Hepatitis C: Difference between revisions

Revision as of 22:36, 30 November 2021

Global prevalence of hepatitis C

Sources of hepatitis C infection

The causative agent is HCV-RNA virus (Flaviviridae). Different genotypes and their subtypes are distinguished, it is easily subject to mutations. There are 6 types of viruses and a large number of subtypes (genotype 1b occurs most often in the Czech Republic). Spread parenterally (blood derivatives – hemophiliacs, i.v. drug addiction, hemodialysis, sexual transmission, perinatally from mother to fetus, transplant grafts),it is about 100 times less contagious than VHB.

Acute HCV has an ICD code of B171, chronic B182 .

The course of infection

The incubation period is 15–160 (most often around 50) days^[1].

Acute infection (asymptomatic or icteric form), in 15% spontaneous elimination, in 85–90% it becomes chronic;
chronic infection.

The infection is often asymptomatic, or it takes the form of vague dyspeptic problems. It is usually without jaundice. It may manifest itself clinically after years as liver cirrhosis (or its complications) or hepatocelullar carcinoma. Jaundice occurs more often in the elderly. Hepatic failure is rare. The development of liver cirrhosis is slow, accelerated by HBV and alcohol. Asymptomatic carriers are rare.

Diagnostics

We determine serologically - anti-HCV antibody (not only in infected persons, but also in those who eliminated the virus spontaneously or by antiviral treatment). PCR detection of viral RNA is an indicator of active infection. Anti-HCV is demonstrable about 3 weeks after exposure, it has no preventive effect against reinfection.It is characterized by a small link between biochemistry and histology (even slightly increased ALT, large changes). For this reason, we have to resort to lliver biopsy more often.

Ig production may be delayed; if acute HCV is suspected, the test should be repeated. Chronic hepatitis C requires a biopsy with staging (advanced liver fibrosis) to show a risk of progression to liver cirrhosis. The virus cannot be grown on tissue cultures, so PCR or Ig anti-HCV is detected.

Therapy

We treat HCV infection with antivirals - a combination of IFN-α (pegylated) with ribavirin. The course lasts 6 or 12 months and negative PCR for viral RNA 24 weeks after the end of treatment is considered a criterion for curing the infection. IFNs are of two types - conventional and pegylated (bound to polyethylene glycol - they are released gradually, applied s.c. once a week).

Newer treatment from 2015 is possible with the so-called 3D combination of drugs: Sofosbuvir, Simeprevir, ledipasvir and others. This treatment may or may not be combined with Ribavirin or IFN alpha (according to the genotype of the virus) and the therapy lasts 12-24 weeks. The side effects are quite mild but the treatment is very expensive. Unlike previous therapy, there is a success rate of up to 97%. Another treatment method is liver transplantation.

Prophylaxis

There is no effective vaccine against HCV (due to the high variability of the virus), post-exposure Ig prophylaxis or antivirals does not make sense either.

Links

Sources

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 __NOTOC__
-<!----------------------------------------------------------------------------------------------------------------
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--------------------------------------------------------------------------------------------------------------->
-{{Infobox - virus
-| název = ''Virus hepatitidy C''
-| obrázek = Hepatocellular carcinoma histopathology (2) at higher magnification.jpg
-| popisek =Histopatologický obraz hepatocelulárního karcinomu u pacientky s chronickou jaterní cirhózou indukovanou infekcí HCV
-| čeleď = [[Flaviviridae]]
-| nk = RNA
-| zdroj = člověk
-| přenos = parenterálně
-| výskyt = kosmopolitní
-| onemocnění = virová hepatitida C
-| diagnostika = serologicky protilátka anti-HCV
-| terapie = protivirová léčba (kombinace IFN–α (pegylovaných) s ribavirinem)
-| očkování = není
-}}
 [[File:HCV prevalence 1999.png|thumb|right|450px|Global prevalence of hepatitis C]]
 [[File:Hepatitis C infection by source (CDC) - en.svg|thumb|450px|right|Sources of hepatitis C infection]]
-The causative agent is HCV-RNA [[virus]] (''Flaviviridae''). Different [[genotyp|genotypes]]  and their subtypes are distinguished, it is easily subject to [[mutace|mutations]]. There are 6 types of viruses and a large number of subtypes (genotype 1b occurs most often in the Czech Republic). Spread parenterally ([[krevní deriváty|blood derivatives]] – hemophiliacs, i.v. drug addiction, [[hemodialýza|hemodialysis]], sexual transmission, perinatally from mother to [[plod|fetus]], [[transplantační štěp|transplant grafts]]),it is about 100 times less contagious than VHB.
+The causative agent is HCV-RNA virus (''Flaviviridae''). Different [[Genotype Variation, Mutations and Recombination|genotypes]]  and their subtypes are distinguished, it is easily subject to [[Mutator genes, genome stability|mutations]]. There are 6 types of viruses and a large number of subtypes (genotype 1b occurs most often in the Czech Republic). Spread parenterally (blood derivatives – hemophiliacs, i.v. drug addiction, hemodialysis, sexual transmission, perinatally from mother to fetus, transplant grafts),it is about 100 times less contagious than VHB.
-Acute HCV has an [[MKN|ICD code]] of B171 {{MKN-10|B15-B19|B171}}, chronic B182 {{MKN-10|B15-B19|B182}}.
+Acute HCV has an ICD code of B171, chronic B182 .
 ===The course of infection===
@@ Line 49: / Line 23: @@
 #'''chronic infection'''.
-The infection is often asymptomatic, or it takes the form of vague dyspeptic problems. It is '''usually without jaundice'''. It may manifest itself clinically after years as liver cirrhosis (or its complications) or  [[hepatocelulární karcinom|hepatocelullar carcinoma]]. [[Ikterus|Icterus]] occurs more often in the elderly. Hepatic failure is rare. The development of [[cirhóza|liver cirrhosis]]  is slow, accelerated by HBV and [[alkohol|alcohol]]. Asymptomatic carriers are rare.
+The infection is often asymptomatic, or it takes the form of vague dyspeptic problems. It is '''usually without jaundice'''. It may manifest itself clinically after years as liver cirrhosis (or its complications) or  hepatocelullar carcinoma. [[Jaundice (icterus)|Jaundice]] occurs more often in the elderly. Hepatic failure is rare. The development of liver cirrhosis  is slow, accelerated by HBV and alcohol. Asymptomatic carriers are rare.
 ===Diagnostics===
-We determine serologically - '''anti-HCV''' [[protilátka|antibody]] (not only in infected persons, but also in those who eliminated the virus spontaneously or by antiviral treatment). [[PCR]] detection of '''viral RNA''' is an indicator of active infection. Anti-HCV is demonstrable about 3 weeks after exposure, it has no preventive effect against reinfection.It is characterized by a small link between biochemistry and histology (even slightly increased [[ALT]], large changes). For this reason, we have to resort to [[játra|l]][[biopsie|liver biopsy]] more often.
+We determine serologically - '''anti-HCV''' antibody (not only in infected persons, but also in those who eliminated the virus spontaneously or by antiviral treatment). [[PCR]] detection of '''viral RNA''' is an indicator of active infection. Anti-HCV is demonstrable about 3 weeks after exposure, it has no preventive effect against reinfection.It is characterized by a small link between biochemistry and histology (even slightly increased ALT, large changes). For this reason, we have to resort to [[játra|l]]<nowiki/>liver biopsy more often.
 Ig production may be delayed; if acute HCV is suspected, the test should be repeated. Chronic hepatitis C requires a biopsy with staging (advanced liver fibrosis) to show a risk of progression to liver cirrhosis. The virus cannot be grown on tissue cultures, so '''PCR or Ig anti-HCV is detected.'''
@@ Line 62: / Line 36: @@
 ===Prophylaxis===
-There is no effective [[očkování|vaccine]] against HCV (due to the high variability of the virus), post-exposure Ig prophylaxis or [[virostatika|antivirals]] does not make sense either.
+There is no effective [[Vaccination|vaccine]] against HCV (due to the high variability of the virus), post-exposure Ig prophylaxis or antivirals does not make sense either.
 <noinclude>
 ==Links==
-===Související články===
+===Related articles===
-*[[Virové hepatitidy]]
+*[[Viral hepatitis]]
-*[[Hepatitidy]]
+*[[Jaundice]]
+*[[Jaundice (icterus)]]
-===Zdroje===
+===Sources===
 *{{Citace
@@ Line 92: / Line 68: @@
 }}
-===Externí odkazy===
+===External links===
 *[[wikipedia:cs:Hepatitida C|Hepatitida C (česká wikipedie)]]
-===Reference===
+===References===
 <references />
-===Použitá literatura===
+===Literature used===
 *{{Citace