Literature Review: Hepatitis C Virus Propagation and Treatment

This literature review provides an overview of Hepatitis C Virus (HCV), a major cause of liver diseases globally. It discusses the virus's symptoms, which can be mild or asymptomatic in the early stages but lead to chronic liver damage, cirrhosis, and liver cancer if left untreated. The review covers the ...Read More

Literature review of the propagation of Hepatitis C virus genetic constitution
Abstract
Hepatitis C is identified as the main cause of diseases related to Liver. It is associated with the
issue of global health problem as there is enormous growth towards cirrhosis and hepato cellular
cancer. If hepatitis C is chronic then it is known as asymptomatic and it has damaged the liver
upto large extent before it is diagnosed. Instead of reaching the chronic state of liver disease, it is
necessary to have early treatment of acute Hepatitis C infection (Cristina & Costa-Mattioli,
2007). However, it is one of the prominent reasons for getting liver transplant these days. This
virus is escalated due to contact with the contaminated blood, for example, from sharing needles
or from unsterilized tattoo marking equipment (Cristina & Costa-Mattioli, 2007). This document
discusses the literature review of Hepatitis C virus, its symptoms, study of the control of disease,
clinical practice attribute, techniques for the treatment and its responses with respect to any kind
side effects.

Introduction
At an early stage of Hepatitis C disease, infected people often have mild or no symptoms.
Usually, symptoms like fever, dark urine, pain in abdominal and pale skin are developed in the
body. This virus prevails in the liver of the patient ranges between 75% to 85% of those infected
at an early stage (Okamoto, 2007). Chronic infection with hepatitis C has no symptoms.
However, it often leads to damaged liver up to some extent and causes cirrhosis which is a
chronic disease intrupting with the normal functioning of the liver; the reason behind it is excess
intake of alchohol and cirrhosis grows with the complications such as cancer in liver or liver
failure. This virus deploys mostly by blood to blood interaction cerebrate with the usage of
medicine, non sterilized or not properly sterilized medical equipment (Okamoto, 2007). Using
blood screening, the risk by introducing blood or blood plasma via vein is less. It might be
spread from a mother suffering from Hepatitis to her baby during the birth time. It is not caused
by facile contact at all. With the advancement in medicine treatment for Hepatitis C virus, the
whole platform for its cure changed to a different level (Okamoto, 2007). However, the power to
control this disease using current treatments depends on Hepatitis C virus genotype and
particular characteristics of the patients. At start symptoms of hepatitis C are most commonly
includes the joint pain, stretched muscles, and allergic skin. Diseases caused due to HCV are
Arthralgias, Sensory neuropathy, Pruritus, Paresthesias, and Sicca syndrome.
As a different view, one can have the disease but not able to recognize the symptoms for years.
So the person inflamated with HCV are not aware of this disease until a doctor prescribes the
blood test for one or another reason. In case, the patient is suffering from chronic HCV then one
can have symptoms of fatigue, stomach upset, reduction in daily appetite, muscle stretch, joint
pain (Okamoto, 2007). On the other, it may lead to symptoms of cirrhosis which affects the
patient who is suffering from hepatitis C for a long time. It causes jaundice, urine turn to dark
yellow (Okamoto, 2007). So, one can have blood test whenever this kind of symptoms lasts in
the patient’s body.
Treatment for Hepatitis C
As per recent advances in medicine, treatments for HCV are having different folds. The most
recent as well as the most common method was taking drugs in the form of tablets. The treatment
of HCV depends on various factors such as what kind of hepatitis C virus is the cause hepatitis.
Among various HCV , the common type is genotype 1, followed by genotypes 2 and 3.
Genotypes 4, 5 and 6 are very rare (Cristina & Costa-Mattioli, 2007).
As per epidemiology, Hepatitis C is root cause for the chronic hepatitis C virus in the United
States. These infections stands out for 20% of all cases of acute hepatitis and for more than 40%
of all referrals to active liver clinics (Kay & Zoulim, 2007). HCV infections account for
approximately 30,000 new infections and 8000-10,000 deaths each year in the United States
(Kay & Zoulim, 2007). Among new infections, 60% occur in intravenous drug users; less than

20% of new cases are acquired through sexual exposure; and 10% are due to other causes,
including occupational or peri natal exposure and haemodialysis (Kay & Zoulim, 2007).
The overall percentage of anti-HCV antibodies in the US is 1.8% of its total population. Nearly
74% of these patients are having positive HCV RNA, meaning that the active virus continues to
grow. Therefore, approximated 3.9 million individuals are suffering from HCV and 2.7 million
individuals in the US have chronic HCV. Genotype 1a occurs in 57% of patients; genotype 1b
occurs in 17%.From 1989-1993, the occurrence of HCV to approximately 28,000 new cases per
year, reflecting an 80% decrease (Bhamidimarri, Park & Dieterich, 2011). Decreased
transfusion-associated disease and a dramatic decrease in intravenous drug use accounted for this
change. Around the globe, more than 170 million individuals have hepatitis C virus
(Bhamidimarri, Park & Dieterich, 2011). The prevalence rates in healthy blood donors are 0.01-
0.02% in the United Kingdom and northern Europe, 1-1.5% in southern Europe, and 6.5% in
parts of equatorial Africa. Prevalence rates as high as 22% are reported in Egypt and are
attributed to the use of parenteral antischistosomal therapy (Bhamidimarri, Park & Dieterich,
2011).Hepatitis is more alarming among minority populations than other populations, which
further associated with lower status at economy level and educational levels.
Patho physiology
The root cause of hepatitis C i.e. HCV is a single-stranded RNA virus belonging to the
Flaviviridae family and Flavivirus genus.The natural targets of hepatitis C are hepatocytes and,
possibly, B lymphocytes (Bhamidimarri, Park & Dieterich, 2011).
RNA-dependent RNA polymerase, an enzyme critical in HCV replication, lacks proofreading
capabilities and generates a large number of mutant viruses known as quasispecies. These
represent minor molecular variations with only 1-2% nucleotide heterogeneity (Bhamidimarri,
Park & Dieterich, 2011). HCV quasispecies poses a major challenge to immune-mediated control
of HCV and may explain the variable clinical course and the difficulties in vaccine development.
Prognosis
Infection with HCV is self-limited in only a small minority of infected persons. Chronic
infection develops in 70-80% of patients infected with HCV Cirrhosis develops within 20 years
of disease onset in 20% of persons with chronic infection. The onset of chronic hepatitis C
infection early in life often leads to less serious consequences. Hepatitis B virus (HBV)
confection, iron overload, and alpha 1-antitrypsin deficiency may promote the progression of
chronic HCV infection to HCV-related cirrhosis (Bhamidimarri, Park & Dieterich, 2011). Two
studies of compensating cirrhosis in the United States and Europe showed that decomposition
occurred in 20% of patients and that HCC occurred in approximately 10% of patients. The
survival rate at 5 and 10 years was 89% and 79%, respectively (Pease, 2013). HCC develops in
1-4% of patients with cirrhosis each year after an average of 30 years. The risk of cirrhosis and
HCC doubles in patients who acquired HCV infection via transfusion. Progression to HCC is

more common in the presence of cirrhosis, alcoholism, and HBV confection (Bhamidimarri,
Park & Dieterich, 2011).
Background of Hepatitis C
Hepatitis C is a big issue around the globe. The hepatitis C virus is the root cause of both acute
as well as chronic hepatitis. According to World Health Organization around 3% of the total
world’s population has been inflamated with the hepatitis C virus and there are more than 170
million chronic carriers who are at risk of developing liver cirrhosis or liver cancer (Waheed,
2015).
The prevalence of HCV infection varies country to country . For example, Frank et al reported in
2000 that Egypt had the highest number of reported infections, largely attributed to the use of
contaminated parenteral antischistosomal therapy (Pease, 2013). This led to a mean prevalence
of HCV antibodies in persons in Egypt of 22% (Pease, 2013).
Review of ledipasvir and sofosbuvir
The only tablet for the cure of the hepatitis C virus inhibitor ledipasvir and the HCV inhibitor
sofosbuvir was recently approved in the US. A well supported virological acknowledgement
12 weeks post-treatment was seen in 99 % of treatment-naive patients receiving
ledipasvir/sofosbuvir for 12 weeks along with there is no additional worth advised by the
adjoining of ribavirin or extending the duration for treatment upto 24 weeks (Waheed, 2015)..
The results are seen upto 99 % (Bansal, 2015) who received ledipasvir/sofosbuvir for the
duration of 12weeks and 24 weeks. This Data reinforce the usage of ledipasvir/sofosbuvir in
chronic HCV genotype 4 infection, in HCV and HIV co-infection and, in combination with
ribavirin, in patients with chronic HCV genotype 1 or 4 infections who have decompensated
cirrhosis or are liver transplant recipients and in chronic HCV genotype 3 infection. Oral
ledipasvir/sofosbuvir was generally well tolerated. In conclusion, ledipasvir/sofosbuvir is an
important new single-tablet regimen that represents a significant advance in the treatment of
chronic hepatitis C (Keating, 2015).
Review of Hepatitis C drug of your choice
Ribavirin is another drug used for treating hepatitis C virus. It may given to patients for other
reasons by consulting with the doctor. Ribavirin approved by the FDA for HCV (Waheed, 2015).
It is not recommended to take this medicine alone to treat hepatitis C infection as a very worse
blood related problem known as haemolytic anaemia can be caused by this medicine. This may
lead to heart disease in a worse position and lead to very serious and deadly heart attacks.
Consult the doctor if individuals are having heart problems along with HCV (Keating, 2015). It
is not recommended to take ribavirin capsules if the patient is suffering from heart disease or any
heart problems it is strictly recommended to consult your doctor immediately if you have chest
pain while taking this medicine. Do not take if the patient is pregnant. Use of this medicine

during pregnancy may cause birth defects or loss of the baby before delivery (Mirazo, Ramos,
Russi & Arbiza, 2013). If someone gets pregnant or plan on getting pregnant while consuming
this medicine, then consult or call your doctor right away. Pregnant women can make use of two
kinds of birth control pills that one can trust while using ribavirin do not consume this medicine
if you are living with a sex partner who is pregnant (Keating, 2015). If the patient gets pregnant
while taking this medicine or within the time period of 6 months after stop consuming this
medicine then call your doctor immediately.
Summary
With the help of the literature survey, the various factors causing Hepatitis C and their
corresponding symptoms, treatments are surveyed very well with reference to research articles
mentioned in the reference section (Mirazo, Ramos, Russi & Arbiza, 2013). Therefore, one can
take precautions to prevent Hepatitis C instead of queuing up for its treatments. Sometimes
people are unaware of their small negligence towards their health measure which causes liver
disorders. With the help of ledipasvir and sofosbuvir, one can treat hepatitis C and the individual
must follow a healthy diet to overcome the weakness caused by this disease (Bansal, 2015). The
worst case is when hepatitis C prevails up to large extent in the human body and the drug
treatment shows no result, so patient goes for a liver transplant to prevent the root cause of this
virus. This virus is escalated due to contact with the contaminated blood, for example, from
sharing needles or from unsterilized tattoo marking equipment (Bansal, 2015). Problem last due
to the fact that people just ignore the starting symptoms of hepatitis C which leads to chronic
Hepatitis which demands serious treatment and if it reaches its worst position where the
individual is suffering from heart disease along with hepatitis C then it may require liver
transplant

References
Bansal, A. (2015). Immune Thrombocytopenia Due To Hepatitis A Virus: Case Report and
Review of Literature. Journal Of Pediatrics & Neonatal Care, 3(2).
Bhamidimarri, K., Park, J., & Dieterich, D. (2011). Management of Hepatitis B Virus
Coinfection: HIV, Hepatitis C Virus, Hepatitis D Virus. Current Hepatitis Reports, 10(4), 262-
268.
Cristina, J., & Costa-Mattioli, M. (2007). Genetic variability and molecular evolution of
Hepatitis A virus. Virus Research, 127(2), 151-157.
Kay, A., & Zoulim, F. (2007). Hepatitis B virus genetic variability and evolution. Virus
Research, 127(2), 164-176.
Keating, G. (2015). Ledipasvir/Sofosbuvir: A Review of Its Use in Chronic Hepatitis
C. Drugs, 75(6), 675-685.
Mirazo, S., Ramos, N., Russi, J., & Arbiza, J. (2013). Genetic heterogeneity and subtyping of
human Hepatitis E virus isolates from Uruguay. Virus Research, 173(2), 364-370.
Okamoto, H. (2007). Genetic variability and evolution of hepatitis E virus. Virus
Research, 127(2), 216-228.
Pease. (2013). Hepatitis C Virus Associated Hemophagocytic Lymphohistiocytosis: Case Report
and Literature Review. Journal Of Hematology.
Waheed, Y. (2015). Ledipasvir and sofosbuvir: Interferon free therapy for HCV genotype 1
infection. World Journal Of Virology, 4(1), 33.