ASSIGNMENT NO: 1

HEPATITISE C
COURSE:
NUTRITIONAL BIOCHEMISTRY
SUBMITTD TO:
DR. KOUSER PERVEEN
GROUP NO: 1
ROLL NO:
1, 5, 7, 9, 23, 27,45,71, 80, 100
Hepatitis C (HCV)
Hepatitis C is a contagious liver infection caused by the hepatitis C virus (HCV). The virus can cause both
acute and chronic hepatitis, ranging in severity from a mild illness lasting a few weeks to a serious, lifelong
illness. This is a major cause of liver cancer. The hepatitis C virus is a blood borne virus.

After the virus has spread to a new host, it must seek out and attach itself to the cells of their liver. Once the
virus has infected the liver cells, it can reproduce. This is why the virus is associated with liver disease.HCV
infection may be short term (acute) or long term (chronic). When you first develop the disease, it’s considered
to be acute. This phase lasts for about 6 months.The most common modes of infection are through exposure to
small quantities of blood. This may happen through injection drug use, unsafe injection practices, and unsafe
health care, transfusion of unscreened blood and blood products, and sexual practices that lead to exposure to
blood. Globally, an estimated 71 million people have chronic hepatitis C virus infection. A significant number
of those who are chronically infected will develop cirrhosis or liver cancer.

WHO estimated that in 2016, approximately 399 000 people died from hepatitis C, mostly from cirrhosis and
hepatocellular carcinoma (primary liver cancer). Antiviral medicines can cure more than 95% of persons with
hepatitis C infection, thereby reducing the risk of death from cirrhosis and liver cancer, but access to diagnosis
and treatment is low. There is currently no effective vaccine against hepatitis C; however, research in this area
is ongoing.

History;
A major protein from the hepatitis B virus was discovered in 1963 by scientists at the NIDDK (then called the
National Institute of Arthritis and Metabolic Diseases), which eventually allowed for testing of the blood
supply. It was assumed that the remaining cases were either caused by the hepatitis A virus, or by the hepatitis
B virus that may have slipped through the screening process. By the mid-1970s, however, investigators had
identified the hepatitis A virus, they showed that the remaining hepatitis cases were neither hepatitis A nor
hepatitis B. Something else was damaging the liver, and the signs were pointing to a third virus. Also, unlike
hepatitis B, people with this disease rarely experienced acute symptoms, which could mean that the disease
could slip into a chronic state before an individual had any obvious signs that he or she was even infected. For
the next 15 years, the stealthy culprit behind this disease was unknown, and thus the disease was simply called
non-A, non-B hepatitis.

The non-A, non-B hepatitis virus was identified in 1989 by scientists at a California biotechnology company
called Chiron who were collaborating with investigators at the Centers for Disease Control and Prevention
(CDC). The research confirmed that this was a new virus now officially called the hepatitis C virus, or HCV.
This was a landmark advance in medicine that allowed for development of tests to detect HCV, which were
rapidly applied to screen blood donations.
HCV life cycle:
Key steps in the life cycle of HCV include entry into the host cell, uncoating of the viral genome, and
translation of viral proteins, viral genome replication, and the assembly and release of virions. All these events
occur outside the nucleus of the host cell.

Following is the brief explanation of stages involved in HCV life cycle;

1. Attachment;The HCV virus circulates in blood and targets the hepatic cells, through blood transfusions
and other contaminations. First stage is attachmentvirus cell with host cell by the receptors present on
the surface of hepatic cells. Receptors signal the virus for the attachment.
2. Entry; The viral cell gets entry into the hepatic cells by outer barriers. Barrier then surrounds the virus
and swallows it up, and brings it into the cell the process well known as Endocytosis.
3. Uncoating;after getting entry uncoating of capsid takes place. The positive strand RNA is released.
4. Replication and translation; viral RNA strand goes to Rough Endoplasmic Reticulum (RER) and start
the translation process to produce positive strand RNA. Translation leads to replication of viral RNA
polyprotein.
5. Maturation: The poly protein is processed by both host and viral proteases into structural non-
structural proteins. The essential step is interaction of these polyproteins with host’s protein
Cycophilin-Ato make a complex that is enable to replicate. After replication RNA of virus start
developing its outer covering.
The virus’s coating is made of different protein-based coverings. These are developed by ribosomes, or
cell protein builders, during this stage and released. Protein units called capsomeres come together and
form new particles around the viral RNA. These make a covering shaped like a sphere, known as a
capsid. The capsid protects the virus’s genetic material.
 6. Release; in the final stage, the new virus creates a bud with itself inside. A protective coating surrounds
the bud. It’s released through the barrier of your liver cell, ready to infect another of your liver cells.
This process continues until the infected liver cell dies

Causes of hepatitis C;
Hepatitis C mainly caused by contact with or by blood transfusion.
High risk activities include;

 Sharing drug use equipment. Anything involved with injecting street drugs, from syringes, to needles,
can have small amounts of blood on it that can transmit hepatitis C. Pipes and straws to smoke or snort
drugs can have blood on them from cracked lips or nosebleeds.

 Sharing tattoo or piercing tools. Non sterile items and ink can spread contaminated blood.

 Nonsterile medical equipment. Tools that aren’t cleaned properly between uses can spread the virus.

 Blood or cutting rituals. Sharing of surgical tools or blood transfusion from the infected person is main
cause of HCV transmission. Places that don’t screen blood for hepatitis are at the riskfor this disease.

Medium-risk activities include:

 Sharing or not disposing of grooming and hygiene supplies. This includes razors, toothbrushes, nail
clippers, or anything else that could have your blood on it. Cover any open wounds or sores with
bandages. Carefully dispose of tampons, sanitary napkins, tissues, used bandages, and anything else that
might have your blood on it.
  Pregnancy and birth. There’s a small risk for a mother to pass the disease on to her child before or
during birth. The odds go up if the mother has HIV.
Your risk of hepatitis C infection is increased if you:
o Are health care workers who has been exposed to infected blood, which may happen if an
infected needle pierces your skin
o Received a blood transfusion or organ transplant before 1992
o Received clotting factor concentrates before 1987
o Received hemodialysis treatments for a long period of time
o Were ever in prison
o Were born between 1945 and 1965, the age group with the highest incidence of hepatitis C
infections

Stages of Hepatitis C;
The hepatitis C virus affects people in different ways and has several stages:
1. Incubation period. This is the time between first exposure to the start of the disease. It can last
anywhere from 14 to 80 days, but the average is 45 days.
2. Acute hepatitis C. This is a short-term illness that lasts for the first 6 months after the virus enters
your body. After that, some people who have it will get rid of, or clear, the virus on their own.
3. Chronic hepatitis C. If your body doesn’t clear the virus on its own after 6 months, it becomes a
long-term infection. This can lead to serious health problems like liver cancer or cirrhosis.
4. Cirrhosis. This disease leads to inflammation that, over time, replaces your healthy liver cells with
scar tissue. It usually takes about 20 to 30 years for this to happen, though it can be faster if you
drink alcohol or have HIV.
5. Liver cancer. Cirrhosis makes liver cancer more likely. Your doctor will make sure you get regular
screenings because there are usually no symptoms in the early stages.

Symptoms of HCV:
Many people strongly associate hepatitis infections with jaundice, which is the yellowing of the skin, eyes and
mucous membranes. Jaundice rarely occurs in acute or chronic hepatitis C infection, and hepatitis A and B
infections can also occur without jaundice.
In both acute and chronic hepatitis C infection some people may experience symptoms such as exhaustion,
pain in the limbs, nausea, flatulence, abdominal pain, loss of appetite, pale-colored stools or dark urine;
however, these are all rather non-specific symptoms. Patients and doctors may often interpret these symptoms
as signs of over-work or stress rather than as possible indications of hepatitis C infection.
Even when a doctor orders blood tests for a patient, hepatitis C infection is only detected for sure if there is a
targeted search for the virus. Liver enzyme values, such as ALT and AST, are often increased, but this is not
necessarily the case for everyone with hepatitis C.
Some people have hepatitis C for many years before the first symptoms appear. As a result of this, chronic
hepatitis C often goes undetected for a long period of time. The damage to the liver continues quietly.
By the time hepatitis C has been diagnosed, many people have already developed the serious long-term
consequences of the disease. It is not for nothing that hepatitis C is sometimes called the 'silent killer'.

Recommended diet for HCV patients:

A healthy diet for persons infected with HCV includes:
♦ Adequate but not excessive energy intake, spread out over the day
♦ Adequate protein intake for fighting infection and for liver regeneration
♦ Plenty of vegetables and fruit to maximize free radical-fighting antioxidants (emphasize variety and color)
♦ Foods those are rich in vitamin A and vitamin C
♦ Avoidance of alcohol to protect the liver and allow it to regenerate
♦ limited high fat and high sugar foods
♦ Food intake balanced with some activity, within physical limitations

HCV Virus Testing;

Different tests are available for detection and diagnosis of acute and chronic hepatitis C, such as
Anti HCV EIA (enzyme immunoassay), indicates the presence of antibody only, not distinguishes acute or
chronic stage of disease.

HCV RNA test also called as PCR (polymerase chain reaction) performed to measure the amount of HCV
RNA in the body indicating the active viral replication. The qualitative OCR is more sensitive and is preferred
for the initial testing. This test often used to guide treatment decision and to follow the progress of treatment.

HCV genotype; HCV has at least 6 genotypes and about 67 subtypes. Genotype 1 is most common in United
States about 70-75% of infections. The positive genotype indicates presence of HCV virus.

Gamma-glutamyl transferase (GGT) is an enzyme that is found in many organs throughout the body, with the
highest concentrations found in the liver. GGT is elevated in the blood in most diseases that cause damage to
the liver or bile ducts. This test measures the level of GGT in a blood sample.

Aspartate aminotransferase (AST) is an enzyme found in cells throughout the body but mostly in the heart
and liver and, to a lesser extent, in the kidneys and muscles. In healthy individuals, levels of AST in the blood
are low. When liver or muscle cells are injured, they release AST into the blood. This makes AST a useful test
for detecting or monitoring liver damage.

Alkaline phosphatase (ALP) is an enzyme found in several tissues throughout the body. The highest

concentrations of ALP are present in the cells that comprise bone and the liver. Elevated levels of ALP in the
blood are most commonly caused by liver disease or bone disorders. This test measures the level of ALP in the
blood. In the liver, ALP is found on the edges of cells that join to form bile ducts, tiny tubes that drain bile.

Alanine aminotransferase (ALT) is an enzyme found mostly in the cells of the liver and kidney. Much smaller
amounts of it are also found in the heart and muscles. This test measures the level of ALT in the blood.
The function of ALT is to convert alanine, an amino acid found in proteins, into pyruvate, an important
intermediate in cellular energy production. In healthy individuals, ALT levels in the blood are low. When the
liver is damaged, ALT is released into the blood, usually before more obvious signs of liver damage occur, such
as jaundice. This makes ALT a useful test for early detection of liver damage.

Bilirubin is an orange-yellow pigment, a waste product primarily produced by the normal breakdown of heme.
Heme is a component of hemoglobin, which is found in red blood cells (RBCs). Bilirubin is ultimately
processed by the liver to allow its elimination from the body. This test measures the amount of bilirubin in the
blood to evaluate a person's liver function or to help diagnose anemia caused by RBC destruction (hemolytic
anemia).

The liver panel measures enzymes, proteins, and substances that are produced, processed or eliminated by the
liver and are affected by liver injury. Some are released by damaged liver cells and some reflect a decrease in
the liver's ability to perform one or more of its functions. When performed together, these tests give a healthcare
practitioner a snapshot of the health of a person's liver, an indication of the potential severity of any liver injury,
change in liver status over time, and a starting place for further diagnostic testing
Treatment for HCV Virus:
Unlike Hepatitis A and Hepatitis B, a vaccine for Hepatitis C is not available. Hepatitis C infection
is treated with antiviral medications intended to clear the virus from patient’s body. Doctor
may recommend one medication or a combination of two to three medications to be taken for
12 – 24 weeks or longer.  Blood tests and doctor visits are necessary during this time so that
your response to treatment can be carefully monitored and evaluated.
The purpose of using medications to treat Hepatitis C is to clear the Hepatitis C virus from your
bloodstream, slow down progression of inflammation and scarring of your liver, and reduce the
chances of developing cirrhosis and liver cancer.
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