hepatitis C virus

HISTORICAL BACKGROUND The hepatitis C virus is a small, spherical enveloped RNA virus approximately 50 nm diameter. Its buoyant density in sucrose is only 1.06 g/cm3 but much of the virus in chronically infected individuals appears to be bound to antibody, which imparts a higher density of approximately 1.17g/cm17. Genomic organization of hepatitis C virus shows A 5’ non-coding (NC) region consists of approximately 340 nucleotides and contains an apparent internal ribosomal entry site (IRES). Immediately downstream is a single large open reading frame (ORF) of approximately 9,000 nucleotides, encoding a large poly protein precursor of approximately 3,000 amino acids that is co-translationally or post-translationally cleaved into separate proteins by a combination of host and viral proteases. A capsid protein, two envelope proteins (E1 and E2), and a small protein (P 7) of unknown function are encoded in the 5’ region of the ORF. At least six nonstructural proteins, including protease, helicase, and RNA polymerase enzymes and regulatory peptides, are arrayed in the 3’ portion of the ORF. Finally, there is a 3’ NC region that consists of approximately 50 nucleotides, a polypyrimidine tracked and a highly conserved terminal sequence of approximately 100 nucleotides. Testing for HCV infection typically involves analysis of a serum sample for anti-HCV antibody and for viral genomic DNA. However, current diagnostic tests are often limited in the sensitivity ith which they can detect genetically and serologically altered HCV strains. The mechanism of liver injury in acute and chronic hepatitis C type is unknown, but since there is little evidence as to the cytopathogenicity of HCV, it is thought that liver damage may in fact be mediated by the host’s cellular immune response to the infection. Given the lack of definitive symptoms, liver histology and the circulating levels of liver enzymes are currently considered to be the most reliable predictors of progression to cirrhosis. Studies show that severe necro-inflammatory activity, as well as severe fibrosis in hepatic tissue, both due to elevated levels of liver enzymes can be correlated with progression to cirrhosis within 10 years. In cases where inflammation and fibrosis is mild, progression is slowed and even limited Factors influencing the rate of progression of chronic hepatitis C to cirrhosis and liver cancer include alcohol abuse, the duration of the infection and possibly viral titer. REFERENCES: 1. Khan R U. A case – control study of Risk factors associated with hepatitis C infection among pregnant women in hospitals of Karachi Pakistan 2006. (1-4) 2. Ghaz H O Hepatitis C virus in pregnancy Umma-Qura univ J Sci Med Eng [2007]; vol 19; No. (137-144) 3. Shah F U, Salih M, Malik I A, Hussain I. Increasing prevelance of chronic hepatitis and associated risk factors. Pak J Med, 2002; 41(2):1-8. 4. Haider Gulfareen, Zehra Nishat, Munir A A. Hepatitis C Freequency, Risk factors and pregnancy outcome 2009. JSur, 2009; 14(1) 5. Shaikh F, Naqvi S Q H, Jilani K, Memon R A D. Prevalence and Risk factors for Hepatitis C Virus during pregnancy. Gomal J Med 2009 Vol 7, No. 2 6. Roberts A.E, Yeung Latifa Maternal infant transmission of hepatitis C virus infection 2006 (S106-S113) 7. Martin j. C. Preganant with Hepatitis C: Preventing Mom-To-Child Transmission 2005; (1-3) 8. Baker N Philip. Perinatal infections obstetrics by Ten Teachers 2000; 16(200-219) 9. Yee J L, Weiss L H, Langner G R, Herrera J, Kaslow A R, Leeuwen J D Risk factors for acquisition of hepatitis C virus infection: a case series and potential implications for disease surveillance 200 10. Kumar A, Sharma A, Gupta R.K, Kar P, and chakravarti A. Prevalence and risk factors for hepatitis C virus among pregnant women. Indian J M 2007; vol 26: (211-215) 11. Summaries for patients. Hepatitis c virus infection in the United States 1999 through 2002. Ann Intern Med 2006; 144:120 12. Zhou DX, Tang NL, Tam JS et al, Hepatitis C virus genotype distribution among intravenous drug user and the general population in Hong Kong J Med Virol. 2006; 78: 574-81. 13. Parkin SP, Khan Hl, Cubitt WD. Detection of antibodies to hepatitis C virus in dried blood spot samples from mother and their offspring in Lahore. Pak J Clin Microbiol 1999; 37; 2061 14. Roy KM, Goldberg D, Taylor A, Mills P. Investigating the source of hepatitis C virus infection among individuals whose route of infection is undefined: a study of ten cases, Scand J Infect Dis 2003; 35: 326-28. 15. Benjelloun S, Bahbouhi B, Sekkat S, Bernnani A. Had N, Benslimane A. Anti-HCV seroprevalence and risk factors of hepatitis C virus infection n Moroccan population groups. Res Virol 1996; 147:247-255. 16. Robinson JW, Rosas M, Guzman E, Patarroyo ME, Moreno A. Comparison of prevalence of anti-hepatitis C virus antibodies in differing South America population. J Med Virol 1996; 50: 188-192. 17. Alter MJ, Mast EE, Moyer LA, Margolis HS. Hepatitis C, infect Dis Clin North Am 1998; 12:13-26. 18. Guadagnino V, Stroffolini T, Rapicetta M, Costantino A, Kondili LA. Prevalence, risk factors and genotype distribution of hepatitis C virus infection in the general population: a community-based survey in south Italy, Hepatology 1997; 26: 1006-1011. 19. Esteban JL, Lopez-Talavera JC. Gensca J. Madoz P. Viladomia L. Muaniz E, Martin-Vega C. High rate of infectivity and liver disease in blood donors with antibodies to hepatitis C virus. Ann Intern Med 1991; 115:443-449. 20. Report of a WHO consultation organization in collaboration with the Viral Hepatitis Prevention Board, Antwep, Belgium. Global surveillance and control of hepatitis C. J Viral Hepat 1999; 6:35-47. 21. Takahashi M, Yamanda G, Miyamoto R, Doi T, Endo H,Tsuji T, Natural course of chronic hepatitis C. Am J Gastroentrol 1993; 88:240-243 22. Roy KM, Goldberg D, Taylor A, Mills P. Investigating the source of hepatitis C virus infection among individuals whose route of infection is unidentified: a study of ten cases. Scand J Infect Dis 2003; 35; 326-328. 23. Laurer GM, Keefe EB, Ahmed A. The epidemiology of HCV infection, J Clin Gastroenterol 2003; 36:47. 24. Yusuf A, Muhammad A, Ishaq M. Can we afford to operate on patient with HBsAg screening. J Coll Physicians surg Pak1996;9:98-100. 25. Malik IA. Legters IJ. Luqman M. The serological markers of Hepatitis A and B in health population in northern Pakistan. J Pak Med Assoc 1988; 38:67-72. 26. Umer M, Bushra HT, Shuaib A. Spectrum of chronic liver diseas due to HCV infection. J Coll Physicians surg Pak 1999;6:234-237. 27. Wasim J, Nadim J, Jved Y. Hepatitis B and C prevalence and risk factors associated with seropositivity among children in Karachi, Pakistan. BMC infect Disease 2006;6:101-103. 28. Parker SP, Khan HI. Cubitt WD. Detection of antibodies to Hepatitis C virus in dried blood spot samples from mothers and their offspring in Lahore, Pakistan J Clin Microbiol 1999;37:2061-2063. 11. Terrault N A. Sexual Activity as a Risk factor for hepatitis C hepatology 2002 (1-6) 12. Massari M; Petrosillo N, Ippolito Giuseppe, solforosil, Bonazzil, Clementi M, and Manzin A. Transmission of hepatitis C virus in a gynecological surgery setting JCM 2001; vol 39; No 8 13. Mboto Ci , Andy iE, Eni O I, Jewell A P. Prevalence, socio demographic characteristics and Risk gactores for Hepatitis C infection among pregnant women in Calabar Municipality, Nigeria [Online] 2010, 10(2)L 116-120 14. Khattak S T, Marwat M A, Khattak I D, Khan T M, Naheed T. Comparison of frequency of Hepatitis B and Hepatitis C in pregnant women in urban and rural area of district swat. J Ayub Med Coll Abbottabad. 2009; 21(2) 15. Wodak A. An over view of Hepatitis C in st. vinvent’s hospital darling hurst NSW 2010 16. Landes M, Newell M L, Barlowp, Fiores, Malyuta R, Martinelli P, Posokhoya S, Sarasiv, Semenenko, Stelmah A, Tibaldic and Thomec. Hepatitis Bor Hepatitis C Coinfection in HIV infected pregnant women in Europe. British HIV Medicine 2008: 9(526-534) 17. Murphy E L, M Stephen, Bryzman A simon, Glynn A met. Thomason Ruth A, Williams Alan E, Nass Catherie C, Ownby Helen E, B George, Sehreiber, Kong fanhul, R Keith, Neal, and George J Nemo. Risk factors for hepatitis C virus infection in united states blood donors. Hepatology 2000; vol 131, No. 3

c virus PREVALENCE

The prevalence of hepatitis C infection is not well documented in many countries, partly due to the expense and practical difficulties involved in the detection of HCV RNA in the serum of infected individuals. Based on the available statistics, it is estimated that 3% of the total world population is infected with the hepatitis C virus (WHO, 2006). INCIDENCE Approximately 170,000,000 people worldwide and 4,000,000 in the United States are infected with HCV, 3-4 million people are newly infected each year. Perinatal transmission from mother to fetus or infants is relatively low but possible (less than 10%).11,12 Seroprevalence of HCV in Pakistan is unclear and its epidemiology particularly in women and children has yet to be established.13 The prevalence of HCV in general population ranges from 4-25.7%.14 HCV seroprevalence in the general population ranges from 1% to 2% in number of countries including the United State15-17 to 12.6% in parts of Italy,18 and 14.1% in areas of Japan19. Since the discovery of hepatitis C virus (HCV) was reported in 1989, much has learned about its epidemiology and pathogenesis. Similarly 170 million of the world population is suffering from hepatitis C.20 The prevalence of chronic hepatitis C in the Asia-pacific region is variable between 4% to 12%. 21 The prevalence of HCV in general population range from 4-25.7%. 22 With highest number of infection reported in Egypt. 23 The prevalence among general public of HBV, HCV infection in Pakistan is 10% 24,25 and 4-10% respectively. 26 In pregnant women of Pakistan Hepatitis B and Hepatitis C virus infection are reported to be 2.5% and 6.7% respectively.27,28 The prevalence of anti-HCV in antenatal clinic attenders in greater London area and Northern and Yorkshire region was found to be 0.43% (of 25938 women) and 0.21% (of 16675 women) respectively. 29 The HCV prevalence of 0.38% and 0.20% were seen inner and outer districts of London respectively. 30 Another UK study of an antenatal population of 0.14%. 31 In a national survey among 30259 childbearing women throughout Scotland, the HCV seroprevvalence was found to be 0.29-0.40%. 32 Little is known about Hepatitis C virus infection in pregnant women in India. The seroprevalence of anti HCV antibody in the healthy general population of India was found to be 1.5% each in 234 voluntary blood donors and 65 pregnant women. HCV infection was not detected in 250 randomly selected antenatal women in Shimla (Himachal Pradesh). 33 The current estimated global prevalence of HCV is 3%, which equates to approximately 170 million people. 34 Sub-Saharan Africa is 6%, west Africa is 2.4% and Southern and East Africa is 1.6%. 35 In comparison, prevalence in the middle east is 4.6%, South-East is 2.15%, North America is 1.7% and Europe is 1.03%. 36 Highest prevalence of 20-30% is reported in Egypt. 37 The present study shows that the prevalence of anti-HCV in pregnant Saudi mothers in Makkah is 6.66%. 38

woman and hiv | Risk factor of HCV in pregnant women

hepatitis c virus: INTRODUCTION WHO data of 2004 estimates that about 170 million people, 3% of world’s population , are infected with HCV. 1 DEFINITION Hepatitis C virus (HCV) is a single standard enveloped positive stand RNA virus belonging to the flaviviridae pestivirus family, and is associated with significant in morbidity and mortality. 2 HCV was first identified in the USA in 1989 as a major causative agent of post transfusion non A, non B hepatitis the prevalence of union hepatitis C in the ASIA- pacific region is variable between 4% to 12%. Risk factors are HCV infection blood products, injection, intranasal drugs, razor blade/tooth brushes body/ ear piercing, tattooing occupational exposure, and sexual activity. Fetal scalp sampling and electrode avoidance to prevent vertical transmission is developing countries like Pakistan excessive holding of contaminated blood, from unsafe practices, includes administration of unnecessary injections one also responsible for the spread of hepatitis infection care less handling of diagnostic equipment in the diagnostic laboratories due to lack of gloves, gowns and mask, to protect them from the contaminated blood, leads to increased prevalence of hepatitis infection in the health works similarly dialysis staff, staff working in angiography labs, medical ICU’S surgeons and paramedics staff and risk of getting the infection. 3 About 4000,000 in the united stated are infected with HCV, 3-4 million people are newly infected each year, and over 2.7 million have ongoing chronic infection.4 HCV Sero Prevalence in Pakistan ranging from 0.7% to 20%. Perinatal transmission from mother to fetus or infant is relatively possible less then 10% the prevalence of HCV in general population ranges from 4-25.-7%. Viral hepatitis during pregnancy is associated with higher risk of maternal complications, has a high rate of maternal complication causing fetal and neonatal hepatitis and it has been reported as a leading cause of maternal motility. But in babies who are infected at birth the life time risk of server liver disease is likely high. 5 Mother to infant transmission of hepatitis C virus is comparatively uncommon. Prevalence of antibody to HCV in pregnant women is 0.1% to 2.4% although in some endemic areas it is much higher. The rate of mother to infant transmission is 4% to 7% per pregnancy women with HCV viremia. Breast feeding poses no important risk of HCV transmission if nipple not traumatized6. Hepatitis C can be transmitted from mother to fetus during pregnancy through the exchange of blood in the placenta, but also during delivery due to close contact between the blood of mother and baby, as well as from other secretions7. There is no reliable evidence to quantity and risk of transmission through barest feeding and this generally assumed to be very low, if it occurs at all vertical transmission may be reduced by delivery via caseran section before the rupture of membrane concluded that caseran section does not reduce the risk of vertical transmission. 7 It may be transmitted sexually, but transmission is not very efficient, with only 1.2 percent of long terms partners becoming infected8. House hold transmission e.g. via razor or tooth brushes, and occur but is considered rare. 9 Anti HCV screening of blood products introduced during the early 1990 has minimized this mode of HCV a acquisition leaving vertical transmission from infected mothers as the predominant mode of infection.10 The study was conducted in Liaquat university of medical and health sciences (LUMHS) primary object of my study was to determine the prevalence of HCV infection in pregnant women

Objective of hepatitis a in pregnancy

hepatitis c in pregnancy To determine the risk factors of hepatitis C in pregnancy like: 1. Blood transfusion 2. Use of intravenous drugs 3. History of previous surgery 4. Dental consultation 5. Sexual contacts 6. Drug abuses 7. Sharing of razors and tooth brushes 8. Piercing and tattooing MATERIAL AND METHOD : STUDY DESIGN : Descriptive case series SETTING : Patients with hepatitis C in pregnancy in obstetrics and gynecology wards of liaquat university hospital Hyderabad. STUDY DURATION : 6 months after approval of synopsis SAMPLE SIZE : SAMPLE TECHNIQUE : Non-probability, purposive type. SAMPLE SELECTION : INCLUSION CRITERIA : 1. Women with hepatitis C in pregnancy confirmed on Elisa. 2. Between age 20-35 years of age. EXCLUSION CRITERIA : 1. Non Pregnant patient with hepatitis C virus DATA COLLECTION PROCEDURE : 100 cases of pregnant women with hepatitis C collected from unit I obstetrical and gynecological department of liaquat university hospital Hyderabad will be included in this study after fulfilling inclusion criteria patients will be care fully evaluated by detailed history, clinical examination, and investigation. DATA ANALYSIS PROCEDURE : Data will be entered and analyzed on SPSS version 11.

RISK FACTORS OF HEPATITIS C IN PREGNANCY

hepatitis c in pregnancy INTRODUCTION : Based on WHO data of 2004 estimates that about 170 million people, 3% of world’s population, are infected with HCV 1. The prevalence of chronic hepatitis C in the Asia-pacific region is variable between 4% to 12%. Hepatitis C virus are transmitted through contaminated blood transfusion, Surgery, surgical instruments, Dental surgery and excessive dental consultations, sexual contacts, drug abuses, sharing of the house hold items such as razors, tooth brushes and shaving from the barbers. In developing countries like Pakistan excessive holding of contaminated blood, from unsafe practices, includes administration of unnecessary injections, are also responsible for the spread of hepatitis C virus infection. Care less handling of diagnostic equipment in diagnostic laboratories due to lack of gloves, gowns and masks, to protect them from the contaminated blood, leads to increased prevalence of Hepatitis C infection in the health workers. Similarly haemodialysis staff, staff working in angiography labs, medical intensive care units, surgeons and paramedics staff are at risk of getting the infection 2. Mother to infant transmission of hepatitis C virus is comparatively uncommon. Prevalence of antibody to HCV in pregnant women is 0.1% to 2.4%, although in some endemic areas it is much higher. The rate of mother to infant transmission is 4% to 7% per pregnancy in women with HCV virenia. Breast feeding poses no important risk of HCV transmission if nipple not traumatized 3. Hepatitis C can be transmitted from mother to fetus during pregnancy through the exchange of blood in the placenta, but also during delivery due to close contact between the blood of mother and baby, as well as from other secretions 4. It may be transmitted sexually, but transmission is not very efficient, with only 1.2 percent of long terms partners becoming infected 5. Risk of hepatitis C transmission by sexual contact differs by the type of sexual relationship. Persons in long-term monogamous partnerships are at lower risk of HCV acquisition (0% to 0.6% per year) than persons with multiple partners or those at risk for sexually transmitted diseases (0.4% to 0.8% per year) 6. Nosocomal transmission of HCV in the operating room patient to patient shared equipment breathing circuits and multi dose vials can cause hepatitis C 7. Factors like piercing and tattooing may cause hepatitis C by unskilled individuals professionals trained in improper hygiene 8.