Liver

Hepatitis C virus
BY

Mohamed Ahmed
Mogahed
Mohamed Ahmed
Ghed
Mohamed Mahmoud
Kandeel
Section
:3
Mahmoud
Refaey

Mohamed
Mohamed
Mohamed
Esawy
Mohamed

Ahmed Abada
Salem Zayed
Mohamed El-

Salah El-Hagr

Sup : Dr / Naiera

Introduction

Why ?

?what you need to know about the liver

general anatomy
- The liver is the second largest
organ in the human body and
the
largest
gland.
- It lies under the diaphragm in
the right upper quadrant and
extends to the left upper
quadrant
of
the
abdomen.
- The liver has the general
shape of a prism or wedge , with
its base to the right and its apex
to
the
left.
- It is pinkish brown in color,
with a soft consistency, and is
highly
vascular
and
easily
friable.

what you need to know about the liver ?

Segmental liver anatomy
The liver is functionally divided into:
1. First order division; Right & Left Hemiliver.
2. Second-order division based on bile ducts and
4 segments.
3. Third-order division; 8 segments.

hepatic artery;

what you need to know about the liver ?

what you need to know about the liver ?

Microscopic anatomy of the liver and hepatic
circulation
There is a couple of terms that we need to be acquainted with:
1. Classic (simple) hepatic lobule.
2. Hepatic Acinus with its 3 zones-.
3. Portal Tract (Canal) (Triad).

what you need to know about

the liver ?

what you need to know about the liver ?

what you need to know about the liver ?

What is Hepatitis ?
Hepatitis

means inflammation of the liver .

Inflammation is the painful , red swelling that results

when tissues of body become injured or infected .
Inflammation can cause organs to not work properly.

Types of hepatitis
Hepatitis A: The hepatitis A virus is transmitted when fecal matter containing

the virus is ingested, most commonly through food. Infections with hepatitis A
are self-limited and never result in chronic infection or serious liver damage. A 2shot series vaccine is available (recommended for international travel) and can
provide life-long immunity

Hepatitis B: The hepatitis B virus is transmitted through blood and sexual fluids.
Unprotected sexual contact, injection drug use, and mother-to-child are the most
common routes of infection. Chronic infection is possible, and a high risk for
unimmunized infants and young children exposed to the virus. A 3-shot series
vaccine is available (required in most states for children in school) and can
provide life-long immunity

Types of hepatitis
Hepatitis D: The hepatitis D virus (also known as delta

hepatitis) is transmitted through blood, but can only infect

someone when the hepatitis B virus is also present. Hepatitis
D is uncommon in the United States, and there is no vaccine

Hepatitis E: Like hepatitis A, the hepatitis E virus is transmitted

through the ingestion of fecal matter, most commonly in
contaminated water in countries with poor sanitation.
Hepatitis E is rare in the United States, but common in other
parts of the world. There currently is no vaccine

Hepatitis C virus

History & Statics

It

is impossible to really know the origins of HCV since

there are no stored blood samples to test for the virus that
are older than 50 years.

However,

given the nature of the evolution of all viruses,

hepatitis C has probably been around for hundreds of
thousands of years or more before evolving into the current
strains.

It

was identified as a disease in 1989.

History & Statics

130-150 million people globally have chronic hepatitis C infection.

About 3 to 4 millions are infected every year

About 350,000 die every year

Hepatitis C is found worldwide .

The most affected region are Africa , Central and East Asia .

The country with the most prevalence of hepatitis C is Egypt with

about 15 million people infected (22% of population)

History & Statics

Causes
The

hepatitis C virus is a bloodborne virus. It is most

commonly transmitted through:

injecting drug use through the sharing of injection equipment;

in health care settings due to the reuse or inadequate sterilization of medical

equipment, especially syringes and needles;

the transfusion of unscreened blood and blood products;

HCV can also be transmitted sexually and can be passed from an infected mother
to her baby; however these modes of transmission are much less common.

Hepatitis C is not spread through breast milk, food or water or by casual contact
such as hugging, kissing and sharing food or drinks with an infected person.

Causes

Prevention
Primary

prevention

There is no vaccine for hepatitis C, therefore prevention of HCV infection depends upon
reducing the risk of exposure to the virus in health-care settings, in higher risk populations,
for example, people who inject drugs, and through sexual contact.

The

following list provides a limited example of primary

prevention interventions recommended by WHO:

hand hygiene: including surgical hand preparation, hand washing and use of gloves;

safe handling and disposal of sharps and waste;

provision of comprehensive harm-reduction services to people who inject drugs including

sterile injecting equipment;

testing of donated blood for hepatitis B and C (as well as HIV and syphilis);

training of health personnel;

promotion of correct and consistent use of condoms.

Prevention
Secondary

and tertiary prevention

For people infected with the hepatitis C virus, WHO recommends:

education and counselling on options for care and treatment;

immunization with the hepatitis A and B vaccines to prevent

coinfection from these hepatitis viruses to protect their liver;

early and appropriate medical management including antiviral

therapy if appropriate; and

regular monitoring for early diagnosis of chronic liver disease.

Concequences

During the initial infection people often have mild or no symptoms. Occasionally
a fever, dark urine, abdominal pain, andyellow tinged skinoccurs.
The virus persists in the liver in about 75% to 85% of those initially infected.
Early on chronic infection typically has no symptoms. Over many years however,
it often leads toliver diseaseand occasionallycirrhosis.
In some cases, those with cirrhosis will develop complications such as
liver failure,liver cancer, oresophagealandgastric varices .

Concequences

Concequences

Symptoms
The

incubation period for hepatitis C is 2 weeks to 6

months.
Following initial infection, approximately 80% of people do
not exhibit any symptoms.
Those who are acutely symptomatic may exhibit fever,
fatigue, decreased appetite, nausea, vomiting, abdominal
pain, dark urine, grey-coloured faeces, joint pain and
jaundice (yellowing of skin and the whites of the eyes).

Symptoms

Symptoms

Analysis
HCV

infection is diagnosed in 2 steps:

1- Screening for anti-HCV antibodies with a serological test identifies people who have
been infected with the virus.

2- If the test is positive for anti-HCV antibodies, a nucleic acid test for HCV RNA (PCR) is
needed to confirm chronic HCV infection because about 1545% of people infected with
HCV spontaneously clear the infection by a strong immune response without the need for
treatment. Although no longer infected, they will still test positive for anti-HCV antibodies.

After a person has been diagnosed with chronic hepatitis C infection, they should have an
assessment of the degree of liver damage (fibrosis and cirrhosis). This can be done by
liver biopsy or through a variety of non-invasive tests.

In addition, these people should have a laboratory test to identify the genotype of the
hepatitis C strain.

Analysis

Behaving with infected people

We

behave normally with hepatitis C infected people

Because :
Hepatitis C is not spread through breast milk, food or
water or by casual contact such as hugging, kissing and
sharing food or drinks with an infected person.
But we have just to take care of their personal tools as
(the scissors , nail clipper & Toothbrush ) and their
blood .

vaccine
Avaccinecapable

of protecting againsthepatitis C, is not

available. Although vaccines exist forhepatitis Aand
hepatitis B, development of a hepatitis C vaccine has
presented challenges.No vaccine is currently available, but
several vaccines are currently under development.

Most

vaccines work through inducing anantibody response

that targets the outer surfaces of viruses. However the
Hepatitis C virus is highly variable among strains and fast
mutated, making an effective vaccine very difficult

vaccine

Genotypes

Genotype 7: there has only been one

confirmed case of genotype 7it was
identified from a Central African immigrant.

Genotypes

Treatments

1991:200
1

1991:200
1

Normal Interferon (Has many side effects ) .

Cure ratio: about 9% in genotype 1&4 , and about 30% in genotype 2&3

Normal Interferon with Ribavrin Short acting

Cure ratio: about 29% in genotype 1&4 and about 32% in genotype 2&3.

PEG-interferon alpha + Ribavirin Long acting

2001:201
4

Cure ratio: about 41% in genotype 1&4 , and about 75% in genotype 2 ,
3 , 5 & 6.

Treatments
Telaprevir or Boceprevir ( Act on Protease ) with Interferon .

2011:2 Cure ratio: Tellabrevir 79% & Bocypriver 66% in genotype 1 .

014

Simeprevir Olysio ( Protease) with PEG-interferon alpha &

Ribavirin .

Ribavirin .
Nov.
Cure ratio: 80% in genotype 1 & 4
2013

Sofosbuvir Sovaldi (polymerase)

Dec. Cure ratio: 90% in genotype 1 but 30% relapsed in genotype 4 .

2013

Treatments
Oct.
2014

Ledipasvir/Sofosbuvir Harvoni ( inhibit viral replication ) Interferonfree Therapies

Cure ratio: exceeded 95%. (Need Ribavrin in presence of cirrhosis )

Nov.
2014

Sofosbuvir Sovaldi + Simeprevir Olysio (Need Ribavrin in presence

of cirrhosis )
Cure ratio: exceeded 95%.

Dec.
2014

Ritonavir /Ombitasvir/Paritaprevir (Viekira_Pak)

Cure ratio: exceeded 97%.

Treatments
Ombitasvir/Paritaprevir/Ritonavir (Known in Egypt >
Qurevo)
July Cure ratio: 100% success (not used for patients with
2015 cirrhosis or liver function failure rate higher than the
medium)
DaclatasvirDaklinza(Need Ribavrin in presence of
cirrhosis )
July
2015 Cure ratio: exceeded 97%.

2016

Zepatier

Treatments

Treatments
Mechanis
m
Old Drugs

New Drugs

Act more on immunity

enhancement

Act directly on virus by

inhibiting its enzymes like
Protease & Polymerase .

Management
Hepatitis

C is Manageable! If you are HCV+, you

can take steps to prevent or slow liver damage!!

Lifestyle
NO alcohol or smoking
Discuss ANY medications with your healthcare
provider
Diet
Reduce your intake of salt, fat and iron
Increase your intake of fresh fruits and
vegetables and your water consumption
Hepatitis A and B vaccinations

Summary
Liver
functional
histology

Hepatitis
C
Virus

What
is
Hepatitis

Types
of
Hepatitis

Any questions ?

Thank
you !