What is hepatitis C?

Hepatitis C is a virus that causes liver disease. HCV is spread by contact with the blood of an infected person. HCV is this country's most common blood-borne disease, infecting at least 2 out of every 100 people.

Hepatitis C is a small, enveloped, single-stranded RNA virus of the family flaviviridae. Because the virus mutates rapidly, changes in the envelope protein may help it evade the immune system. Inside your body, hepatitis C continuously mutates. Researchers have identified at least six genetically distinct genotypes that can coexist in the body, evading discovery and attack by the immune system.

PROTECT YOURSELF

Exposure and transmission of hepatitis C

As a first responder to an accident or crime scene, your risk of exposure to hepatitis C is increased. You are exposed through contaminated blood and/or body fluids. You could contract the virus at a fire, accident or crime scene, through broken glass, jagged metal, a needle stick, or performing other life-saving procedures.

Reportable exposures:

You can get hepatitis C from these exposures:

Percutaneous events: when blood or other body fluids enter through the skin. This might happen in the following ways:

By a needle stick from a bloody needle
A cut from a bloody sharp object
Fluids entering through an open wound, scrape, broken cuticle, or chapped skin
Mucocutaneous events: when blood or other body fluids enter through mucous membranes, such as in the eye, nose, or mouth.


If you think you’ve been exposed, do the following:

Immediately wash all areas of contact with soap and water
Flush your eyes with water
Do not eat, drink, smoke, put on makeup, or handle contact lenses
Nonexposures:

You cannot get hepatitis C from any of these sources:

Blood on intact skin
Blood on clothing or equipment
Being near an infected person
Talking to an infected person

SIGNS & SYMPTOMS 80% of persons have no signs or symptoms.
jaundice
fatigue
dark urine
abdominal pain
loss of appetite
nausea

CAUSE Hepatitis C virus (HCV)

LONG-TERM EFFECTS Chronic infection: 75-85% of infected persons
Chronic liver disease: 70% of chronically infected persons
Deaths from chronic liver disease: <3%
Leading indication for liver transplant

TRANSMISSION




Recommendations for testing based on risk for HCV infection
Occurs when blood or body fluids from an infected person enters the body of a person who is not infected.
HCV is spread through sharing needles or "works" when "shooting" drugs, through needlesticks or sharps exposures on the job, or from an infected mother to her baby during birth.

Persons at risk for HCV infection might also be at risk for infection with hepatitis B virus (HBV) or HIV.

Recommendations for Testing Based on Risk for HCV Infection

PERSONS RISK OF INFECTION TESTING RECOMMENDED?
Injecting drug users High Yes
Recipients of clotting factors made before 1987 High Yes
Hemodialysis patients Intermediate Yes
Recipients of blood and/or solid organs before 1992 Intermediate Yes
People with undiagnosed liver problems Intermediate Yes
Infants born to infected mothers Intermediate After 12-18 mos. old
Healthcare/public safety workers Low Only after known exposure**
People having sex with multiple partners Low No*
People having sex with an infected steady partner Low No*

*Anyone who wants to get tested should ask their doctor.
** View current post-exposure prophylaxis recommendations.



PREVENTION There is no vaccine to prevent hepatitis C.
Do not shoot drugs; if you shoot drugs, stop and get into a treatment program; if you can't stop, never share needles, syringes, water, or "works", and get vaccinated against hepatitis A & B.
Do not share personal care items that might have blood on them (razors, toothbrushes).
If you are a health care or public safety worker, always follow routine barrier precautions and safely handle needles and other sharps; get vaccinated against hepatitis B. (View current post-exposure prophylaxis recommendations.)
Consider the risks if you are thinking about getting a tattoo or body piercing. You might get infected if the tools have someone else's blood on them or if the artist or piercer does not follow good health practices.
HCV can be spread by sex, but this is rare. If you are having sex with more than one steady sex partner, use latex condoms* correctly and every time to prevent the spread of sexually transmitted diseases. You should also get vaccinated against hepatitis B.
If you are HCV positive, do not donate blood, organs, or tissue.

TREATMENT & MEDICAL MANAGEMENT
National Institutes of Health fact sheet on treatment


HCV positive persons should be evaluated by their doctor for liver disease.
Interferon and ribavirin are two drugs licensed for the treatment of persons with chronic hepatitis C.
Interferon can be taken alone or in combination with ribavirin. Combination therapy is currently the treatment of choice.
Combination therapy, using pegylated interferon and ribavirin, can get rid of the virus in up to40% of those with genotype 1 and up to 80% for those with genotype 2 or 3.
Drinking alcohol can make your liver disease worse.

STATISTICS & TRENDS Number of new infections per year has declined from an average of 240,000 in the 1980s to about 25,000 in 2001.
Most infections are due to illegal injection drug use.
Transfusion-associated cases occurred prior to blood donor screening; now occurs in less than one per million transfused unit of blood.
Estimated 3.9 million (1.8%) Americans have been infected with HCV, of whom 2.7 million are chronically infected.

SEN Virus Variants Are "Unequivocally Transmitted By Blood
Transfusion" in the US
By Harvey S. Bartnof, MD
One of the more recent viruses that potentially has been associated
with hepatitis is SEN virus (SEN-V). However, the cause-and-effect
link between SEN-V and hepatitis or other disease has been a matter
of debate within the research community. Even today, hepatitis can
occur after a blood transfusion; yet tests for all known viruses
have been negative. Now, researchers from the US National Institutes
of Health (NIH) have reported that two SEN-V variants are
"unequivocally transmitted by blood transfusion," and that they
"might be the causative agent [infecting organism] of
post-transfusion hepatitis" [liver infection after a blood
transfusion]. If SEN-V causes hepatitis after a blood transfusion in
2000, screening the world blood supply for this virus would be of
paramount importance. Co-authors of the report included Drs. T.
Umemura and Harvey J. Alter, MD.
Dr. Alter and his colleagues found that SEN-V DNA was detected in
five of 243 (2.1%) of normal US blood donors, using a PCR
(polymerase chain reaction) test. He also found that ten of 262
surgery patients were positive before they had surgery and blood
transfusion(s). Among the remaining 252 patients who were negative
for SEN-V DNA before surgery, 3% of 97 non-transfused patients
became DNA positive after surgery. However, 40% of the remaining 155
patients became SEN-V DNA positive after blood transfusion
associated with surgery. That difference was highly statistically
significant.
Dr. Alter also analyzed the association of SEN-V with hepatitis
after transfusion. Among transfusion patients who did not have SEN-V
DNA beforehand, new infection with this virus was detected in ten of
12 (83%) patients who developed hepatitis post-transfusion that was
not due to hepatitis viruses A, B, C, D or E. New SEN-V infection
was also detected in 32 out of 94 (34%) who did not develop
hepatitis after transfusion. In addition, new SEN-V infection was
detected in 20 of 49 (41%) of patients who developed acute hepatitis
C after transfusion.
The rate of new infection with SEN-V was significantly higher after
transfusion among those who developed hepatitis that was not due to
hepatitis viruses A-E (83%) than among those who did not develop
hepatitis (34%). The 83% rate also was significantly higher than
among those who did not receive a blood transfusion, 3%.
Among those patients who developed hepatitis after blood
transfusion, infection with SEN-V occurred before or at the same
time that the first increase in ALT (alanine aminotransferase, liver
enzyme to diagnose hepatitis) occurred. This time relationship is an
important part of the reason for the authors' conclusions.
Based upon other data, Dr. Alter also reported that less than 5% of
persons infected with SEN-V after blood transfusion develop
detectable hepatitis.
The researchers concluded that the two SEN-V variants are
"unequivocally transmitted by blood transfusion." Also, they
concluded that the two SEN-V variants are present in approximately
2% of US blood donors. In addition, "The high rate of SEN-V
infection in transfusion-associated hepatitis cases [not due to
hepatitis A, B, C, D or E] and the temporal association between
viremia [SEN-V DNA in blood] and ALT [liver enzyme] elevation
suggests that SEN-V might be a causative agent [organism] of
post-transfusion hepatitis." They continue, "However, it appears
that the majority of SEN-V infected patients do not develop
hepatitis." Lastly, "Further studies, particularly of intrahepatic
replication [growth in liver cells], are needed to establish
causality."
This reviewer finds the results somewhat déjà vu to the discovery
and documentation of transmission by blood transfusion of HIV,
hepatitis B virus (HBV) and hepatitis C virus. Given the potential
implications of the current study, one can easily envision future
screening of the world blood supply for SEN-V if future studies
definitively establish a causal relationship between infection and
growth in liver cells. It is currently unknown whether SEN-V is
transmitted by sexual contact, needle/"works" sharing, from
mother-to-newborn or by breastmilk.
4/26/00
References
Umemura T, Alter HJ and others. The incidence of SEN virus infection
in transfusion-associated hepatitis. Abstract and poster
presentation G018 at the 10th International Symposium on Viral
Hepatitis and Liver Disease; April 9-14, 2000; Atlanta, Georgia.
Copyright 2001 by HIV and Hepatitis.com. All Rights Reserved
Subject: INFO: Effect on treatment outcome of coinfection with SEN
viruses in patients with hepatitis C.

1: Lancet 2001 Dec 8;358(9297):1961-2 Related Articles, Books,
LinkOut
Effect on treatment outcome of coinfection with SEN viruses in
patients with
hepatitis C.
Rigas B, Hasan I, Rehman R, Donahue P, Wittkowski KM, Lebovics E.
The newly discovered SEN D and SEN H viruses are transmitted
parenterally and
can cause post-transfusion hepatitis. We assessed whether
coinfection of
patients with chronic hepatitis C and SEN D or SEN H correlates with
the
outcome of treatment with interferon and ribavirin. Of 31 patients
with
hepatitis C studied, six were positive for SEN D and seven for SEN H
(one was
positive for both). All of those positive for SEN D and five of
those positive
for SEN H failed to respond to therapy. Overall response (RNA titre
and alanine
aminotransferase concentration after treatment) was lower in
SEN-infected
patients than uninfected patients (p=0.025). We conclude that
coinfection with
SEN viruses is frequent in chronic hepatitis C patients and might
adversely
affect the outcome of treatment with interferon and ribavirin.
Publication Types:
a.. Letter
PMID: 11747922 [PubMed - in process]
Here is another site to learn more
http://www.malattieepatiche.it/ru/asp/news.asp?Codice=241#241

New insights in to the natural history of hepatitis C virus infection


Health Research Board & Cork University Hospital

--------------------------------------------------------------------------------


Liam Fanning




A viral version of the 'invasion of the body snatchers' - the Hepatitas C virus invades the human liver.

Chronic hepatitis C infection is a ubiquitous disease, affecting over 200 million people worldwide. The hepatitis C virus (HCV) is spread by exposure to infected blood or blood products. The most striking feature of hepatitis C virus infection is the tendency toward chronicity. The human leukocyte associated antigen (HLA) is a host-encoded protein that presents bacterial and viral proteins to the infected individual's immune system. The HLA has been shown to influence host response to the HIV and the hepatitis B virus.

Researchers at the Hepatitis C Unit, Cork, Department of Medicine, Cork University Hospital, have assessed the likely influence of host HLA on the ability of infected individuals to eliminate the HCV. The study population was infected from a single source, with a single type of the hepatitis C virus, and the year of infection was known for each individual. The study population was equally divided between those who had evidence of exposure to the HCV, but who had cleared the virus, and those who were persistently infected with the virus.

In a series of experiments, DNA was isolated from the blood of these individuals. Their genetic profile was determined molecularly at two specific locations on chromosome 6. Analysis of this genetic data revealed that presence of a particular HLA group was associated with a greater likelihood of clearance of the hepatitis C infection. Additional analysis identified a HLA gene, which was associated with persistent hepatitis C infection in this study population. Evidence from the study may lead to the identification of crucial protein segments from the HCV important for immune system mediated clearance.

Chronic hepatitis C is characterized by persistent viraemia (i.e. the continuous presence of detectable virus), the natural variation of which is undefined. Researchers at the Hepatitis C Unit have evaluated the amount of virus present in the blood over an extended period of patient follow-up and developed a model for predicting change in viral load over time in their study population. The results of this research suggest that viral load appears to increase over time in the chronically infected individual. This model, which is currently undergoing prospective evaluation, may enable the prediction of when chronically infected individuals are likely to have a serum viral load correlated with likely response to anti-viral therapy.

The ongoing goal of the Hepatitis C Unit is to define the viral and host factors that influence the natural progression of hepatitis C virus infection