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Hepatitis C and Related Medical Issues Research Paper

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Introduction

The word hepatitis originates from the Latin language which translates to inflammation of the liver.(Howard “Hepatitis c” Pp 1). This means hepatitis mainly affects the liver leading to its inflammation and impairment of the liver functions. Key among these functions is detoxification of the blood hence regulating its composition. Production of bile which is very essential for the digestive process is also a function of the liver. Metabolism of some metallic compounds, production of coagulation factors, storage of energy, breaking and releasing out of ammonia back to protein synthesis are all functions of the liver. There are several forms of the disease hepatitis depending on the causative agent. According to Henkel, there are five forms of hepatitis C marked by letters A, B, C, D and E (p.5).

Hepatitis C is caused by the virus hepatitis C. It is an infectious blood borne disease. The virus mainly affects the liver and may have very adverse effects on it. Once in the body the virus replicates at the lymph nodes and the hepattocellular cell lines. (Meller Gunji et al 1994 cited at Feitelson p.113) Hepatitis C occurs in two conditions both the acute and the chronic phases. The acute one has rare indications of symptoms. It only lasts for the first six months after infection by the Hepatitis C virus. The second phase is the chronic phase and as stated by Henkel (p 5) it takes over after the six months and may last for 20 to 30 years before the manifestation of symptoms. Complication of other diseases may speed up the show of symptoms otherwise, the disease is normally found accidentally or through blood screening for instance during blood donation. The other way of identifying the disease is by looking out for the patient’s history. This viral disease does not have a vaccine yet. Due to the fact that it does not show signs and the mild signs seen at the acute phase are not so serious, the patient may opt not to seek any medication. This has led to a wide spread of the disease and the current reported condition in the world is approximately 150 to 200 million people infested with about 350 000 cases not reported. The US has an epidemiology of 4 million people infected. (Remis, R. S 2001 pp12) The highest population is within the HIV population. This co infection is due to the fact that both viruses (the HIV virus and the Hepatitis C virus) are blood borne and survive well in almost the same environment. The percentage of people with co infection stands at 14% (Branch., p. 22) A high population of this disease has also been found in Egypt; Africa.

History

Hepatitis C virus was discovered in 1989 by scientist at the Chiron Corporation who had been carrying on the hepatitis research on monkeys (Fitelson pp 8-11). It was published in the Land mark paper in the journal science later that year and the formerly described Non A and Non B Hepatitis virus was named Hepatitis C (Howard” Hepatitis C” p. 7). This virus was found to be different from the known hepatitis A and B, as it spread after transfusion and was not food borne but blood borne. It was not until 1992 that a method of detecting the virus in the blood was found and now the blood could be screened for Hepatitis C before transfusion. This has reduced the risks of transferring the virus via blood transfusion from 30% to almost 0% as observed in 2000. (Feitelson pp 5). From then on so many ways of testing have been used including the use of machines but it is the biopsy of the liver at the chronic stage that has been the most effective. Some medications have also been developed to curb this disease although effective at early stages.

In the five known Hepatitis viruses (A, B, C, D and E), it is only the C virus has been found to be from the hepacivirus genus in the family flaviviridae (Feitelson pp 21). There consists of around six genotypes of this virus in the human body. It is a small virus in an enveloped form. The Hepatitis C virus is single stranded in nature and has a very positive response to the RNA. (NDDIC).

The virus spreads through blood contact which is more evident in people who use the same injections in administration of drugs. Inhalation of drugs like cocaine also accounts for the spread of the disease. Transfusion of infected blood was the main cause of spreading the virus, but since 1992 when a way of identifying the virus from blood screens in was discovered, there has been massive reduction of patients who have contracted the disease through this mode (Health Canada pp 270). This is due to the fact that all the blood is screened before giving it to the recipient. Clark JM, (Pp 3004) says Organ transplants from infected persons to healthy individuals contribute greatly to the viral transmission. Lactogenic medication and dental exposure also results to transfer of the virus from one individual to the other. This is also a matter of unsterilized equipments used in the process as well as poorly sterilized equipments. Occupational exposure is a method of contracting the virus especially for the medics. In this case, the nurses, doctors and emergency health providers come into contact with the blood of the infected persons accidentally. It may also be an accidental prick with a needle from the patient’s injections. Body piercing and tattooing are avenues that continue the spread of this virus. This is so in cases where the tools used are not properly sterilized or the ink been contaminated. Another way in which the virus can be spread is by sexual exposure especially with one who has both Hepatitis C and a sexually transmitted disease like HIV/AIDS. Sharing of personal items for instance; toothbrushes, razors and nail cutters poses a danger of spreading the virus (Centers for Disease Control and Prevention pp 22). An unborn child can contract the disease from an infected mother during birth process or even the blood circulation process at the womb. Blood products transferred to the patient in hospital like clotting factors and plasma, if not properly screened may result to the spread of the disease.

Classification

As earlier stated the disease occurs in two forms the acute form and the chronic form. The acute form is characterized by the e absence of major or any symptoms. Te few persons who develop some symptomatic signs they are too mild to be taken to hospital thus most of the patients just ignore medication and gives chance for the infection to develop to the chronic stage (Angus Reid Group pp 35). The symptoms in this stage do not direct to a specific disease live alone Hepatitis C. They include signs like; pain in the abdomen, feeling tired, yellowish discoloration of membranes (the white part of the eye, mucus membranes and the skin) called icterus or jaundice, itching and flu symptoms. Decreased appetite, sleep disturbances headaches and mood swings are also signs of the acute phase of the disease.

In the chronic form of the disease, there are very few directive symptoms but the disease is noted by a lot of fatigue where on feels so tied even early in the morning. This fatigue may be associated with the one caused by diabetes or heart problems. It is caused by the slow in toxin removal in the blood systems hence slow circulation. Flu-like signs are also carried on to this phase. Other signs noted in the acute phase which are just advanced in this phase include; itching causing sleep disturbances, abdominal pains, lowered levels of appetite, headaches and mood swings. Fever and outbursts of anger are signs associated with the chronic form of Hepatitis C. Muscle pains joint pains, and depression highlights signs of this phase. The abdominal pains further develop to diarrhea and a nausea feeling is common. There is a very great loss in weight within a short period of time. The brain is affected and causes impairment in thinking, memory, self awareness and the general behavior of oneself therefore results into some mental depression. Chronic Hepatitis C may cause indigestion problems called dyspepsia.

The chronic phase if not well treated advances to liver fibrosis and further to liver cirrhosis or even hepattocellular carcinoma (liver cancer) (NCFID). Liver fibrosis is the accumulation of tough fibrous proteins like collagen in the tissues of the liver. It entails the disarrangement of the tissues forming the scar and degradation of the matrix. This results into cirrhosis or even liver failure thus portal hypertension. At this stage (portal hypertension) no amount of drugs can reverse the situation and therefore only a liver transplant can save the individual.

On the other hand, liver cirrhosis is a total change of liver tissues by the fibrous protein tissues responding to the infection of the liver (Howard “The liver disorders” pp9). This occurs when the liver is totally damaged and is seen by development of nodules on the liver surface. This causes a major loss in the liver functions. It is characterized by fluid retention in the abdomen a case referred to as ascites. The other complication is disturbed mental condition leading to a state of coma caused by accumulation of ammonia and other toxins eliminated by the liver hence they find their way to the brain. At this stage the color of the liver changes to yellow and jaundice is evident. This also causes the urine to appear dark. Jaundice is developed due to lack of bilirubin by the liver. Along with jaundice is the change of nail color (only a third of the nail has color the rest is white) and nail shape as the nail folds at the top part. The liver is responsible for the production of coagulation factors (Rowe, W. pp 44).

Mode of transmission

When its functions stop there is a state of a lot of injury and uncontrolled bleeding. Itching continues due to deposition of bile and its products at the surface of the skin. Bone pains are also experienced in the condition of liver cirrhosis while fingers get deformed as the spleen and veins in the abdomen and esophagus enlarges. Upon examination the stools are found to be fatty. There are other reproductive associated complications like; impotence, infertility and loss of libido. In the men their breasts develop a firm mass extended at the nipples. A person suffering from liver cirrhosis is very sensitive to drugs as he has a very low level/rate of metabolism of the compounds in the drugs. In cirrhosis condition the blood does not pass normally through the lung circulation amounting to dyspnea and cyanosis (Howard J. “The Hepatitis C” p 17). It further leads to increased pressure at the lungs causing portal hypertension.

The last result of chronic Hepatitis C is the advancement of liver problems to cancer of the liver. This is a condition referred to as hepattocellular carcinoma. This is an absolute failure of the liver functions and requires a liver transplant. All this lower the immune system and expose the patient to secondary infections.

Symptoms

Several tests have been conducted to identify the presence of Hepatitis C. Although the diagnosis is rare on the acute phase, it can still be conducted. This is so due to the fact that, the symptoms at this stage do not call for any serious medical attention. The diagnosis at the chronic phase needs a lot of caution as it does not have very specific symptoms to the disease. Most symptoms are for cirrhosis which may not have occurred as a result of Hepatitis C but other factors like; excessive consumption of alcohol and fatty liver disease. Hepatitis B may also cause liver cirrhosis. The very advanced stages of this disease (Hepatitis C) may occur when one is already dead since it takes 20-30 year to manifest the symptoms as seen earlier in this work. The other choice that is now left is to consider the medical history of the patient. This calls for doctors to be very careful with patients especially if the symptoms they have are minor. At whatever case the doctors should not settle on mare assumptions after getting the signs that the patient presents but rather, they should carry out all possible tests to out rule possibilities of treating the wrong disease or just the symptoms leaving the root cause of the problem. Any history of drug abuse, inhaled drugs, alcoholism, piercing and tattooing should be taken to great considerations. Trying to get the contact trace on the individuals who had some sexual affairs with the patient may also lead to diagnosis of the disease in these people as highlighted by Mast, E, E. and M, J. Alter (p 22). Contact tracing is not much used because it creates a fear in people seeking medical assistance especially on sexually transmitted diseases.

Laboratory test are very vital in diagnosis of the Hepatitis C virus. Blood testing can be carried out to determining whether there is any form of unusual liver functions and liver enzyme formation. Blood screening especially for blood donors is a sure way of diagnosing Hepatitis C. Blood tests can also be carried out to determine the exposure of the Hepatitis C virus in the patient’s blood. This is done by checking on the antibodies that respond to Hepatitis C virus. The antibodies can be detected after a breeding period of about four months (Jennkins pp 9). A very positive answer can however be detected after six months. This test may not work for patients who do not have enough antibodies for there is a certain level required for the antibodies to be seen. This method of antibodies screening is not very effective as only few patients develop antibodies to the level needed for detection. It also has a disadvantage where the test only shows exposure and cannot tell if the patient has an ongoing infection. This therefore calls for more tests to determine the presence of an infection in the patient. When one tests negative and there are some other indications of Hepatitis C.

Blood tests do not give the best results compared to biopsy examinations that show the condition of the liver. The blood tests are however preferred due to less cost and non involvement in surgical measures. The blood tests carry several stages as shown by Jennkins (pp 9). The stages may be a pre-examination to biopsy tests or just a completion of the diagnosis of the disease. The first test to be done is the ALT test to determine the amount of enzyme alanine amino transfer in the liver. This is followed by the EIA (Enzyme immuno assay) that seeks to reveal the antibodies affiliated to the HCV. This test is always 90-95% accurate (Jennkins pp 9). RIBA (Recombinant immunoblot assay) test is then done to detect the specific antibodies and finally the PCR (Polymerase chain reaction) test for the viral load hence determine the severity of the infection. This is possible because the virus was observed to be a single stranded RNA (Hagedorn, C. H. and Rice, C. M pp 12). Other possible tests include; the transcription mediated amplification (TMA), the ELISA test and branched DNA (b-DNA) test (). These tests are advantageous because they detect the exposure of the patient to the virus, the presence of an infection and give the viral load of the virus (the quantity/population of the virus in the blood). The last test on Hepatitis C is the genotype testing. This needs some caution since the viral genotype and viral load are not a clear show of the liver damage.

To this point chronic Hepatitis C is more diagnosed through a combination of the above tests and extra hepatic manifestations seen in the presence of the Hepatitis C virus. Such manifestations include: thyroid inflammation and hyper or hypo thyrosis (disruption of the thyroid function). Porphyria cutanea tarda which is defined as low levels of enzyme that helps in heme formation thus one gets blister formation on contact with the sun rays is also an extra hepatic manifestation. Kidney inflammation, presence of large amounts of cryoglobulin proteins in the blood and diabetes mellitus can be associated with extra hepatic functioning of the body. Some individuals may encounter dryness of the mouth, eyes and the nose. A condition called sicca syndrome (Askari. K Fred &Danie. S Cutler pp 43).

When one has been diagnosed of Hepatitis C, then the next thing that follows is treatment. Seeking medication at an early stage is very vital as the very late stages can not be reversed even in the use of drugs. The acute phase can clear on its own and registers 90% success upon treatment as shown by (Health Canada pp 268). Caution should be taken to avoid spontaneous clearance without treatment as the symptoms may ease out yet living the virus still under multiplication at the liver. This later develops into the chronic form of the disease.

In cases of the chronic stages there are very small chances of self recovery. It therefore calls for administration of drugs. The most commonly used drugs are pegylated interferon alpha used in conjunction with an anti viral drug called ribavirin. They are given according to the genotype because some genotypes require much more dosage to clear than others. Genotype 1 which is more common in the US is given a dose that takes 12 months (NDDIC), while genotype 2 and 5 take 6 months. In genotype 6 the medicine is administered for a whole year. The treatment is much easier in cases of a low viral load. Since the number of viruses is small and their multiplication rate is also low then their clearance is faster. There are more drugs still under the experimental stages and we hope that they will be a great improvement to the current drugs in reducing the prevalence of the disease. Some of the drugs under study include: pyrimidine (to be used with interferons), protease inhibitors and polymerase inhibitors. There are also some developments on albuferon, zadaxin and DAPY for treatment of Hepatitis C (Fred MW et el pp 980). The current used drugs show some side effects like; flu syndrome, fatigue, muscle pains, nausea and vomiting, low grade fever, skin irritations and coughs. The adverse side effects include: temporary disabilities, anemia and diseases involving the heart and the circulatory system, bone marrow suppression, permanent hair loss as well as massive unrecoverable weight loss (Fred MW et el pp 982). Psychiatric problems may develop on the use of these drugs and due to the earlier faced psychological stress, result to suicidal ideation.

Prevention to any disease is always the best cure. Hepatitis C can be prevented by change of some behavioral aspects and been a little more careful with hygienic aspects. Hepatitis C patients should take precaution and get vaccinated against Hepatitis A and B to avoid infection that could worsen their liver conditions. People suspecting to have Hepatitis should keep off from alcohol consumption as it increases liver fibrosis and liver cirrhosis. Alcohol also increases the chances of contracting liver cancer. Smoking increases incidents of scars in the liver developing to liver fibrosis (Shiell, A. & Law, M. 22). Therefore smoking should also be a behavior to avoid. Sharing of needles and equipments used in drug administration should be unheard of. People should be advised to avoid some tattoo methods that seem to be unhygienic and the sharing of tattoo equipments that are not properly sterilized. Keep off unsanitary methods of piercing the body or even acupuncture (Askari. K Fred &.Danie. S Cutler p. 77-79). Be careful in case of helping in an accident event avoiding injury to yourself or direct contact with blood from the casualties. Do not share personal items like tooth brushes, razors, nail cutters or the manicure/pedicure set (Howard J. “The Hepatitis C” p 17). In case of sex with multiple partners ensure you use a condom.

Conclusion

To conclude, it is only reasonable to advocate for the preventive measure be put into great consideration. As much as, Hepatitis C would seem to be harmless it is killing quite a number of our youth so anti drug campaigns should be emphasized in schools. Medical practitioners should also exercise more caution in blood related practices. The government should enhance drug control measures to reduce the spread of this silent killer.

Work cited

Angus Reid Group. Hepatitis C: Final report. Report to Health Canada. (2000) pp 34-40.

Askari. K Fred &Danie. S Cutler. Hepatitis C, the silent epidemic: the authoritative guide. UK: perseus publishing. (1999) pp 25-90.

Branch, C.L. Hepatitis C: State of the art at the millennium. US: Thieme publishers (2000) pp 37-38.

Centers for Disease Control and Prevention. Recommendations for prevention and control of Hepatitis C virus (HCV) infection and HCV related chronic disease. Morbidity and Mortality weekly report 1998; 47: pp 1-39.

Clark J. M, and Diehl AM. Nonalcoholic fatty liver disease: an under recognized cause of cryptogenic cirrhosis. JAMA. (2003): pp 3000-4.

Feitelson Mark. Hepatitis C: From laboratory to clinic. USA: Cambridge University press. (2002) pp 5-113.

Fred MW, ML Shiffman, KR Reddy et al. Peginterferon alfa-2a plus ribavirin for chronic hepatitis C infection. New England Journal of Medicine. (2002) 347: pp 972-982.

Hagedorn, C. H. and Rice, C. M. The hepatitis C viruses. Berlin, Germany: Springer-Verlag. (2000). pp 8-29.

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Henkel John. Hepatitis C: New cure helps some but cure remains elusive. US: Diane publishing Co. (1999) pp 5-10.

Howard J. Worman. The Hepatitis C: source book. USA: Mc Graw-hill professional publisher. (2002). pp 5-19.

Howard J. Worman. The liver disorders: source book. USA: Mc Graw-hill professional publisher. (1999). pp 9-32.

Jenkins Mark. Hepatitis C: Practical, medical & spiritual guidelines for daily living with HCV. Hazelden publishers. (2000). pp 9.

Kaplowits N &D. Laurie. Drug induced liver disease. New York: Marcel. (2003) pp 450-451.

Mast, E, E. and M, J. Alter. Hepatitis C: Semi pediatric infectious disease (1997). pp 6-28.

Remis, R. S. Estimating the number of people co-infected with hepatitis C virus and human immunodeficiency virus in Canada. Report to Health Canada. (2001). Pp 70-92.

Rowe, W., Rowe, J. and Malowaniec, L. (2000). Hepatitis C: Mental health issues.

Canadian Journal Of Public Health, 91. Supplement 1: (2000). pp 42-44.

Shiell, A. and Law, M. G. The cost of hepatitis C and the cost-effectiveness of its prevention. Health Policy. 58: (2001).pp 121-131.

Strader DB, T. Wright, DL. Thomas & LB Seef. Diagnosis, management and treatment of Hepatitis C: Hepatology (2004) 1147-1171.

National Center for Infectious Diseases: . (NCFID). 2008. Web.

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