Hepatitis C In Children

Hepatitis C:

Hepatitis C is an infectious disease affecting primarily the liver, caused by the hepatitis C virus (HCV). The infection is often asymptomatic, but chronic infection can lead to scarring of the liver and ultimately to cirrhosis, which is generally apparent after many years. In some cases, those with cirrhosis will go on to develop liver failure, liver cancer or life-threatening esophageal and gastric varices.

HCV is spread primarily by blood-to-blood contact associated with intravenous drug use, poorly sterilized medical equipment and transfusions. An estimated 130–170 million people worldwide are infected with hepatitis C. The existence of hepatitis C (originally “non-A non-B hepatitis”) was postulated in the 1970s and proven in 1989.It is not known to cause disease in other animals.

The virus persists in the liver in about 85% of those infected. This persistent infection can be treated with medication; peginterferon and ribavirin are the current standard therapy. Overall, between 50–80% of people treated are cured. Those who develop cirrhosis or liver cancer may require a liver transplant. Hepatitis C is the leading cause of liver transplantation though the virus usually recurs after transplantation.No vaccine against hepatitis C is currently available.

Hepatitis C infection facts:

•     HCV is one of several viruses that cause hepatitis (inflammation of the liver).
•     Up to 85% of individuals who are initially (acutely) infected with HCV will fail to eliminate the virus and will become chronically infected.
•     HCV is spread most commonly through inadvertent exposure to infected blood. Intravenous drug abuse is the most common mode of transmission. The risk of acquiring HCV through sexual contact is low.
•     Generally, patients do not develop symptoms of chronic infection with HCV until they have extensive scarring of the liver (cirrhosis). Some individuals, however, may have fatigue and other non-specific symptoms in the absence of cirrhosis. A minority of patients with HCV have symptoms from organs outside of the liver.
•     In the U.S., Infection with HCV is the most common cause of chronic hepatitis and the most common reason for liver transplantation.
•     HCV is diagnosed by determining levels in the blood of antibodies to the virus and then confirmed with other tests for viral RNA. The amount of viral RNA in the blood (viral load) does not correlate with the severity of the disease but can be used to track the response to treatment.
•     A liver biopsy may be used to assess the amount of liver damage (liver cell injury and scarring), which can be important in planning treatment.
•     Considerable progress has been made in the treatment of HCV, although response rates remain imperfect, approximately 50%-60% for genotype 1. Combined therapy with pegylated interferon and ribavirin is the standard treatment regimen.
•     Treatment results in reduced inflammation and scarring of the liver in most sustained responders and also occasionally (and to a much lesser extent) in those who relapse or do not respond.

Causes, incidence, and risk factors:

Hepatitis C infection is caused by the hepatitis C virus (HCV). People who may be at risk for hepatitis C are those who:

•       Have been on long-term kidney dialysis

•       Have regular contact with blood at work (for instance, as a health care worker)
•       Have unprotected sexual contact with a person who has hepatitis C (this is much less common, but the risk is higher for those who have many sex partners, already have a sexually transmitted disease, or are infected with HIV)

•       Inject street drugs or share a needle with someone who has hepatitis C
•       Received a blood transfusion before July 1992
•       Received a tattoo or acupuncture with contaminated instruments (the risk is very low with licensed, commercial tattoo facilities)
•       Received blood, blood products, or solid organs from a donor who has hepatitis C
•       Share personal items such as toothbrushes and razors with someone who has hepatitis C (less common)
•       Were born to a hepatitis C-infected mother (this occurs in about 1 out of 20 babies born to mothers with HCV, which is much less common than with hepatitis B)
• Hepatitis C has an acute and chronic form. Most people who are infected with the virus develop chronic hepatitis C.

About 1.5% of the U.S. population is infected with HCV.

Diagnosis:

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). 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.

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.Chronic infections are typically without symptomatic during the first few decades,[8] and thus it is 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.

Symptoms

Most people who were recently infected with hepatitis C do not have symptoms. About 10% have jaundice that gets better.

Of people who get infected with HCV, most develop chronic HCV infection. Usually there are no symptoms.

If the infection has been present for many years, the liver may be permanently scarred, a condition called cirrhosis. In many cases, there may be no symptoms of the disease until cirrhosis has developed.

The following symptoms could occur with hepatitis C infection:

•       Abdominal pain (right upper abdomen)
•       Abdominal swelling (due to fluid calledascites)
•       Bleeding from the esophagus or stomach (due to dilated veins in the esophagus or stomach called varices
•       Dark urine
•       Fatigue
•       Fever
•       Itching
•       Jaundice
•       Loss of appetite
•       Nausea
•       Pale or clay-colored stools
•       Vomiting

Treatment:

HCV induces chronic infection in 50–80% of infected persons. Approximately 40-80% of these clear with treatment. In rare cases, infection can clear without treatment. Those with chronic hepatitis C are advised to avoid alcohol and medications toxic to the liver,and to be vaccinated for hepatitis A and hepatitis B. Ultrasound surveillance for hepatocellular carcinoma is recommended in those with accompanying cirrhosis.

Medications

In general, treatment is recommended in those with proven HCV infection liver abnormalities.Current treatment is a combination pegylated interferon alpha and the antiviral drug ribavirin for a period of 24 or 48 weeks, depending on HCV genotype.When combined with ribavirin, pegylated interferon-alpha-2a may be superior to pegylated interferon-alpha-2b, though the evidence is not strong. Improved outcomes are seen in 50–60% of people. Combining either boceprevir or telaprevir with ribavirin and peginterferon alfa improves antiviral response for hepatitis C genotype 1. Adverse effect with treatment are common with half of people getting flu like symptoms and a third experiencing emotional problems. Treatment during the first six months is more effective than once hepatitis C has become chronic. If someone develops a new infection and it has not cleared after eight to twelve weeks, 24 weeks of pegylated interferon is recommended. In people with thalassemia, ribavirin appears to be useful but increases the need for transfusions.Several alternative therapies are claimed by their proponents to be helpful for hepatitis C including milk thistle, ginseng, and colloidal silver.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.

Hepatitis C Information for the Public:

Hepatitis C is a contagious liver disease that results from infection with the Hepatitis C virus. It can range in severity from a mild illness lasting a few weeks to a serious, lifelong illness. Hepatitis C is usually spread when blood from a person infected with the Hepatitis C virus enters the body of someone who is not infected. Today, most people become infected with the Hepatitis C virus by sharing needles or other equipment to inject drugs. Before 1992, when widespread screening of the blood supply began in the United States, Hepatitis C was also commonly spread through blood transfusions and organ

Transplants:

Hepatitis C can be either “acute” or “chronic.” Acute Hepatitis C virus infection is a short-term illness that occurs within the first 6 months after someone is exposed to the Hepatitis C virus. For most people, acute infection leads to chronic infection. Chronic Hepatitis C is a serious disease than can result in long-term health problems, or even death.

There is no vaccine for Hepatitis C. The best way to prevent Hepatitis C is by avoiding behaviors that can spread the disease, especially injection drug use.

What is hepatitis C infection?

Hepatitis C infection is an infection of the liver caused by the hepatitis C virus (HCV). It is difficult for the human immune system to eliminate HCV 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 the U.S., the number of new cases of HCV infection has declined from a peak of 200,000 annually to about 17,000 in 2007. When the virus first enters the body, however, there usually are no symptoms, so these numbers are estimates. Up to 85% of newly-infected people fail to eliminate the virus and become chronically infected. In the U.S., more than three million people are chronically infected with HCV. Infection is most commonly detected among people who are 40 to 60 years of age, reflecting the high rates of infection in the 1970s and 1980s. There are 8,000 to 10,000 deaths each year in the U.S. related to HCV infection. HCV infection is the leading cause of liver transplantation in the U.S and is a risk factor for liver cancer.

What is the nature (biology) of the hepatitis C virus?

‘Hepatitis’ means 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 are made up of an outer coat (envelope) and contain enzymes and proteins that allow the virus 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 it has been difficult to develop an effective vaccine since the vaccine must protect against all genotypes

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