CHAPTER ONE
1.1INTRODUCTION
Hepatitis C infection is an infection of the liver caused by the hepatitis C virus (HCV). HCV is one of several viruses that can cause hepatitis. 'Hepatitis' means inflammation of the liver(Ryan and Ray,2004).It is unrelated to the other common hepatitis viruses (for example, hepatitis A or hepatitis B). HCV is a member of thehepacivirus genus in the familyFlaviviridae. There are at least six distinctly different strains of the virus which have different genetic profiles (genotypes). In the U. S., genotype 1 is the most common form of HCV. Even within a single genotype there may be some variations (genotype 1a and 1b, for example). Genotyping is important to guide treatment because some viral genotype respond better to therapy than others (Wilkins et al. 2009).
According to Hepatitis C NSW (2010), here are some of the things that can happen once the body contract hepatitis C.
The body may deal with hepatitis C of its own accord and you may never get sick.About 25% of all people who contract hepatitis C will clear the infection (although this happen less commonly in people with HIV). For a range of reasons, hepatitis C infection is eradicated from the body in these people, usually within 12 months of having been infected.
Hepatitis C may remain present in the body. About three quarters of people who contract hepatitis C will be chronically infected. This means that they have detectable hepatitis C virus (measured by a PCR test) in their blood for a period of longer than twelve months. People in this group may be at risk of developing liver problems over time.
The genetic diversity of HCV is one reason that it has been difficult to develop an effective vaccine since the vaccine must protect against all genotypes. It is difficult for the human immune system to eliminate HCV from the body, and infection with HCV usually becomes chronic. Over decades, chronic infection with HCV damages the liver and can cause liver failure. Up to 85% of newly-infected people fail to eliminate the virus and become chronically infected. Infection is most commonly detected among people who are 40 to 60 years of age, reflecting the high rates of infection in the 1970s and 1980s. There are 8,000 to 10,000 deaths each year in the U.S. related to HCV infection. HCV infection is the leading cause of liver transplantation in the U.S and is a risk factor for liver cancer.
Most of the signs and symptoms of HCV infection relate to the liver. Less commonly, HCV infection causes conditions outside of the liver. Symptoms are generally mild and vague, including a decreased appetite, fatigue, nausea, fever. Headache, muscle or joint pains, and weigh loss.Hepatitis C after many year
becomes the primary cause of cirrhosis and liver cancer. About 10–30% of people develop cirrhosis over 30 years (Meisel, et al. 1995).
HCV infection can cause the body to produce unusual antibodies called 'cryoglobulins'. These cryoglobulins cause inflammation of the arteries (vasculitis) which may damage the skin, joints, and kidneys. In addition, these patients may develop Raynaud's phenomenon in which the fingers and toes turn color (white, then purple, then red) and become painful at cold temperatures(Iannuzzella, and Vaglio, 2010).
Two skin conditions, lichen planus and porphyria cutaneatarda, have been associated with chronic infection with HCV. HCV also is associated with B-cell lymphoma, a cancer of the lymph system.
Doctors use various tests to determine if a person has hepatitis C. One type of test measures antibodies in the blood, indicating that a person been exposed to HCV; the two most common antibody tests are called ELISA and RIBA. Viral load tests measure how much HCV genetic material is present in the blood; the two most common viral load tests are called PCR and bDNA.
Who to test for hepatitis c virus
According to MMWR (1998) Persons who ever injected illegal drugs,
Persons who were ever on chronic (long-term) hemodialysis;
Persons with persistently abnormal alanine aminotransferase level
Persons who were notified that they received blood from a donor who later tested positive for HCV infection;
Persons who received a transfusion of blood or blood components and organ transplant before July 1992; and
Healthcare, emergency medical and public safety workers after needle sticks, or mucosal exposures to HCV-positive blood
Children born to HCV-positive women.
1.2 OBJECTIVES
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