So let's start with hepatitis C virus.
Transmitted via a parenteral or
blood exposure route,
but also exposure to other blood
and body fluids,
via sexual contact or
perinatal exposure -- a baby's born
to hepatitis C-infected mothers.
The clinical manifestations are,
or include acute infection, which
overall, is milder than hepatitis B virus,
a chronic infection which occurs
in 3/4 of the cases.
The viremia associated with that
lasts for at least, in fact, frequently over
10 years, and occasionally --
not as severely as hepatitis B --
but occasionally is associated
with progression to
cirrhosis of the liver
with liver failure and a need
Antibodies acquired during
any stage of this don't
give immunity, and in fact, it has
been difficult to obtain
and create, I should say,
a successful hepatitis C vaccine
because the envelope proteins
expressed by hepatitis C
are quite variable
There's changing, so it's a shifting target.
Looking at the table on the
right side of the slide,
is a bit of a closer drill down
to what acute
hepatitis looks like in the setting
of hepatitis C.
The prodromal phase is very much a non-
specific, viral illness with fever,
malaise, and anorexia.
The preicteric, meaning prior to onset
of jaundice and liver failure,
is an escalation of gastrointestinal-
type symptoms, so nausea,
vomiting, nonspecific abdominal pain,
and then fever with rigors.
And then the icteric phase when there
is an acute hepatitis,
assuming that the patient hasn't bypassed
that and gone into the chronic phase.
But acutely, there will be rapid
onset of jaundice
with dark urine, increasing liver enzymes,
exactly as you would expect,
and even a mild hepatitis A case where
there's acute hepatitis.
The identification of hepatitis C virus
is largely initially accomplished
through an enzyme-linked immunosorbent assay,
which is unable to distinguish acute versus
chronic infection, acute versus
It simply says that indeed there
is serologic evidence
of infection with hepatitis C.
However, after screening a patient
with an ELISA test,
ne then goes to recombinant immunoblot
assay, the RIBA,
and/or a polymerase chain reaction, PCR,
to do a much more molecular diagnostic
approach to confirm
presence of active hepatitis C virus, and
even to quantify how much is present.
Again, the scanning electron
micrograph in front of you
simply shows a hepatitis C virus,
which has been purified from cell
culture in the laboratory.
Not a common way of diagnosing the virus
and certainly, a very labor-intensive
way to demonstrate the virus.
Prevention and treatment.
Well, of course, the best treatment is
prevention, in the first place, and so all
blood or blood donors and transplant
for solid organ donors
are screened by ELISA,
which is a very sensitive way to look
for presence of hepatitis C.
For those patients who become
infected through a
parenteral or sexually-acquired exposure,
or even those babies born to a
hepatitis C-infected mother,
there are antivirals that
have some efficacy.
Currently, the use of interferon
alpha and ribavirin together
have been historically the best combination,
but there is now increasing evidence
with use of the antiretrovirals
commonly used to treat HIV infection,
which in combination with interferon alpha,
have been even more successful.
We shall see if there's a possible cure
coming down the pipelines,
but current data looks quite promising.
Until that happens, though, and while under
going the interferon alpha-based therapy,
supportive regimen is the best way to go.