Hepatitis C
ANTH 394
Alisha Wong
What is Hepatitis C?
● Bloodborne virus caused by the Hepatitis C Virus (HCV)
● Acute and chronic hepatitis C
● Ranging severity from mild illness lasting a few weeks to a serious lifelong illness
● HCV infects the liver and is the leading cause of liver disease and indication of liver
transplant
● Found worldwide
○ ~ 71 million people infected
○ 2015 ~ 1.75 million new cases, 843 000 being cured and, 399 000 people died from
hepatitis C
○ Prevalence of HCV infection is highest in African, European and Eastern
Mediterranean regions.
Brief History
● Hepatitis C increased dramatically starting in the 1940s due to the
expanded use of parenteral procedures and injection drug use
● Incidences declined in the 1990s following the discovery of the HCV
● Despite the declining incidence, a large number of people who were
infected 30–60 years ago are now dying from hepatitis C related liver
diseases, as these complications often take decades to develop.
● The number of deaths per year due to hepatitis C continues to increase.
● Some countries are also experiencing a recent resurgence of HCV
infection among young PWID and HIV-infected men
Transmission (Person to person)
● Exposure to infected blood
● Needle sharing for drug use
● Reuse or inadequate sterilization of medical equipment
● Transfusion of unscreened blood and blood products
● Receiving a tattoo or piercing in unsanitary conditions
● Can be transmitted sexually and passed from mother to unborn
child, however not very common
Signs and Symptoms Incubation period: 2-6 weeks
● Acute Symptoms
○ Decreased appetite
○ Grey-colored feces
○ No symptoms
○ Dark urine
○ Abdominal pain
○ Fatigue
○ Joint pain
○ Jaundice
○ Fever ● Chronic Symptoms
○ Liver fibrosis and cirrhosis
○ Liver failure and cancer
○ Hepatocellular carcinoma (HCC)
Figure 1. Natural progression of HCV infection
(WHO, 2016)
Diagnosis
● Screening for anti-HCV antibodies
○ HCV serology test
○ Presence of antibodies to hepatitis C virus (anti-HCV) indicates history of
exposure to HCV
● If positive for anti-HCV antibodies -> test for HCV RNA
○ Nucleic acid test (NAT)
○ Determine if you are currently infected with HCV
● Assessment of degree of liver damage
○ Biopsy or non invasive tests
● Identify genotype of hepatitis C strain
Treatment
● Degree of liver damage and virus genotype guide treatment and management
of disease
○ Each strain of hepatitis C virus respond differently to treatment
○ Cure rate depends on strain of virus
● Does not always require treatment
○ Immune response may clear the infection
● Direct Acting Antiviral (DAA) medications
○ Oral medicine that directly inhibit the replication cycle of HCV
○ Sofosbuvir, daclatasvir and ledipasvir
○ Can cure more than 95% of hepatitis C infections
○ Side effects can occur
○ Range from 8 weeks to 48 weeks
Figure 2. Recommended regime with treatment duration
(WHO,2016)
At Risk Population
● People who inject drugs
● Recipients of infected blood products
● Children born to mothers who are HCV infected
● People with sexual partners who are HCV infected
● People getting tattoos or piercings
● Prisoners and previously incarcerated people
● People with HIV, HBV, & TB
Prevention
● Currently no vaccine for hepatitis C -> must reduce risk of
exposure
○ Hand washing/use of gloves in surgical practice
○ Safe and appropriate use of health care injections
○ Safe handling and disposal of sharps and waste
○ Education on safe injections and provision of sterile injecting
equipment
○ Testing donated blood and organs
Global annual mortality from hepatitis, HIV, tuberculosis, and malaria between 2000 and 2015 (WHO,
2016)
Barriers to Treatment
● HCV testing: most people with HCV infection remain undiagnosed as few have access to HCV
testing
● Laboratory capacity: Diagnosis of chronic infection, viral genotype and assessment of the degree
of liver fibrosis requires sophisticated laboratory capacity
● Health systems: HCV therapy is only provided in specialized centres by hepatologists or other
subspecialists.
● Marginalization: People with HCV infection frequently come from vulnerable groups because of
low socioeconomic status, poor access to health care, or because they belong to groups that are
stigmatized such as people who inject drugs (PWID) or prisoners
● Cost: In the US in 2013, drug price to treat one person was US$ 84 000, has now come down to
US$ 50 000, generic formulation as low as US$ 900/patient for 12 weeks of treatment
Public Health Initiative
● WHO organizes World Hepatitis Day on July 28 every year to increase
awareness and understanding of viral hepatitis
● Eliminate viral hepatitis as a public health problem by 2030
○ National testing policies to target high-prevalence groups in the
general population and in key populations
○ Testing and treatment administered by general practitioners and
other health-care workers in primary-care clinics
○ Ensuring that anti discrimination laws protect vulnerable groups
and confidentiality principles
○ Reducing cost of testing and treatment
Hepatitis C in the Past
● 400 B.C.
○ Hippocrates described a condition called “epidemic jaundice”
○ More than 40,000 cases recorded
○ Today believed many of these cases of jaundice were forms of hepatitis
● 1942-1945
○ 182,383 people were hospitalized for HCV during World War II
■ Service members who were vaccinated against yellow fever
■ Source of infection was traced to the clear fluid in the blood that
was used in the vaccine -> serum hepatitis
■ Transmitted through blood transfusions -> acute hepatitis
Discussion/Questions?
What do you think is the biggest contributor to the lack
of diagnosis of hepatitis C virus? Lack of symptoms?
Stigma around drugs use? Availability of testing?
What other potential health initiatives could improve
the diagnosis and treatment of hepatitis C virus?
Chen, S. L., & Morgan, T. R. (2006). The natural history of hepatitis C virus (HCV) infection.
International journal of medical sciences, 3(2), 47-52.
Coburn, R. (2015, October 28). Hepatitis C origins traced back to WWII hospitals - BBC News. Retrieved
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Global hepatitis report, 2017. (2017, July 12). Retrieved from
http://www.who.int/hepatitis/publications/global-hepatitis-report2017/en/
Guidelines for the screening, care and treatment of persons with chronic hepatitis C infection. (2016,
August 09). Retrieved October 22, 2018, from
http://www.who.int/hepatitis/publications/hepatitis-c-guidelines-2016/en/
Hepatitis C. (n.d.). Retrieved October 22, 2018, from
http://www.who.int/news-room/fact-sheets/detail/hepatitis-c
Hoff, E. C., & Coates, J. B. (1964). Preventive Medicine in World War 2(Vol. V). Washington: Off. of the
Surgeon General, Dep. of the Army.
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Retrieved October 22, 2018, from http://www.immunize.org/
Petruzziello, A., Marigliano, S., Loquercio, G., Cozzolino, A., & Cacciapuoti, C. (2016). Global
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