1. HEPATITIS C VIRUS Presented By: Rabia Ejaz Tahira Karim Hafsa Iftikhar

2. TABLE OF CONTENTS: Introduction Structure Genome Genotype Life cycle Hepatitis C Risk factors Symptoms IDUs Prevalence Classification Treatment

3. INTRODUCTION: HCV was discovered in 1989 as the major causative agent of non-A, non-B hepatitis. It is plus stranded RNA virus. Hepatitis C virus (HCV) is a small (55–65 nm in size), enveloped, positive-sense single- stranded RNA virus of the family Flaviviridae. Hepatitis C virus is the cause of hepatitis C in humans. Hepatitis C virus mutate rapidly.

4. STRUCTURE: Heptitis C virus particle consist of core of genetic material (RNA) It is surrounded by icosahedral protein further encased in a lipid (fatty) envelope of cellular origin. Two viral envelope glycoproteins, E1 and E2, are embedded in the lipid envelope.

6. GENOME Hepatitis C virus genome is positive sense single stranded RNA genome. at 5’ and 3’ end of RNA are UTR that are not translated into proteins but are important to translation and replication of viral RNA. Genome is composed of both structural and non- structural proteins.

8. GENOTYPES There are eleven genotypes of HCV of which six are major genotypes. genotype 3 is most common in pakistan In 1997 it was reported in a small study that the 87% individuals in Pakistan had genotype 3. In 2004, a panel of 30 top gastroenterologist of the country met in a conference and reported that 75%-90% HCV patients in Pakistan had genotype 3a. Qazi et al in 2006 reported that 71% patients had genotype 3 while only 10% had genotype 1. In 2007 it was reported that 81% individuals had genotype 3 while only 9.5% had genotype 1.

10. LIFE CYCLE OF HEATITIS C VIRUS

11. INTRODUCTION: Hepatitis C is a viral disease that leads to swelling (inflammation) of the liver. Hepatitis C is an infection of the liver caused by the Hepatitis C Virus (HCV). The hepatitis C virus (HCV) is a virus that infects the liver, and can cause inflammation and scarring of the liver. The initial phase of HCV infection is called acute hepatitis C. If the virus persists in the body for more than six months, the disease enters the chronic hepatitis C phase..

12. HIGH RISK FACTORS : Blood transfusion Barber Unnecassry and unsave needles Breast feeding Babies born to infected mothers Heamodialysis

13. LOWER RISK FACTOR: sharing personal hiegene item with infected person(toothbrushes, razors,scissors and nail clippers) Contaminated tattoo needles and ink contaminated body piercing implements

14. SYMPTOMS: The HCV infection takes years to produce symptoms in those infected with this virus. About 35% of the infected people may produce symptoms while the rest may not produce symptoms at all. HCV does not have prominent symptoms in the early stage. The infected individual may experience vague symptoms such as abdominal pain impaired digestion loss of appetite lassitude weakness itching

15. Patients in the advanced stage may experience more severe symptoms such as paleness (whiteness) of eyes loss of appetite depression bleeding from rectum bloody vomiting exhaustion weight loss Advanced stage symptoms of Hepatitis C are those due to chronic inflammation of liver (hepatitis), cirrhosis (scarring of tissues) of liver and/or liver failure.

16. HCV in Injecting Drug Users (IDUs) It was estimated that there was about 5 million drug users in Pakistan out of which 15% were regular IDUs. There is an increase shift among addicts from inhalatory to injectable drugs due to decrease in quality and availability of heroin (common inhalatory drug used in Afghanistan and Pakistan).

18. Prevalence in Pakistan: There are various reports regarding HCV seroprevalence in IDUs from different areas of Pakistan. It was reported that HCV seroprevalence in Karachi population was 94 %. Kuo et al in 2006, reported that HCV seroprevalence in IDUs population of Lahore and Quetta was 88%, in a separate study from Quetta it was reported that HCV seroprevalence was 60%. HCV seroprevalence among the IDUs of Rawalpindi and Abottabad was 17.3% and 8% respectively

20. Incubation period  2-25 weeks  average 7-9 weeks Virus enter the body Binds & enters cell (usually liver receptor) Virus loses lipid coat and polyprotein envelop – freeing RNA Enzymes in the cell make large viral protein to help make new viral RNA Virus releases new virus into blood and eventually kills host cell Replication - > 1 trillion per day

21. HEPATITIS C classification ACUTE HEPATITISCHRONIC HEPATITIS  Acute hepatitis is the rapid, sharp, painful onset of the disease. Acute symptoms are more painful for patients, but they last for only three or four weeks. Depending on the patient's immune system, acute symptoms range from mild to severe liver failure  chronic hepatitis is less common and symptoms are less severe. Chronic hepatitis remains in the patient's system for months or even years. Its symptoms are usually mild, but continual infection and destruction of the tissue causes liver damage leading to cirrhosis. Cirrhosis is caused by scarring of the liver, and it can lead to failure or liver cancer.

23. TREATMENT FOR HCV Interferon: Interferon is the only agent of proven efficacy in the treatment of hepatitis C. Standard treatment is interferon alfa-2b at a dose of three million units three times a week. The initial course of treatment is 6 months, but require retreatment. The goal of interferon treatment is suppression of active disease; this usually requires long term therapy. Eradication of virus does not appear to be a realistic goal in most patients.

24. Ribavarin: It inhibit the replication of RNA virus in cell culture. It is an anti-viral drug which is nucleoside analog.It is taken orally twice a day. It decreases hepatitis C virus infectivity in a dose treatment manner The exact way ribavirin work when it enter the cell is unknown.

25. Side effects  Interferon  Fatigue  Muscle/Joint pain  Nausea  Headaches  Anxiety  Depression  Dry Skin/rashes  Ribavirin  seems to make interferon side effects worse – especially fatigue-Anemia

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