85% newly infected cases develop chronic infection 60-70% of them develop chronic liver disease. 5-20% develop cirrhosis 1-5% die of cirrhosis or liver cancer In 25% of HCC underlying cause is HCV

Diagnosis
Diagnosis of often missed as the pts are asymptomatic. Common methods of AB detection cannot differentiate between chronic or acute infection. Presence of AB against HCV indicates that a person is or has been infected. It shows high infectivity

Diagnosis
The HCV recombinant immuno blot Assay (RIBA) and PCR Detected HCV RNA testing are used to confirm the diagnosis.

Prevention
Primary prevention There is no vaccine against HCV. The risk of infection can be reduced by avoiding the following: 1. Unnecessary or unsafe injections 2. Unsafe blood products 3. Unsafe sharps waste collection and disposal 4. Use of illicit drugs and sharing of injection equipment

 Unprotected sex with HCV infected people. Sharing of sharp personal items contaminated with infected blood Tattoos, piercing and acupuncture performed with contaminated blood.

Secondary prevention
For people infected with HCV WHO recommends: 1. Education and counseling on options for care and treatment 2. Immunization with hep A and B vaccine to prevent coinfection from theses virus to protect the liver. 3. Early and appropriate medical management including anti viral therapy 4. Regular monitoring for early detection of liver disease

Treatment
There are 6 genotype of the virus which may respond differently to the treatment. Combination of anti viral therapy with interferon and ribavirin has been the mainstay for HC treatment Unfortunately interferon is not widely available. This means that HC is a curable disease but for many people this is not a reality.

Hepatitis D
In 1977, a previously unrecognized nuclear AG was detected in hepatocytes of pts with chronic HB. The AG resembled HBcAG in its subcellular localization. Its presence was always associated with HBV inf, but it rarely co existed with HBcAG. It was termed delta AG. Pts with delta AG developed anti delta AB.

 The virus like delta agent was subsequently shown to be associated with the most severe forms of acute and chronic hepatitis in many HBsAG +Ve pts.The disease it caused was designated delta or type D hepatitis.

What causes the disease?

Hepatitis D or Delta hepatitis is caused by hepatitis D virus, a defective RNA virus. It requires the help of a hepadna virus like HBV for its own replication. Its is transmitted percutaneously or sexually through contact with infected blood or blood products.

 Individuals who are not infected with HBV, and have not been immunized against HBV, are at risk of infection with HBV with simultaneous or subsequent infection with HDV. HDV infection of chronically infected HBVcarriers may lead to fulminant acute hepatitis or severe chronic active hepatitis, often progressing to cirrhosis. Chronic hepatitis D may also lead to the development of hepatocellular carcinoma.