By :

Sherif Mohamed Farid

2005/1767
 Outline
Introduction
HCV
Incidence of hepatitis c virus in Egypt
Mode of transmission and symptoms
Diagnosis
Treatment and management
Preventive approaches
What’s meant by
hepatitis ?
Types of hepatitis causing viruses ?

Mode of transmission for all hepatic viruses ?

Incubation period and chronicity ?

The most fatal and possible complication ?

Vaccination ?
 P.O.C Hepatitis A Virus Hepatitis B Virus Hepatitis C Hepatitis D Virus Hepatitis E Virus
Virus

Nucleic acid RNA DNA RNA * RNA

Major Fecal–oral Blood Blood Blood occur Water

transmission Ingestion Sexual as co- Ingestion
contact infection with
HBV
Incubation 15–45 40–180 20–120 30–180 14–60
period (days)

Chronicity No Yes Yes Yes No

vaccination Yes Yes No No No

Liver cancer No Yes Yes Yes No

 HCV
“Silent
Killer”
Morphology
Immunity Vs.
HCV
It’s RNA virus ----------> Mutation Rates

 Serotypes ---------> 6 Genotypes (with

subtypes under each genotype)
Pathogenesis
 1%
HCC

Cirrhosis
15-20%

Chronic Hepatitis
80-90%

HCV Infection

100%

Graphic courtesy of Dr. H.B. El-Serag.

Types of HCV patients
Acute hepatitis C ( asymptomatic)
First 6 months after exposure to HCV.
Can be cleared from blood.

Chronic hepatitis C (occur in 80% in

patientswith acute infection)
Lasts more than 6 months after exposure to
HCV.
AST levels are elevated more than in acute
phase.
HCV in numbers…….
 In 1973 it was known as non A ,non B hepatitis .

 In 1989 it was given the name Hepatitis C virus.

 Worldwide, 170 million infected with HCV (3% of pop.)

 Infection in the USA : 3.9 million Americans infected with

HCV (1.8% of pop.) according to National Health and
Nutrition examination Survey

 In USA, approximately 10,000 to 12,000 deaths are

attributed to HCV infection annually
 Incidence of HCV of
Egypt
60 % in Rural Areas are HCV carriers according to
2002 Population with Life expectancy 66 years.

epidemic levels for HCV carrier ratio 10-13% of total

population.

The acute infection resolves in 30-40% of

individuals and the rest will have a chronic infection.

1.75 million Patients with chronic liver disease and

577.00 with advanced liver disease.

About 90% of HCV positive patients in Egypt are

infected with genotype 4 of HCV.
Mode of transmission
Source : “carrier having viral particles in
his/her blood”

As it’s a blood borne virus, its’ portal of entry

is parentrally through direct blood to blood
contact with an infected patient blood.
There is unclear relation between
schistosomiasis and HCV infection ?
Risk factors…….
Blood or blood derivatives transfusion (before
1992)
Needle stick (very common)
Injecting drug users
Sharing contaminated needles, razors,
toothbrushes and other body piercing
instruments
Medical procedures without ensuring aseptic
conditions
Organ transplantation
Cont’d
Hemodialysis in patients with kidney faliure
Intranasal drugs (caffeine addiction)
Practicing unprotected sexual activity (rare)
Vertical transmission (form mother to fetus-
rare-)
Ways in which HCV can NOT
Spread
Sneezing or coughing .
 Hugging and casual contact.
 Breast feeding.
 public toilets.
 animal or Mosquito bites.
 Sharing food or water.
When diagnostic tests for
HCV are done ?
Incidence of a needle stick
injection drug users
Recipients of blood products or organ transplant
before 1992
Long-term partner relations with infected
individuals
Children born to HCV-infected mothers
Persons with tattoos or body piercing
Persons with unexplained/abnormal ALT levels
Persons with a history of drinking alcohol excessively
Symptoms
Patients are mainly asymptomatic and
practicing normal life

In acute infection patient may suffer from

fatigue, jaundice, dark urine, clay color stool
and hepatomegally may occur
Diagnosis
Liver enzymes test (ALT & AST)
 Non-specific biochemical marker
 Give a reflection for liver condition

 May be used to determine treatment efficacy

 Must be followed by serological detection of anti-

HCV Ab
Indirect serological
diagnosis
ELISA (EIA-3 )-–>recent & most sensitive

Detect antibodies against HCV in patient serum

(indirect)
 unreliable to identify acute infection (delayed Ab
production)
1. Positive Results 1. Negative Results
• Current infection • Not infected with
• Resolved/past HCV
infection • Immuno-
compromised patient
• Acute infection

 Test results to be confirmed with Immunoblotting assay(RIBA)

RIBA (recombinant immuno-blot assay )

 detect antibodies reactivity by serum incubation

on four recombinant viral antigens.

 Virus antigens are blotted and color changes

indicate that antibodies are adhering to Antigens.

 Positive result depends on 50% reaction with

recombinant viral Antigens.

 Confirm EIA positive result but need more

confirmation by any HCV-RNA detection tests.
HCV-RNA detection (nucleic acid test)
 Detect 50 to 100 copies/ml (high sensitivity)

E.X : PCR & TMA amplification.

a- Qualitative test
 Presence or absence of virus.
b- Quantitative test (Viral load)
 Number of copies/ml (determine the effectiveness
of therapy )
c- Genotype test (subtype of HCV)
 Before start of therapy
Liver biopsy
 Determining the severity of disease and evaluating
the degree of liver fibrosis and cirrhosis.
 Recommended before liver transplantation.

*possible complication :
 Re-Infection

 painful
Elastrography (liver biopsy alternative)

 Elasticity & stiffness of liver (non-invasive mechanism)

 Sound and magnetic wave transmitted through liver and
velocity of return is measured.
Treatment &
Management
Preventive approaches
Universal screening of Blood and Blood products
Make injectable drugs your last choice of
treatment and use disposable syringes for one
time only
 Prevent needle stick injuries and report if it
occurs
High standards of sterilization of medical and
dental equipment
Don’t share personal items that might have blood on them
like razors, toothbrushes, nail clippers, scissors……
Keep yourself away form any contact with any
Use detergents and disinfectants for removal
of any germs and ensure sanitization
HCV patient must tell his/her doctor about
being carrier for the virus to take the
appropriate precautions
 distribution of medical awareness to people
telling them how to protect themselves from
getting the infection