Hepatitis C

STEP 4
Epidemiology
• WHO says hepatitis C that is transmitted through contaminated blood
kills 350,000 people worldwide every year
• Indonesia ranks third in the world for most people with hepatitis after
India and China with the estimated number of patients as many as 30
million people who suffer from hepatitis B and C
Etiology
• Hepatitis C virus (Hepatitis C Virus = HCV) is a single-chain RNA virus
of the Flaviviridae family.
• This virus replicates in hepatocytes and does not damage cells
directly.
• Serum half-life: 2-3 hours HCV is grouped into 6 genotypes (1-6)
distributed throughout the world.
• Incubation period: 2 weeks - 6 months
Pathophysiology
• HCV enters the hepatocytes by
binding to a specific cell surface
receptor.
• Then the core protein of the virus
penetrates the cell wall by a chemical
process where the fat membrane joins
the cell wall and then the cell wall will
surround and swallow the virus and
bring it into the hepatocytes.
• Viruses can make liver cells treat viral
RNAs like their own.
• ForViral RNA is used as a template to
mass produce polyproteins (process of
translation
• Polyproteins are broken down into
smaller protein units.
• Now viral RNA copies itself in bulk
(billions of times) to produce material
in forming new viruses.
• The new virus will interact with the
structural proteins, which will then
form the nucleocapsid and then a new
viral nucleus. The protein envelope
will then coat the new virus core.
• The adult virus is then removed from
the hepatocytes into the blood vessels
through the cell membrane.
Diagnosis
• Acute stage • Symptoms that may arise:
- Most patients are asymptomatic - Fatigue
and undiagnosed after acute HCV - Missing appetite
infection.
- HCV RNA is detected within 1-2 - Weak
weeks after infection and increases - Jaundice / yellow
rapidly. - Abdominal pain
- HCV RNA levels are stable at 105 - - Dark urine
107 IU / mL causing elevated levels
of ALT and the onset of symptoms • Acute infection will develop
of gekala hepatitis. chronic in 85% of patients, as can be
seen from the HCV RNA that persists
- Symptoms occur at 7 weeks after for 6 months.
infection and last for 3-12 weeks
2. Chronic Stage 3. The advanced stage
• In the chronic phase, serum HCV and Symptoms that may arise:
ALT RNA levels may fluctuate, even - Spider nevi
undetectable / return to normal.
• Symptoms that may occur in chronic - Splenomegaly
infection: - Erythema in the palm of the hand
- Fatigue - Testicular atrophy
- Upper right abdominal pain - Cap Medusae
- Nausea
- Appetite lost / decreased
- Hepatomegaly can be seen from
physical examination.
Management
• Objective of therapy: cure HCV • Pharmacological therapy
infection and restore tissue - Standard therapy: 1x weekly
condition of the body. PEG-IFN injection and Oral
• Nonpharmacology therapy Ribavirin 1x daily
- Anti-hepatitis A and B vaccine
- Balanced nutrition diet
- Avoid alcohol
- Quit smoking
- Regular exercise
Complication
• Liver cirrhosis
• Liver Failed
• Liver cancer