Patho physiology

Discuss About The Propagation Hepatitis Genetic Constitution?

At an early stage of Hepatitis C disease, infected people often have mild or no symptoms. Usually, symptoms like fever, dark urine, pain in abdominal and pale skin are developed in the body. This virus prevails in the liver of the patient ranges between 75% to 85% of those infected at an early stage  (Okamoto, 2007). Chronic infection with hepatitis C has no symptoms. However, it often leads to damaged liver up to some extent and causes cirrhosis which is a chronic disease intrupting with the normal functioning of the liver; the reason behind it is excess intake of alchohol and cirrhosis grows with the complications such as cancer in liver or liver failure. This virus deploys mostly by blood to blood interaction cerebrate with the usage of medicine, non sterilized or not properly sterilized medical equipment (Okamoto, 2007). Using blood screening, the risk by introducing blood or blood plasma via vein is less. It might be spread from a mother suffering from Hepatitis to her baby during the birth time. It is not caused by facile contact at all. With the advancement in medicine treatment for Hepatitis C virus, the whole platform for its cure changed to a different level (Okamoto, 2007). However, the power to control this disease using current treatments depends on Hepatitis C virus genotype and particular characteristics of the patients. At start symptoms of hepatitis C are most commonly includes the joint pain, stretched muscles, and allergic skin. Diseases caused due to HCV are Arthralgias, Sensory neuropathy, Pruritus, Paresthesias, and Sicca syndrome.

As a different view, one can have the disease but  not able to recognize the symptoms for years. So the person inflamated with HCV are not aware of this disease until a doctor prescribes the blood test for one or another reason. In case, the patient is suffering from chronic HCV then one can have symptoms of fatigue, stomach upset, reduction in daily appetite, muscle stretch, joint pain (Okamoto, 2007). On the other, it may lead to symptoms of cirrhosis which affects the patient who is suffering from hepatitis C for a long time. It causes jaundice, urine turn to dark yellow (Okamoto, 2007). So, one can have blood test whenever this kind of symptoms lasts in the patient’s body.

As per recent advances in medicine, treatments for HCV are having different folds. The most recent as well as the most common method was taking drugs in the form of tablets. The treatment of HCV depends on various factors such as what kind of hepatitis C virus is the cause hepatitis. Among various HCV , the common type is genotype 1, followed by genotypes 2 and 3. Genotypes 4, 5 and 6 are very rare (Cristina & Costa-Mattioli, 2007).

Prognosis

As per epidemiology, Hepatitis C is root cause for the chronic hepatitis C virus in the United States. These  infections stands out for 20% of all cases of acute hepatitis and for more than 40% of all referrals to active liver clinics (Kay & Zoulim, 2007). HCV infections account for approximately 30,000 new infections and 8000-10,000 deaths each year in the United States (Kay & Zoulim, 2007). Among new infections, 60% occur in intravenous drug users; less than 20% of new cases are acquired through sexual exposure; and 10% are due to other causes, including occupational or peri natal exposure and haemodialysis (Kay & Zoulim, 2007).

The overall percentage of anti-HCV antibodies in the US is 1.8% of its total population. Nearly 74% of these patients are having positive HCV RNA, meaning that the active virus continues to grow. Therefore, approximated 3.9 million individuals are suffering from HCV and 2.7 million individuals in the US have chronic HCV. Genotype 1a occurs in 57% of patients; genotype 1b occurs in 17%.From 1989-1993, the occurrence of HCV to approximately 28,000 new cases per year, reflecting an 80% decrease (Bhamidimarri, Park & Dieterich, 2011). Decreased transfusion-associated disease and a dramatic decrease in intravenous drug use accounted for this change. Around the globe, more than 170 million individuals have hepatitis C virus (Bhamidimarri, Park & Dieterich, 2011). The prevalence rates in healthy blood donors are 0.01-0.02% in the United Kingdom and northern Europe, 1-1.5% in southern Europe, and 6.5% in parts of equatorial Africa. Prevalence rates as high as 22% are reported in Egypt and are attributed to the use of parenteral antischistosomal therapy (Bhamidimarri, Park & Dieterich, 2011).Hepatitis is more alarming among minority populations than other populations, which further associated with lower status at economy level and educational levels.

The root cause of hepatitis C i.e. HCV is a single-stranded RNA virus belonging to the Flaviviridae family and Flavivirus genus.The natural targets of hepatitis C are hepatocytes and, possibly, B lymphocytes (Bhamidimarri, Park & Dieterich, 2011).

RNA-dependent RNA polymerase, an enzyme critical in HCV replication, lacks proofreading capabilities and generates a large number of mutant viruses known as quasispecies. These represent minor molecular variations with only 1-2% nucleotide heterogeneity (Bhamidimarri, Park & Dieterich, 2011). HCV quasispecies poses a major challenge to immune-mediated control of HCV and may explain the variable clinical course and the difficulties in vaccine development.

Infection with HCV is self-limited in only a small minority of infected persons. Chronic infection develops in 70-80% of patients infected with HCV Cirrhosis develops within 20 years of disease onset in 20% of persons with chronic infection. The onset of chronic hepatitis C infection early in life often leads to less serious consequences. Hepatitis B virus (HBV) confection, iron overload, and alpha 1-antitrypsin deficiency may promote the progression of chronic HCV infection to HCV-related cirrhosis (Bhamidimarri, Park & Dieterich, 2011). Two studies of compensating cirrhosis in the United States and Europe showed that decomposition occurred in 20% of patients and that HCC occurred in approximately 10% of patients. The survival rate at 5 and 10 years was 89% and 79%, respectively (Pease, 2013). HCC develops in 1-4% of patients with cirrhosis each year after an average of 30 years. The risk of cirrhosis and HCC doubles in patients who acquired HCV infection via transfusion. Progression to HCC is more common in the presence of cirrhosis, alcoholism, and HBV confection (Bhamidimarri, Park & Dieterich, 2011).

Background of Hepatitis C

Hepatitis C is a big issue around the globe. The hepatitis C virus is the root cause of both acute as well as chronic hepatitis. According to  World Health Organization around 3% of the total  world’s population has been inflamated with the hepatitis C virus and  there are more than 170 million chronic carriers who are at risk of developing liver cirrhosis or liver cancer (Waheed, 2015).

The prevalence of HCV infection varies country to country . For example, Frank et al reported in 2000 that Egypt had the highest number of reported infections, largely attributed to the use of contaminated parenteral antischistosomal therapy (Pease, 2013). This led to a mean prevalence of HCV antibodies in persons in Egypt of 22% (Pease, 2013).

The only tablet for the cure of the hepatitis C virus inhibitor ledipasvir and the HCV inhibitor sofosbuvir  was recently approved in the US. A well supported virological acknowledgement 12 weeks post-treatment was seen in 99 % of treatment-naive patients receiving ledipasvir/sofosbuvir for 12 weeks along with there is no additional worth advised by the adjoining of ribavirin or extending the duration for treatment  upto 24 weeks (Waheed, 2015).. The results are seen upto 99 % (Bansal, 2015) who received ledipasvir/sofosbuvir for the duration of 12weeks and 24 weeks. This Data reinforce the usage of ledipasvir/sofosbuvir in chronic HCV genotype 4 infection, in HCV and HIV co-infection and, in combination with ribavirin, in patients with chronic HCV genotype 1 or 4 infections who have decompensated cirrhosis or are liver transplant recipients and in chronic HCV genotype 3 infection. Oral ledipasvir/sofosbuvir was generally well tolerated. In conclusion, ledipasvir/sofosbuvir is an important new single-tablet regimen that represents a significant advance in the treatment of chronic hepatitis C (Keating, 2015).

Ribavirin is another drug used for treating hepatitis C virus. It may  given to patients for other reasons by consulting with the doctor. Ribavirin approved by the FDA for HCV (Waheed, 2015). It is not recommended to take this medicine alone to treat hepatitis C infection as a very worse blood related problem known as haemolytic anaemia can be caused by this medicine. This may lead to heart disease in a worse position and lead to very serious and deadly heart attacks. Consult the doctor if individuals are having heart problems along with HCV (Keating, 2015). It is not recommended to take ribavirin capsules if the patient is suffering from heart disease or any heart problems it is strictly recommended to consult your doctor immediately if you have chest pain while taking this medicine. Do not take if the patient is pregnant. Use of this medicine during pregnancy may cause birth defects or loss of the baby before delivery (Mirazo, Ramos, Russi & Arbiza, 2013). If someone gets pregnant or plan on getting pregnant while consuming this medicine, then consult or call your doctor right away. Pregnant women can make use of two kinds of birth control pills that one can trust while using ribavirin do not consume this medicine if you are living with a sex partner who is pregnant (Keating, 2015). If the patient gets pregnant while taking this medicine or within the time period of 6 months after stop consuming this medicine then call your doctor immediately.

With the help of the literature survey, the various factors causing Hepatitis C and their corresponding symptoms, treatments are surveyed very well with reference to research articles mentioned in the reference section (Mirazo, Ramos, Russi & Arbiza, 2013). Therefore, one can take precautions to prevent Hepatitis C instead of queuing up for its treatments. Sometimes people are unaware of their small negligence towards their health measure which causes liver disorders. With the help of ledipasvir and sofosbuvir, one can treat hepatitis C and the individual must follow a healthy diet to overcome the weakness caused by this disease (Bansal, 2015). The worst case is when hepatitis C prevails up to large extent in the human body and the drug treatment shows no result, so patient goes for a liver transplant to prevent the root cause of this virus. This virus is escalated due to contact with the contaminated blood, for example, from sharing needles or from unsterilized tattoo marking equipment (Bansal, 2015). Problem last due to the fact that people just ignore the starting symptoms of hepatitis C which leads to chronic Hepatitis which demands serious treatment and if it reaches its worst position where the individual is suffering from heart disease along with hepatitis C then it may require liver transplant.

References

Bansal, A. (2015). Immune Thrombocytopenia Due To Hepatitis A Virus: Case Report and Review of Literature. Journal Of Pediatrics & Neonatal Care, 3(2).

Bhamidimarri, K., Park, J., & Dieterich, D. (2011). Management of Hepatitis B Virus Coinfection: HIV, Hepatitis C Virus, Hepatitis D Virus. Current Hepatitis Reports, 10(4), 262-268.

Cristina, J., & Costa-Mattioli, M. (2007). Genetic variability and molecular evolution of Hepatitis A virus. Virus Research, 127(2), 151-157.

Kay, A., & Zoulim, F. (2007). Hepatitis B virus genetic variability and evolution. Virus Research, 127(2), 164-176.

Keating, G. (2015). Ledipasvir/Sofosbuvir: A Review of Its Use in Chronic Hepatitis C. Drugs, 75(6), 675-685.

Mirazo, S., Ramos, N., Russi, J., & Arbiza, J. (2013). Genetic heterogeneity and subtyping of human Hepatitis E virus isolates from Uruguay. Virus Research, 173(2), 364-370.

Okamoto, H. (2007). Genetic variability and evolution of hepatitis E virus. Virus Research, 127(2), 216-228.

Pease. (2013). Hepatitis C Virus Associated Hemophagocytic Lymphohistiocytosis: Case Report and Literature Review. Journal Of Hematology.

Waheed, Y. (2015). Ledipasvir and sofosbuvir: Interferon free therapy for HCV genotype 1 infection. World Journal Of Virology, 4(1), 33.