People's Democratic Republic of Algeria

Higher Ministery of Education

Departement of English

Translation Task
Prepared by :
Menouar Bilal Houfaf Asma
Haif Khaif fares Chouia Nour el Houda
Meslem Hamza Sebia Chafia
Provised by :
Miss FARRAH
Translation Steps
Part one :
- Paraphrase te source text in the same language

Part Two :
- Looking for Parallel text in the same Language and in the target Language

Part Three :
-Lookin for specialized terms in the source text

Part Four :
- Terminology Card

Part Five :
- The first Version

Part Six :
- The second Version

Part Seven :
-Summary of the text in the SL and TL

Part Eight
- A report
 PART ONE

Paraphrase the source text in

the same language
 Hepatitis C is an infection disease caused by the hepatitis C virus (HCV) that primarly affects the liver. It is difficult to
eradicate the virus . The HCV becomes chronic which leading to destraction of humman body .About 3 millions poaple in the united
state have this disease .
Many people with Hepatitis have no symptons . In 1970-1980, the most common poeple are infected around 40 to 60 years in
the united state .

The Nature of The Hipatitis C Virus :

Hepatitis is an inflamtory disease of the liver that develops as a result of infection with the virus of HCV which cause
Hepatitis. HCV has no relation with other common virus . Moreover, THIS VIRUS causes yellow fever and dengue .
There are a lot of virus share the same family which contain rihonucleic acid ( RNA) as their genetic materials and contains :
enzymes and proteins that due to uproduction within body s cells, especialy liver cells .
The hepatitis C virus species is classified into six genotypes . In the united state, Although , the most common form of HCV is
genotype 01 .There may become differences in each single genotype. For excamples , genotype 1a and 1 b .
Genotyping is important because some viral genotypes respond better to treatment and the most reason which doesnt allaw to
develop the effective vaccine is the genetic diversity of HCV .
Hepatitis C Symptoms :
Most people who are infected with Hepatitis C Which damages the liver usually doesnt have symptoms.
The time takes for symptoms to appear after the hepatitis virus has entred the body and develop from 5 to 12 weeks and some
people descrided it as flulike . The most hralth problems are linked with this virus are :
Nausa Vomiting Dianhea- Loss of appetite Fatigue pain over the liver Jaundice Dark coloured- urine Stools Become
pale in coler .
Other proplems are related with long term cirrhosis . There are also many conditions with similar symptoms and the drinking
too much alkohol damage the liver .
Symptoms of cirrhosis include the following :
Fatigue or weakness- confusion or difficulty concentrating Headacke Not urinating irrtability.
Hepatitis c (HCV) is spread through contact with an infected persons blood .The hepatitis c virus is a blood borne vrus and the
most common modes of infection are through insafe injection practices , inadequate sterilization ,of medical equipement and the
transfusion of unscreened blood products .
During the 1970s and early 1980 , a lot of patients contracted hepatitis c ,from contamined blood or blood products.
 PART TWO

Looking for Parallel text in the

same Language and in the target
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 Hepatitis C
Key facts
Hepatitis C is a liver disease caused by the hepatitis C virus: the virus can cause both acute and chronic hepatitis infection, ranging in severity from a mild illness lasting a few weeks
to a serious, lifelong illness.
The hepatitis C virus is a bloodborne virus and the most common modes of infection are through unsafe injection practices, inadequate sterilization of medical equipment, and the
transfusion of unscreened blood and blood products.
Globally, between 130150 million people globally have chronic hepatitis C infection.
A significant number of those who are chronically infected will develop liver cirrhosis or liver cancer.
Approximately 700 000 people die each year from hepatitis C-related liver diseases 1.
Antiviral medicines can cure approximately 90% of persons with hepatitis C infection, thereby reducing the risk of death from liver cancer and cirrhosis, but access to diagnosis and
treatment is low.
There is currently no vaccine for hepatitis C; however research in this area is ongoing.

Hepatitis C virus (HCV) causes both acute and chronic infection. Acute HCV infection is usually asymptomatic, and is only very rarely associated with life-threatening disease. About
1545% of infected persons spontaneously clear the virus within 6 months of infection without any treatment.
The remaining 5585% of persons will develop chronic HCV infection. Of those with chronic HCV infection, the risk of cirrhosis of the liver is between 1530% within 20 years.
Geographical distribution
Hepatitis C is found worldwide. The most affected regions are Africa and Central and East Asia. Depending on the country, hepatitis C infection can be concentrated in certain
populations (for example, among people who inject drugs) and/or in general populations. There are multiple strains (or genotypes) of the HCV virus and their distribution varies by
region.
Transmission
The hepatitis C virus is a bloodborne virus. It is most commonly transmitted through:
injecting drug use through the sharing of injection equipment;
the reuse or inadequate sterilization of medical equipment, especially syringes and needles in healthcare settings; and
the transfusion of unscreened blood and blood products.
HCV can also be transmitted sexually and can be passed from an infected mother to her baby; however these modes of transmission are much less common.
Hepatitis C is not spread through breast milk, food, water or by casual contact such as hugging, kissing and sharing food or drinks with an infected person.
Symptoms
The incubation period for hepatitis C is 2 weeks to 6 months. Following initial infection, approximately 80% of people do not exhibit any symptoms. Those who are acutely
symptomatic may exhibit fever, fatigue, decreased appetite, nausea, vomiting, abdominal pain, dark urine, grey-coloured faeces, joint pain and jaundice (yellowing of skin and the
whites of the eyes).
Screening and diagnosis
Due to the fact that acute HCV infection is usually asymptomatic, few people are diagnosed during the acute phase. In those people who go on to develop chronic HCV infection, the
infection is also often undiagnosed because the infection remains asymptomatic until decades after infection when symptoms develop secondary to serious liver damage.
 HCV infection is diagnosed in 2 steps:
1. Screening for anti-HCV antibodies with a serological test identifies people who have been infected with the virus.
2. If the test is positive for anti-HCV antibodies, a nucleic acid test for HCV ribonucleic acid (RNA) is needed to confirm chronic infection because about 1545% of people infected
with HCV spontaneously clear the infection by a strong immune response without the need for treatment. Although no longer infected, they will still test positive for anti-HCV
antibodies.
After a person has been diagnosed with chronic hepatitis C infection, they should have an assessment of the degree of liver damage (fibrosis and cirrhosis). This can be done by liver
biopsy or through a variety of non-invasive tests.
In addition, these people should have a laboratory test to identify the genotype of the hepatitis C strain. There are 6 genotypes of the HCV and they respond differently to treatment.
Furthermore, it is possible for a person to be infected with more than 1 genotype. The degree of liver damage and virus genotype are used to guide treatment decisions and
management of the disease.
Getting tested
Early diagnosis can prevent health problems that may result from infection and prevent transmission of the virus. WHO recommends screening for people who may be at increased risk
of infection.
Populations at increased risk of HCV infection include:
people who inject drugs;
people who use intranasal drugs;
recipients of infected blood products or invasive procedures in health-care facilities with inadequate infection control practices ;
children born to mothers infected with HCV ;
people with sexual partners who are HCV-infected;
people with HIV infection;
prisoners or previously incarcerated persons; and
people who have had tattoos or piercings.

Treatment
Hepatitis C does not always require treatment as the immune response in some people will clear the infection, and some people with chronic infection do not develop liver damage.
When treatment is necessary, the goal of hepatitis C treatment is cure. The cure rate depends on several factors including the strain of the virus and the type of treatment given.
The standard of care for hepatitis C is changing rapidly. Until recently, hepatitis C treatment was based on therapy with interferon and ribavirin, which required weekly injections for
48 weeks, cured approximately half of treated patients, but caused frequent and sometimes life-threatening adverse reactions.
Recently, new antiviral drugs have been developed. These medicines, called direct antiviral agents (DAA) are much more effective, safer and better-tolerated than the older therapies.
Therapy with DAAs can cure most persons with HCV infection and treatment is shorter (usually 12 weeks) and safer. Although the production cost of DAAs is low, these medicines
remain very expensive in many high- and middle-income countries. Prices have dropped dramatically in some countries (primarily low-income) due to the introduction of generic
versions of these medicines.
Much needs to be done to ensure that these advances lead to greater access to treatment globally.

Prevention
Primary prevention
There is no vaccine for hepatitis C, therefore prevention of HCV infection depends upon reducing the risk of exposure to the virus in health-care settings and in higher risk populations,
for example, people who inject drugs, and through sexual contact.
The following list provides a limited example of primary prevention interventions recommended by WHO:
hand hygiene: including surgical hand preparation, hand washing and use of gloves;
safe handling and disposal of sharps and waste;
provision of comprehensive harm-reduction services to people who inject drugs including sterile injecting equipment
 testing of donated blood for hepatitis B and C (as well as HIV and syphilis);
training of health personnel; and
promotion of correct and consistent use of condoms.

Secondary and tertiary prevention

For people infected with the hepatitis C virus, WHO recommends:
education and counselling on options for care and treatment;
immunization with the hepatitis A and B vaccines to prevent coinfection from these hepatitis viruses and to protect their liver;
early and appropriate medical management including antiviral therapy if appropriate; and
regular monitoring for early diagnosis of chronic liver disease.

Screening, care and treatment of persons with hepatitis C infection

In April 2016, WHO updated its "Guidelines for the screening, care and treatment of persons with chronic hepatitis C". These guidelines complement existing WHO guidance on the
prevention of transmission of bloodborne viruses, including HCV.
They are intended for policy-makers, government officials, and others working in low- and middle-income countries who are developing programmes for the screening, care and
treatment of people with HCV infection. These guidelines will help expand of treatment services to patients with HCV infection, as they provide key recommendations in these areas
and discuss considerations for implementation.

Summary of key recommendations

Recommendations on screening for HCV infection
1. Screening to identify persons with HCV infection
It is recommended that HCV serology testing be offered to individuals who are part of a population with high HCV prevalence or who have a history of HCV risk exposure/ behaviour.
2. When to confirm the diagnosis of chronic HCV infection
It is suggested that following a positive HCV virus serological test another test (NAT for the detection of HCV RNA) be performed to diagnose chronic infection. NAT for HCV RNA
should also be performed to assess whether to start treatment for hepatitis C.
Recommendations on care of people infected with HCV
3. Screening for alcohol use and counselling to reduce moderate and high levels of alcohol intake
An alcohol intake assessment is recommended for all persons with HCV virus infection followed by the offer of a behavioural alcohol reduction intervention for persons with
moderate-to-high alcohol intake.
4. Assessing degree of liver fibrosis and cirrhosis
In resource-limited settings, the aminotransferase/platelet ratio index (APRI) or FIB4 tests should be used for the assessment of hepatic fibrosis rather than other non-invasive tests that
require more resources such as elastography or Fibrotest.
Recommendations on hepatitis C treatment
5. Assessing for HCV treatment
All adults and children with chronic HCV infection should be assessed for antiviral treatment.
6. Treatment with direct-acting antivirals (DAAs)
WHO recommends that all patients with hepatitis C be treated with DAA-based regimens, except for a few specific groups of people in whom interferon-based regimens can still be
used (as an alternative regimen for patients with genotype 5 or 6 infection and those with genotype 3 HCV infection who also have cirrhosis).
 7. Telaprevir and boceprevir should no longer be used
These 2 first-generation DAAs, which are administered with pegylated interferon and ribavirin, were recommended in the 2014 guidelines. Evidence now shows that they result in
more frequent adverse effects and less frequent cures compared with newer DAA-based regimens. Thus, these 2 medicines are no longer recommended by WHO.
8. WHO recommends preferred and alternative DAA regimens based on genotype and cirrhosis status
The Guideline Development Group reviewed all the available data (over 200 studies) to determine which regimens were most effective and safest to treat each of the 6 different
genotypes.
WHO response
In May 2016, The World Health Assembly adopted the first Global Health Sector Strategy on Viral Hepatitis, 2016-2021. The strategy highlights the critical role of Universal
Health Coverage and the targets of the strategy are aligned with those of the Sustainable Development Goals. The strategy has a vision of eliminating viral hepatitis as a public health
problem and this is encapsulated in the global targets of reducing new viral hepatitis infections by 90% and reducing deaths due to viral hepatitis by 65% by 2030. Actions to be taken
by countries and WHO Secretariat to reach these targets are outlined in the strategy.
WHO is working in the following areas to support countries in moving towards achieving the global hepatitis goals under the Sustainable Development Agenda 2030:
raising awareness, promoting partnerships and mobilizing resources;
formulating evidence-based policy and data for action;
preventing transmission; and
scaling up screening, care and treatment services.
 Hepatitis C
Hepatitis C is an infectious disease caused by the hepatitis C virus (HCV) that primarily affects the liver.[1] During the initial infection people often have mild or no
symptoms. Occasionally a fever, dark urine, abdominal pain, and yellow tinged skin occurs. The virus persists in the liver in about 75% to 85% of those initially
infected. Early on chronic infection typically has no symptoms. Over many years however, it often leads to liver disease and occasionally cirrhosis.[2] In some
cases, those with cirrhosis will develop complications such as liver failure, liver cancer, or esophageal and gastric varices.[1]
HCV is spread primarily by blood-to-blood contact associated with intravenous drug use, poorly sterilized medical equipment, needlestick injuries in healthcare,
and transfusions.[2][3] Using blood screening, the risk from a transfusion is less than one per two million.[2] It may also be spread from an infected mother to her
baby during birth.[2] It is not spread by superficial contact.[4] It is one of five known hepatitis viruses: A, B, C, D, and E.[5] Diagnosis is by blood testing to look for
either antibodies to the virus or its RNA. Testing is recommended in all people who are at risk.[2]
There is no vaccine against hepatitis C.[2][6] Prevention includes harm reduction efforts among people who use intravenous drugs and testing donated
blood.[4] Chronic infection can be cured about 90% of the time with treatments that include the medications sofosbuvir or simeprevir.[2][4] Previous to this a
combination of peginterferon and ribavirin was used which had a cure rate around 50% and greater side effects. Getting access to the newer treatments however
can be expensive.[4] Those who develop cirrhosis or liver cancer may require a liver transplant. Hepatitis C is the leading reason for liver transplantation, though
the virus usually recurs after transplantation.[An estimated 130200 million people worldwide are infected with hepatitis C.[4][8][9] In 2013 about 11 million new cases
occurred.[10] It occurs most commonly in Africa and Central and East Asia.[4] About 343,000 deaths due to liver cancer and 358,000 deaths due to cirrhosis
occurred in 2013 due to hepatitis C.[11] The existence of hepatitis C originally identifiable only as a type of non-A non-B hepatitis was suggested in the 1970s
and proven in 1989.[12] Hepatitis C infects only humans and chimpanzees.[13]

Signs and symptoms

Acute infection
Hepatitis C infection causes acute symptoms in 15% of cases.[14] Symptoms are generally mild and vague, including a decreased appetite,
fatigue, nausea, muscle or joint pains, and weight loss[15] and rarely does acute liver failure result.[16] Most cases of acute infection are not associated
with jaundice.[17] The infection resolves spontaneously in 1050% of cases, which occurs more frequently in individuals who are young and female.[17]
Chronic infection
About 80% of those exposed to the virus develop a chronic infection.[18] This is defined as the presence of detectable viral replication for at least six months. Most
experience minimal or no symptoms during the initial few decades of the infection.[19] Chronic hepatitis C can be associated with fatigue[20] and mild cognitive
problems.[21] Chronic infection after several years may cause cirrhosis or liver cancer.[7] The liver enzymes are normal in 753%.[22] Late relapses after apparent
cure have been reported, but these can be difficult to distinguish from reinfection.[22]
Fatty changes to the liver occur in about half of those infected and are usually present before cirrhosis develops.[23][24] Usually (80% of the time) this change affects
less than a third of the liver.[23] Worldwide hepatitis C is the cause of 27% of cirrhosis cases and 25% of hepatocellular carcinoma.[25] About 1030% of those
infected develop cirrhosis over 30 years.[7][15] Cirrhosis is more common in those also infected with hepatitis B, schistosoma, or HIV, in alcoholics and in those of
male gender.[15] In those with hepatitis C, excess alcohol increases the risk of developing cirrhosis 100-fold.[26] Those who develop cirrhosis have a 20-fold greater
risk of hepatocellular carcinoma. This transformation occurs at a rate of 13% per year.[7][15] Being infected with hepatitis B in addition to hepatitis C increases this
risk further.[27]
Liver cirrhosis may lead to portal hypertension, ascites (accumulation of fluid in the abdomen), easy bruising or bleeding, varices (enlarged veins, especially in the
stomach and esophagus), jaundice, and a syndrome of cognitive impairment known as hepatic encephalopathy.[28] Ascites occurs at some stage in more than half
of those who have a chronic infection.[29]
Extrahepatic complications
The most common problem due to hepatitis C but not involving the liver is mixed cryoglobulinemia (usually the type II form) an inflammation of small and
medium-sized blood vessels.[30][31] Hepatitis C is also associated with the autoimmune disorder Sjgren's syndrome, a low platelet count, lichen planus, porphyria
cutanea tarda, necrolytic acral erythema, insulin resistance, diabetes mellitus, diabetic nephropathy, autoimmune thyroiditis, and B-cell lymphoproliferative
disorders.[32][33] 2030% of people infected have rheumatoid factor a type of antibody.[34] Possible associations include Hyde's prurigo
nodularis[35] and membranoproliferative glomerulonephritis.[20] Cardiomyopathy with associated abnormal heart rhythms has also been reported.[36] A variety
of central nervous system disorders has been reported.[37] Chronic infection seems to be associated with an increased risk of pancreatic cancer.[6][38]
Occult infection
Persons who have been infected with hepatitis C may appear to clear the virus but remain infected.[39] The virus is not detectable with conventional testing but can
be found with ultra-sensitive tests.[40] The original method of detection was by demonstrating the viral genome within liver biopsies, but newer methods include an
antibody test for the virus' core protein and the detection of the viral genome after first concentrating the viral particles by ultracentrifugation.[41] A form of infection
with persistently moderately elevated serum liver enzymes but without antibodies to hepatitis C has also been reported.[42] This form is known as cryptogenic
occult infection.
Several clinical pictures have been associated with this type of infection.[43] It may be found in people with anti-hepatitis-C antibodies but with normal serum levels
of liver enzymes; in antibody-negative people with ongoing elevated liver enzymes of unknown cause; in healthy populations without evidence of liver disease;
and in groups at risk for HCV infection including those on hemodialysis or family members of people with occult HCV. The clinical relevance of this form of
infection is under investigation.[44] The consequences of occult infection appear to be less severe than with chronic infection but can vary from minimal to
hepatocellular carcinoma.[41]
The rate of occult infection in those apparently cured is controversial but appears to be low.[22] 40% of those with hepatitis but with both negative hepatitis C
serology and the absence of detectable viral genome in the serum have hepatitis C virus in the liver on biopsy.[45] How commonly this occurs in children is
unknown.[46]

Virology
Main article: Hepatitis C virus

The hepatitis C virus (HCV) is a small, enveloped, single-stranded, positive-sense RNA virus.[7] It is a member of the Hepacivirus genus in the
family Flaviviridae.[20] There are seven major genotypes of HCV, which are known as genotypes one to seven.[47] The genotypes are divided into several subtypes
with the number of subtypes depending on the genotype. In the United States, about 70% of cases are caused by genotype 1, 20% by genotype 2 and about 1%
by each of the other genotypes.[15] Genotype 1 is also the most common in South America and Europe.[7]
The half life of the virus particles in the serum is around 3 hours and may be as short as 45 minutes.[48][49] In an infected person, about 1012 virus particles are
produced each day.[48] In addition to replicating in the liver the virus can multiply in lymphocytes.[50]
Transmission

Hepatitis C infection in the United States by source

The primary route of transmission in the developed world is intravenous drug use (IDU), while in the developing world the main methods are blood
transfusions and unsafe medical procedures.[3] The cause of transmission remains unknown in 20% of cases;[51] however, many of these are believed to be
accounted for by IDU.[17]
Drug use
Intravenous drug use (IDU) is a major risk factor for hepatitis C in many parts of the world.[52] Of 77 countries reviewed, 25 (including the United States) were
found to have prevalences of hepatitis C in the intravenous drug user population of between 60% and 80%.[18][52] Twelve countries had rates greater than 80%.[18] It
is believed that ten million intravenous drug users are infected with hepatitis C; China (1.6 million), the United States (1.5 million), and Russia (1.3 million) have
the highest absolute totals.[18] Occurrence of hepatitis C among prison inmates in the United States is 10 to 20 times that of the occurrence observed in the
general population; this has been attributed to high-risk behavior in prisons such as IDU and tattooing with nonsterile equipment.[53][54] Shared intranasal drug use
may also be a risk factor.[55]
Healthcare exposure
Blood transfusion, transfusion of blood products, or organ transplants without HCV screening carry significant risks of infection.[15] The United States instituted
universal screening in 1992[56] and Canada instituted universal screening in 1990.[57] This decreased the risk from one in 200 units[56] to between one in 10,000 to
one in 10,000,000 per unit of blood.[17][51] This low risk remains as there is a period of about 1170 days between the potential blood donor's acquiring hepatitis
C and the blood's testing positive depending on the method.[51] Some countries do not screen for hepatitis C due to the cost.[25]
Those who have experienced a needle stick injury from someone who was HCV positive have about a 1.8% chance of subsequently contracting the disease
themselves.[15] The risk is greater if the needle in question is hollow and the puncture wound is deep.[25] There is a risk from mucosal exposures to blood, but this
risk is low, and there is no risk if blood exposure occurs on intact skin.[25]
Hospital equipment has also been documented as a method of transmission of hepatitis C, including reuse of needles and syringes; multiple-use medication vials;
infusion bags; and improperly sterilized surgical equipment, among others.[25] Limitations in the implementation and enforcement of stringent standard precautions
in public and private medical and dental facilities are known to be the primary cause of the spread of HCV in Egypt, the country with highest rate of infection in the
world.[58]
Sexual intercourse
Whether hepatitis C can be transmitted through sexual activity is controversial.[59] While there is an association between high-risk sexual activity and hepatitis C,
and multiple sexual partners are a risk factor for hepatitis C, there is no conclusive evidence that hepatitis C can be transmitted by sexual activity, since people
who report transmission with sex as their only risk factor may actually have used drugs but denied it.[15] The majority of evidence supports there being no risk
for heterosexual couples with only one sexual partner.[59] Sexual practices that involve higher levels of trauma to the anogenital mucosa, such as anal penetrative
sex, or that occur when there is a concurrent sexually transmitted infection, including HIV or genital ulceration, do present a risk.[59] The United States Department
of Veterans Affairs recommends condom use to prevent hepatitis C transmission in those with multiple partners, but not those in relationships that involve only a
single partner.[60]
Body modification
Tattooing is associated with two to threefold increased risk of hepatitis C.[61] This can be due to either improperly sterilized equipment or contamination of the dyes
being used.[61]Tattoos or piercings performed either before the mid-1980s, "underground," or nonprofessionally are of particular concern, since sterile techniques
in such settings may be lacking. The risk also appears to be greater for larger tattoos.[61] It is estimated that nearly half of prison inmates share unsterilized
tattooing equipment.[61] It is rare for tattoos in a licensed facility to be directly associated with HCV infection.[62]
Shared personal items
Personal-care items such as razors, toothbrushes, and manicuring or pedicuring equipment can be contaminated with blood. Sharing such items can potentially
lead to exposure to HCV.[63][64] Appropriate caution should be taken regarding any medical condition that results in bleeding, such as cuts and sores.[64] HCV is not
spread through casual contact, such as hugging, kissing, or sharing eating or cooking utensils.[64] Neither is it transmitted through food or water.[65]
Mother-to-child transmission
Mother-to-child transmission of hepatitis C occurs in less than 10% of pregnancies.[66] There are no measures that alter this risk.[66] It is not clear when
transmission occurs during pregnancy, but it may occur both during gestation and at delivery.[51] A long labor is associated with a greater risk of
transmission.[25] There is no evidence that breast-feeding spreads HCV; however, to be cautious, an infected mother is advised to avoid breastfeeding if her
nipples are cracked and bleeding,[67] or if her viral loads are high.[51]

Diagnosis

Serologic profile of Hepatitis C infection

There are a number of diagnostic tests for hepatitis C, including HCV antibody enzyme immunoassay or ELISA, recombinant immunoblot assay, and quantitative
HCV RNA polymerase chain reaction (PCR).[15] HCV RNA can be detected by PCR typically one to two weeks after infection, while antibodies can take
substantially longer to form and thus be detected.[28]
Chronic hepatitis C is defined as infection with the hepatitis C virus persisting for more than six months based on the presence of its RNA.[19] Chronic infections
are typically asymptomatic during the first few decades,[19] and thus are most commonly discovered following the investigation of elevated liver enzyme levels or
during a routine screening of high-risk individuals. Testing is not able to distinguish between acute and chronic infections.[25] Diagnosis in the infant is difficult as
maternal antibodies may persist for up to 18 months.[46]
Serology
Hepatitis C testing typically begins with blood testing to detect the presence of antibodies to the HCV, using an enzyme immunoassay.[15] If this test is positive, a
confirmatory test is then performed to verify the immunoassay and to determine the viral load.[15] A recombinant immunoblot assay is used to verify the
immunoassay and the viral load is determined by an HCV RNA polymerase chain reaction.[15] If there is no RNA and the immunoblot is positive, it means that the
person tested had a previous infection but cleared it either with treatment or spontaneously; if the immunoblot is negative, it means that the immunoassay was
wrong.[15] It takes about 68 weeks following infection before the immunoassay will test positive.[20] A number of tests are available as point of care testing which
means that results are available within 30 minutes.[68]
Liver enzymes are variable during the initial part of the infection[19] and on average begin to rise at seven weeks after infection.[20] The elevation of liver enzymes
does not closely follow disease severity.[20]
Biopsy
Liver biopsies are used to determine the degree of liver damage present; however, there are risks from the procedure.[7] The typical changes seen
are lymphocytes within the parenchyma, lymphoid follicles in portal triad, and changes to the bile ducts.[7] There are a number of blood tests available that try to
determine the degree of hepatic fibrosis and alleviate the need for biopsy.[7]
Screening
It is believed that only 550% of those infected in the United States and Canada are aware of their status.[61] Testing is recommended for those at high risk, which
includes injection drug users, those who have received blood transfusions before 1992,[69] those who have been in jail, those on long term hemodialysis,[70] and
those with tattoos.[61]Screening is also recommended in those with elevated liver enzymes, as this is frequently the only sign of chronic hepatitis.[71] Routine
screening is not currently recommended in the United States.[15] In 2012, the U.S. Centers for Disease Control and Prevention (CDC) added a recommendation for
a single screening test for those born between 1945 and 1965.[72]

Prevention
See also: Hepatitis C vaccine

As of 2016, no approved vaccine protects against contracting hepatitis C.[73] However, there are a number of vaccines under development and some have shown
encouraging results.[73]
A combination of harm reduction strategies, such as the provision of new needles and syringes and treatment of substance use, decreases the risk of hepatitis
C in intravenous drug users by about 75%.[74] The screening of blood donors is important at a national level, as is adhering to universal precautions within
healthcare facilities.[20] In countries where there is an insufficient supply of sterile syringes, medications should be given orally rather than via injection (when
possible).[25]

Treatment
HCV induces chronic infection in 5080% of infected persons. Approximately 4080% of these clear with treatment.[75][76] In rare cases, infection can clear without
treatment.[17]Those with chronic hepatitis C are advised to avoid alcohol and medications toxic to the liver,[15] and to be vaccinated for hepatitis A and hepatitis
B.[15] Ultrasound surveillance for hepatocellular carcinoma is recommended in those with accompanying cirrhosis.[15]
Medications
Treatment with antiviral medication is recommended in all people with proven chronic hepatitis C who are not at high risk of dying from other causes.[77] People
with the highest complication risk should be treated first, with the risk of complications based on the degree of liver scarring.[77] The initial recommended treatment
depends on the type of hepatitis C virus with which a person is infected.[77]

HCV genotype 1a: 12 weeks of ledipasvir and sofosbuvir OR 12 to 24 weeks of paritaprevir, ombitasvir, dasabuvir, and ribavirin[6][77]
HCV genotype 1b: 12 weeks of ledipasvir and sofosbuvir OR 12 weeks of paritaprevir, ombitasvir, and dasabuvir[77]
HCV genotype 2: 12 to 16 weeks of sofosbuvir and ribavirin[77]
HCV genotype 3: 12 weeks of sofosbuvir, ribavirin, and pegylated interferon[77]
HCV genotype 4: 12 weeks of ledipasvir and sofosbuvir OR paritaprevir, ritonavir, ombitasvir, and ribavirin, OR 24 weeks of sofosbuvir and ribavirin[77]
HCV genotype 5 or 6: sofosbuvir and ledipasvir[77]
Sofosbuvir with ribavirin and interferon appears to be around 90% effective in those with genotype 1, 4, 5, or 6 disease.[78] Sofosbuvir with just ribavirin appears to
be 70 to 95% effective in type 2 and 3 disease but has a higher rate of adverse effects.[78][79] Treatments that contain ledipasvir and sofosbuvir for genotype 1 has
success rates of around 93 to 99% but is very expensive.[80] In genotype 6 infection, pegylated interferon and ribavirin is effective in 60 to 90% of cases.[81] There is
some tentative data for simeprevir use in type 6 disease as well.[81]
Prior to 2011, treatments consisted of a combination of pegylated interferon alpha and ribavirin for a period of 24 or 48 weeks, depending on
HCV genotype.[15] This produces cure rates of between 70 and 80% for genotype 2 and 3, respectively, and 45 to 70% for genotypes 1 and 4.[79] Adverse effects
with these treatments were common, with half of people getting flu like symptoms and a third experiencing emotional problems.[15] Treatment during the first six
months is more effective than once hepatitis C has become chronic.[28]
Surgery
Cirrhosis due to hepatitis C is a common reason for liver transplantation[28] though the virus usually (8090% of cases) recurs afterwards.[7][82] Infection of the graft
leads to 1030% of people developing cirrhosis within five years.[83] Treatment with pegylated interferon and ribavirin post transplant decreases the risk of
recurrence to 70%.[84]
Alternative medicine
Several alternative therapies are claimed by their proponents to be helpful for hepatitis C including milk thistle, ginseng, and colloidal silver.[85] However, no
alternative therapy has been shown to improve outcomes in hepatitis C, and no evidence exists that alternative therapies have any effect on the virus at all.[85][86][87]

Prognosis

Disability-adjusted life year for hepatitis C in 2004 per 100,000 inhabitants

no data 3540
 <10 4045

1015 4550

1520 5075

2025 75100

2530 >100

3035

The responses to treatment is measured by sustained viral response (SVR), defined as the absence of detectable RNA of the hepatitis C virus in blood serum for
at least 24 weeks after discontinuing the treatment,[88] and rapid virological response (RVR) defined as undetectable levels achieved within four weeks of
treatment. Successful treatment decreases the future risk of hepatocellular carcinoma by 75%.[89]
Prior to 2012 sustained response occurs in about 4050% in people with HCV genotype 1 given 48 weeks of treatment.[7] A sustained response is seen in 70
80% of people with HCV genotypes 2 and 3 with 24 weeks of treatment.[7] A sustained response occurs about 65% in those with genotype 4 after 48 weeks of
treatment. The evidence for treatment in genotype 6 disease is sparse and what evidence there is supports 48 weeks of treatment at the same doses used for
genotype 1 disease.[90]

Epidemiology

Prevalence of hepatitis C worldwide in 1999

It is estimated that 150200 million people, or ~3% of the world's population, are living with chronic hepatitis C.[8][9][91] About 34 million people are infected per
year, and more than 350,000 people die yearly from hepatitis C-related diseases.[91] During 2010 it is estimated that 16,000 people died from acute infections
while 196,000 deaths occurred from liver cancer secondary to the infection.[92] Rates have increased substantially in the 20th century due to a combination of
intravenous drug abuse and reused but poorly sterilized medical equipment.[25]
Rates are high (>3.5% population infected) in Central and East Asia, North Africa and the Middle East, they are intermediate (1.5%-3.5%) in South and Southeast
Asia, sub-Saharan Africa, Andean, Central and Southern Latin America, Caribbean, Oceania, Australasia and Central, Eastern and Western Europe; and they are
low (<1.5%) in Asia-Pacific, Tropical Latin America and North America.[9]
Among those chronically infected, the risk of cirrhosis after 20 years varies between studies but has been estimated at ~1015% for men and ~15% for women.
The reason for this difference is not known. Once cirrhosis is established, the rate of developing hepatocellular carcinoma is ~14% per year.[93] Rates of new
infections have decreased in the Western world since the 1990s due to improved screening of blood before transfusion.[28]
In the United States, about 2% of people have chronic hepatitis C.[15] In 2014, an estimated 30,500 new acute hepatitis C cases occurred (0.7 per 100,000
population), an increase from 20102012.[94] The number of deaths from hepatitis C has increased to 15,800 in 2008[95] having overtaken HIV/AIDS as a cause of
death in the USA in 2007.[96]In 2014 it was the single greatest cause of infectious death in the United States.[97] This mortality rate is expected to increase, as those
infected by transfusion before HCV testing become apparent.[98] In Europe the percentage of people with chronic infections has been estimated to be between
0.13 and 3.26%.[99]
In England about 160,000 people are chronically infected.[100] Between 2006 and 2011 28,000 about 3%, received treatment.[100]
The total number of people with this infection is higher in some countries in Africa and Asia.[101] Countries with particularly high rates of infection include Egypt
(22%), Pakistan (4.8%) and China (3.2%).[91] It is believed that the high prevalence in Egypt is linked to a now-discontinued mass-treatment campaign
for schistosomiasis, using improperly sterilized glass syringes.[25]

History
In the mid-1970s, Harvey J. Alter, Chief of the Infectious Disease Section in the Department of Transfusion Medicine at the National Institutes of Health, and his
research team demonstrated how most post-transfusion hepatitis cases were not due to hepatitis A or B viruses. Despite this discovery, international research
efforts to identify the virus, initially called non-A, non-B hepatitis (NANBH), failed for the next decade. In 1987, Michael Houghton, Qui-Lim Choo, and George
Kuo at Chiron Corporation, collaborating with Daniel W. Bradley at the Centers for Disease Control and Prevention, used a novel molecular cloning approach to
identify the unknown organism and develop a diagnostic test.[102] In 1988, Alter confirmed the virus by verifying its presence in a panel of NANBH specimens. In
April 1989, the discovery of HCV was published in two articles in the journal Science.[103][104] The discovery led to significant improvements in diagnosis and
improved antiviral treatment.[6][102] In 2000, Drs. Alter and Houghton were honored with the Lasker Award for Clinical Medical Research for "pioneering work
leading to the discovery of the virus that causes hepatitis C and the development of screening methods that reduced the risk of blood transfusion-associated
hepatitis in the U.S. from 30% in 1970 to virtually zero in 2000."[105]
Chiron filed for several patents on the virus and its diagnosis.[106] A competing patent application by the CDC was dropped in 1990 after Chiron paid $1.9 million to
the CDC and $337,500 to Bradley. In 1994, Bradley sued Chiron, seeking to invalidate the patent, have himself included as a coinventor, and receive damages
and royalty income. He dropped the suit in 1998 after losing before an appeals court.[107]

Society and culture

See also: List of people with hepatitis C

World Hepatitis Day, held on July 28, is coordinated by the World Hepatitis Alliance.[108] The economic costs of hepatitis C are significant both to the individual and
to society. In the United States the average lifetime cost of the disease was estimated at 33,407 USD in 2003[109] with the cost of a liver transplant as of
2011 costing approximately 200,000 USD.[110] In Canada the cost of a course of antiviral treatment is as high as 30,000 CAD in 2003,[111] while the United States
costs are between 9,200 and 17,600 in 1998 USD.[109] In many areas of the world, people are unable to afford treatment with antivirals as they either lack
insurance coverage or the insurance they have will not pay for antivirals.[112] In the English National Health Service treatment rates for hepatitis C are higher
among wealthier groups per 20102012 data.[100] Spanish anaesthetist Juan Maeso infected 275 patients between 1988 and 1997 as he used the same needles
to give both himself and the patients opioids.[113] For this he was jailed.[114]

Research
As of 2011, there are about one hundred medications in development for hepatitis C.[110] These include vaccines to treat hepatitis, immunomodulators,
and cyclophilin inhibitors, among others.[115] These potential new treatments have come about due to a better understanding of the hepatitis C virus.[116]
The combination of sofosbuvir and velpatasvir in one trial (reported in 2015) resulted in cure rates of 99%.[117]
Animal models
One barrier to finding treatments for hepatitis C is the lack of a suitable animal model. Despite moderate success, current research highlights the need for pre-
clinical testing in mammalian systems such as mouse, particularly for the development of vaccines in poorer communities. Currently, chimpanzees remain the
available living system to study, yet their use has ethical concerns and regulatory restrictions. While scientists have made use of human cell culture systems such
as hepatocytes, questions have been raised about their accuracy in reflecting the body's response to infection.[118]
One aspect of hepatitis research is to reproduce infections in mammalian models. A strategy is to introduce liver tissues from humans into mice, a technique
known as xenotransplantation. This is done by generating chimeric mice, and exposing the mice HCV infection. This engineering process is known to create
humanized mice, and provide opportunities to study hepatitis C within the 3D architectural design of the liver and evaluating antiviral compounds.[118] Alternatively,
generating inbred mice with susceptibility to HCV would simplify the process of studying mouse models.

Special populations
Children and pregnancy
Main article: HCV in children and pregnancy

Compared with adults, infection in children is much less well understood. Worldwide the prevalence of hepatitis C virus infection in pregnant women and children
has been estimated to 18% and 0.055% respectively.[119] The vertical transmission rate has been estimated to be 35% and there is a high rate of spontaneous
clearance (2550%) in the children. Higher rates have been reported for both vertical transmission (18%, 636% and 41%).[120][121] and prevalence in children
(15%).[122]
In developed countries transmission around the time of birth is now the leading cause of HCV infection. In the absence of virus in the mother's blood transmission
seems to be rare.[121] Factors associated with an increased rate of infection include membrane rupture of longer than 6 hours before delivery and procedures
exposing the infant to maternal blood.[123] Cesarean sections are not recommended. Breastfeeding is considered safe if the nipples are not damaged. Infection
around the time of birth in one child does not increase the risk in a subsequent pregnancy. All genotypes appear to have the same risk of transmission.
HCV infection is frequently found in children who have previously been presumed to have non-A, non-B hepatitis and cryptogenic liver disease.[124] The
presentation in childhood may be asymptomatic or with elevated liver function tests.[125] While infection is commonly asymptomatic both cirrhosis with liver failure
and hepatocellular carcinoma may occur in childhood.
Immunosuppressed
See also: Hepatitis C and HIV coinfection

The rate of hepatitis C in immunosuppressed people is higher than the normal population. This is particularly true in those with human immunodeficiency
virus infection, recipients of organ transplants and those with hypogammaglobulinemia.[126] Infection in these people is associated with an
unusually rapid progression to cirrhosis.
 - Terminology card -

SpecializedTerm Equivalent in the Target Synonyms (Source Language)

Language

-Hepatitis C )C( Inflammation of Liver by virus C

-HCV Hepatitis C virus
-Immune System Defence System
-Chronic Incessant, Long-lived
-Liver cancer Liver cancer
-Infection Contagion, Contamination
-Liver transplantation Liver transplantation

-Ribonucleic Acid Ribonucleic Acid

-Hepatitis A )A( Inflammation of liver by virus A
-Hepatitis B )B( Inflammation of liver by virus B
-Flaviviridae Flaviviridae
-Yellow Fever Yellow Jack, Yellow Plaque
-Dengue , Break bone fever
-Envelope Coat, enclosure
-Enzymes Enzyms
-Proteins Proteins
-Genetic Profile Genetic profile
-Genotype Genotype
-Strains Species, decsent

-Symptoms Signs
-Acute phase Severe phase
-Nausea Qualm
-Vomiting , Emises
-Diarrhea Diarrhea
-Loss of Appetite Decreased Appetite
-Fatigue Exhaustion
-Pain Ache
-Abdomen Belly
 -Rib Cage Thorax
-Jaundice Icterus
-Dark-colored urine Dark urine
-Stools , Feces
-Dehydration Desiccation
-Confusion Perturbation
-Headache , Headache
-Not urinating Not micturating
-Irritability Frustration
-Cirrhosis , Liver disease
-Alcoholism Alcoholism
-Liver tissue Hepatic tissue
-Fibrous Tissue Fibrous Tissue
-Scarlike Scar
-Fluid retention Water retention
-Belly Abdomen
-Ascites Peritoneal cavity
fluid,hydroperitoneum
-Disturbances in sleeping Disturbances in sleeping
-Itchy skin Pruritus
-Weight loss Weight loss
-Wasting Weakness
-Vomit Vomitus, Barf
-Mental disturbances Mental disturbances
-Lethargy Tiredness
-Hallucinations Hallucinations
-Hepatic Encephalopathy Portosystemic encephalopathy

-Blood Sanguine fluid, hemoglobin

-HIV Human immunodeficiency virus
-Blood Transfusion Blood transfusion
-Blood Screening Blood Screening
-Plasma Serum
-Hemophilia , Haemophilia
-Hemophiliac Haemophiliac
Infectious diseases viral systemic diseases )

DNA virus

HBV

Hepatocellular carcinoma

HPV

Cervical cancer

Anal cancer

Penile cancer

Vulvar cancer

Vaginal cancer

Oropharyngeal cancer
Oncovirus

KSHV

Kaposi's sarcoma

EBV

Nasopharynx cancer

Burkitt's lymphoma
Hodgkin's lymphoma

Follicular dendritic cell sarcoma

Extranodal NK/T-cell lymphoma, nasal type

MCPyV
 Merkel-cell carcinoma
RNA virus

HCV

Hepatocellular carcinoma

Splenic marginal zone lymphoma

HTLV-I

Adult T-cell leukemia/lymphoma

HIV
Immune disorders
AIDS

DNA virus

JCV

Progressive multifocal leukoencephalopathy

RNA virus

MeV

Subacute sclerosing panencephalitis

Central Encephalitis/
LCV
nervous system meningitis
Lymphocytic choriomeningitis

Arbovirus encephalitis

Orthomyxoviridae (probable)
Encephalitis lethargica

RV

Rabies
 Chandipura virus

Herpesviral meningitis

Ramsay Hunt syndrome type 2

Poliovirus

Poliomyelitis

Post-polio syndrome
Myelitis

HTLV-I

Tropical spastic paraparesis

Cytomegalovirus

Cytomegalovirus retinitis

Eye
HSV

Herpes of the eye

CBV
Cardiovascular Pericarditis

Myocarditis

EpsteinBarr virus

EBV infection/Infectious mononucleosis

DNA virus

Cytomegalovirus
Respiratory system/

acute viral nasopharyngitis/ IV: SARS coronavirus

viral pneumonia Severe acute respiratory syndrome

V: Orthomyxoviridae: Influenzavirus A/B/C

RNA virus
Influenza/Avian influenza

V, Paramyxoviridae: Human parainfluenza viruses

Parainfluenza
 RSV

hMPV

MuV

Mumps

Pharynx/Esophagus
Cytomegalovirus

Cytomegalovirus esophagitis

DNA virus

Adenovirus
Adenovirus infection

Gastroenteritis/ RNA virus

Human digestive system diarrhea
Rotavirus

Norovirus

Astrovirus

Coronavirus

DNA virus

HBV (B)
Hepatitis
RNA virus

CBV
 )HAV (A

)HCV (C

)HDV (D
)HEV (E

)HGV (G

Pancreatitis CBV

BK virus
Urogenital MuV

Mumps

( - ) ( ) ( DNA:
) 40 ( ) ( - )
) ( - ) ( RNA:
( )
) ( DNA:
/ ) ( RNA:
) (
) ( ) (

- ) - (

) (
( ) (

)

) (
/ ) / -( -
/ DNA


 )) ( (

RNA ) /( / / : V
( : V
hMPV )

/ ) (
/ ) ( DNA:
RNA:

) ( DNA:
) ( RNA:

) ( ) ( )(
)G (G

( / ) 6 ( ) (

) ( - )

DNA ) ( )( ) ( ) (

) (
) ( ) 19 /(

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Fibroscan
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.

Hepatitis C Glossary of Terms

Proteins produced by the body to fight infection in response to bacteria, viruses or

other substances. In the case of hepatitis C, antibodies are produced to fight the
Antibodies
virus, and remain in the body long-term regardless of whether the infection is still
present.
Antibody Test A blood test looking for antibodies rather than the virus itself.
Being alert to the potential or actual presence of blood in any situation or
Blood Awareness
environment.
Government subsidised health care available to people who have a Medicare Card.
Bulk Billing
No additional payments are required.
Chronic An illness or medical condition that lasts for a longer than 6 months
Extensive and permanent scarring for the liver. Cirrhosis interferes with normal
Cirrhosis functioning of the liver. Approximately 5-10% of people with hepatitis C develop
cirrhosis.
A general term referring to an infection with two or more infectious agents.
Co-Infection
Hepatitis co-infection refers to infection with hepatitis C and another blood borne
 virus, such as HIV and/or hepatitis B.
The use of two or more drugs at the same time to treat hepatitis C infection. This
Combination Therapy
term currently refers to a combination of the drugs interferon and ribavirin.
Various approaches to healing diseases not regarded as part of orthodox medical
Complimentary Therapies treatment. In relation to hepatitis C, complimentary therapies are often used to
reduce potential side effects of antiviral therapy.
A thin rubber (latex) bag which fits on a mans erect penis to stop pregnancy and
Condom
the spread of sexually transmitted infections.
A rule that stops health workers, doctors and interpreters from repeating what
Confidentiality people tell them or talking about their health to other people. A worker can only
repeat what a client says with the clients permission or in very special situations.
A professional who listens to people talk about personal concerns and helps them
find a solution. Counsellors follow the rules of confidentiality. Counsellors work
Counsellor
at places like community health clinics, mental health services and Family
Planning clinics.
What a doctor decides after looking at a patients signs, symptoms and medical
Diagnosis history; the conclusion a doctor may reach after examining, doing tests and/or
talking with their patients.
Treating someone unfairly because they are different (immigrants, women,
Discrimination persons living with hepatitis C etc). In Australia many types of discrimination are
against the law.
Disease Illness, sickness
Fibroscan A painless test to determine how much liver damage is present.
A term used to describe the specific genetic structure of hepatitis C. Each
Genotype genotype causes different immune responses and responds differently to
treatment. Hepatitis C genotypes include 1,2,3, and 4.
Means inflammation of the liver. Overuse of alcohol and some viruses can cause
Hepatitis
hepatitis. The most common forms of viral hepatitis are A, B and C.
HIV The Human Immunodeficiency Virus which can cause AIDS.
Disease related to the presence of a micro-organism (germ) in or on the body.
Infection Infections may lead to the infected person becoming ill. Infections can be caused
by viruses, bacteria, fungi or parasites.
 Using a needle and syringe to put drugs into the blood stream, under the skin or
Injecting
into the muscle.
A term used to describe a person who takes drugs by using a needle and syringe to
Injecting Drug User (IDU)
put drugs into the blood stream or a muscle.
A substance produced naturally by the body to help defend itself against viral
infection. The administration of synthetically manufactured interferon in large
Interferon
doses can help to reduce or get rid of hepatitis C in the blood and slow down or
stop the disease process.
A clinical procedure in which a small part of the liver is removed to assess the
Liver Biopsy
health of the liver.
To have regular check ups to find out how hepatitis C is progressing or
Monitor
developing.
Side Effect A bad reaction to a medication.
A professional person with special training to talk to people about their concerns
Social Worker and to help them find a solution to problems. Social workers follow the rules of
confidentiality.
A way of finding an illness by taking blood or body fluids from a person and
Test
carefully looking at them.
Transmission The passing of a disease from one person to another.
Something that a person does so that they can stay healthy or get better.
Treatment Treatments can involve taking medicine, complimentary therapies and/or changes
in lifestyle.
The amount of virus (hepatitis C) that is found in a persons blood if they are
Viral Load
infected with that virus.
A germ (micro-organism, microbe) which standard antibiotics cannot fight. HIV,
Virus hepatitis A, B and C are viruses that cannot be treated by antibiotics but can be
treated by antiviral drugs.
 PART FOUR

THE FIRST VERSION

Hepatitis C is an infection of the liver caused by the Hipatitis C virus ( HCV ) . It is difficult for the humane immune system to eliminate the virus from the body , and
infection with HCV usually becomes chronic . Over decades , chronic infection with HCV damages the liver and can cause liver failure in som people . In the U.S. , the
number of new cases of infection with HCV has declined over the last 10 years from the peak of some 200.000 annually to about 19,000 in 2006 . When the virus first
enters the body , there usually are some symptoms , so tese are estimates . Up to 85% of newly infected people fail to clear the virus and become chronically infected
.in the U.S. , more than three million people are chronically infected with HCV . infection is most common among people who are 40 to 60 years of age , infecting the
high rates of infection in the 1973s and 1980s . There are 8,000 to 10,000 deaths each year in the U.S. related to HCV . HCV is the leading cause of liver transplantation
in the U.S and is a risk factor for liver cancer .

. .) (
.
85 . .2006 19,000 200
60 40 . 3
1980 1973 . 10,000 8,000

The nature ( Biology ) of the Hipatitis C Virus

Hepatitis means the inflammation of the liver . HCV is one of several viruses that can cause Hepatitis . It is unrelated to the other common Hepatitis viruses ( for
example , hepatitis A or hepatitis B ) . HCV is a member of the Flaviviridae family of viruses .Other members of this family of viruses include those that cause yellow
fever and dengue .

. .
. .) (
.
 Viruses belonging to this family all have ribonucleic acid ( RNA ) as their genetic material . All hepatitis C viruses made up of an outer coat ( envelope ) and contain
enzymes and proteins that allow the viruses to reproduce within the cells of the body , in particular , the cells of the liver . Although this basic structure is common to all
hepatitis C viruses , 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 genotypes respond better to therapy than others . the genetic diversity of HCV is one reason that has
been difficult to develop an effective vaccine since the vaccine must generate viral proteins from each genotype .

) (. ()
.
. 1 . .) (
. .) 1 1 (
.

Hepatitis C symptoms

although hepatitis C damages the liver , 80% of poeple with the disease do not have symptoms . In those who do , symptoms may not appear for 10-20 years , or even
longer . Even then , the symptoms usually come and go and are mild and vague . Unfortunately , by the time symtomps appear , the damage may be very serious .

. 20-10 . 80
. .

A minority of people have symptoms during the early acute phase of the infection . These symptoms typicallly develop 5-12 weeks after exposure to HCV . some people
describe the symptoms as being flulike . the symptoms may last few weeks or months .

- Nausea

- Vomiting

-Diarrhea
-Loss of appetite

- Fatigue

- Pain over the liver ( on the right side of the abdomen , just undr the rib cage )

- Jaundice - A condition in which the skin and the whites of the eyes turn yellow

-Dark-coloured urine ( may look like cola or tea )

-Stools become pale in color ( grayish or clay colored )

. 12-5 .
. .

) ( -

) ( - --

( -

Prolonged nausea and vomiting can cause dehydration . if you have been vomiting repeatedly , you may notice the following symptoms :

-Fatigue or weakness .

-Confusion or difficulty concentrating .

-Headache .

-Not urinating .
-Irritability .

: .

. -

. -

.-

. -

Chronic hepatitis C can lead to cirrhosis of the liver in many people , a condition traditionally associated with alcoholism . Cirrhosis is a condition in hich healthy liver
issue is replaced by fibrous tissue followed by a scarlike hardening . As this happens , the liver gradually begin to fail , or loss its ability to carry out its normal functions
.Eventually , symptoms develop . Symptoms of the sirrhosis include the following :

-Fluid retention causing sweling of the belly ( ascites ) , legs , or whole body .

- Persistent jaundice

-Fatigue

-Disturbances in sleeping

-Itchy skin

-Loss of appetite , weight loss, wasting

- Vomiting with blood in the vomit

-Mental disturbances such as confusion , lethargy , extreme sleepness, or hallucinations ( hepatic encephalopathy )
 .
: . . .

. ) (-

) ( -

Transmission of the Hepatitis C

Hepatitis C is believed to be transmitted only by blood .However , unlike many other blood borne viruses like ( HIV) virtually any source of blood or blood products
seems to be capable of carrying the virus , even if the source is indirect - like a used razor , for example .This makes hepatitis C far more transmissible than most other
blood borne - including HIV .

Many hepatitis C victims contracted the disease through blood transfusions in the 1970 and in the 1980 .

Rates of post-transfusion hepatitis during this period were determined to have been between 8% and 10%.

effective bloodscreening for the virus was developed and implemented by 1990 , which lowered the rates of post-transfusion hepatitis to less than 5% 1990-1993 .
Since then , improved testing has led to drastic reductions in risk , down to less than 1% after 1993 .However , anyone who had blood transfusion prior to that time is at
risk for having been infected . Incidence of hepatitis C infection among hemophiliacs remained high through 1993 , because plasma used to treat hemophiliacs is often a
mixture from many different donors . However , incidence of new infection among hemophiliacs has rapidly approached zero as better methods have been employed .


. ( )
- . --

1970 . %8 .%10

1990 5 .1993-1990 1 .1993

. 1993

. .
 PART FIVE
THE SECOND VERSION
 () . .
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200 19,000 .2006 . 85
3 . 40 60
8,000 10,000 . 1973 1980

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1990 5 .1993-1990 1 .1993

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 PART SIX
THE SUMMARY IN TL
 C
. C HCV C . ' 'hepatitis

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 . C : .
20 30 . 10 20 .

PART SEVEN

THE REPORT
 SOME DIFFICULTIES IN TRANSLATING A MEDICAL TEXT

Medicine is a field of knowledge in accelerated scientific and technological development that each year may
incorporates a large number of new terms into the medical lexicon. it is only much later on that the first attempts
to translate these terms start to timidly appear, and this leads to further problems: for a lot of words, it is not easy
to find suitable corresponding terms in Arabic, thus making translation difficult. It will be easy to translate if we
have good choice of vocabulary. We are able to combine word by word to be a good text. The problem will emerge
when the translator has no wider choice of vocabulary, especially scientific one. It will be difficult for a translator to
translate it. For example: sub technical word. The translation of sub technical word cannot be found in Arabic. So
the translator should have wider choice of vocabulary to translate it. It also relates to the translators competence
whether she/he understands what to do or not. But having few choice of vocabulary will take long time for
translator to finish the task. Sometimes it is because of the background of translator itself, maybe he/she is not
really familiar with the words. It can not be translators fault only, the limited number of scientific vocabulary in
Arabic is one of the problems. We may not ignore that here are lots of words in which Arabic does not have
compared to English. The translator should find another word that can represent the word or even explain it in
order to make the reading clear.

Translation is not an easy thing. It involves all basic skills you have in English.
Translating the text is another matter. You have to accurately recognize the culture and the context of the text
itself. Even a professional translator will get difficulties in translating it. It includes difficulties in translating
scientific lexicons, translating scientific concept, finding lexical equivalence, having no wider choice of scientific
vocabulary, different style of translating, etc. However, as a translator, you should improve your competence in
this field in order to get confidence from the readers. translation consists of studying the lexicon, grammatical
structure, communication situation, and cultural context of the source language text, analyzing it in order to

determine its meaning, and then reconstructing this same meaning using the lexicon and grammatical structure
which are appropriate in the receptor language and its cultural context, the translator mustfind suitable strategies

to re-express meaning clearly into the target language. at the first time, the translator must realize that the
problems he/she faces while translating, then he/she may consult the dictionary. If it cannot solve this problem
yet, it is better for the translator to consult with the professionalism thatrelated to the scientific study. For example
when you are translating medical text you may go to doctor that know the words in the text. If this one may not
resolve your problem, you may have a research and find by yourself the meaning of the text that causes the
difficulties in translating scientific text.
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