Hepatitis C Virus (HCV) – Flaviviruses

by Sean Elliott, MD

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    00:01 So let's start with hepatitis C virus.

    00:04 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.

    00:17 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.

    00:29 The viremia associated with that chronic infection 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 for transplantation.

    00:49 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.

    01:09 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.

    01:19 The prodromal phase is very much a non- specific, viral illness with fever, malaise, and anorexia.

    01:27 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.

    01:41 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.

    01:50 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.

    02:02 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 prior infection.

    02:16 It simply says that indeed there is serologic evidence of infection with hepatitis C.

    02:22 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.

    02:44 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.

    02:53 Not a common way of diagnosing the virus and certainly, a very labor-intensive way to demonstrate the virus.

    03:00 Prevention and treatment.

    03:03 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.

    03:17 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.

    03:30 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.

    03:48 We shall see if there's a possible cure coming down the pipelines, but current data looks quite promising.

    03:55 Until that happens, though, and while under going the interferon alpha-based therapy, supportive regimen is the best way to go.

    About the Lecture

    The lecture Hepatitis C Virus (HCV) – Flaviviruses by Sean Elliott, MD is from the course Viruses.

    Included Quiz Questions

    1. 75%
    2. 10%
    3. 25%
    4. 50%
    5. 85%
    1. ...enzyme-linked immunosorbent assay (ELISA).
    2. ...recombinant immunoblot assay (RIBA).
    3. ...qualitative polymerase chain reaction (PCR).
    4. ...quantitative polymerase chain reaction (PCR).
    5. ... histological evaluation.

    Author of lecture Hepatitis C Virus (HCV) – Flaviviruses

     Sean Elliott, MD

    Sean Elliott, MD

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