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Viral Hepatitis C

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Liver Diseases

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Abstract

Hepatitis C virus (HCV) is a blood-borne virus endemic throughout the world and a major cause of liver disease. HCV is transmitted parenterally and less than 25% of cases of acute infection become clinically evident. Most patients who acquire HCV cannot eliminate it spontaneously and develop a chronic infection with a high propensity to evolve into liver cirrhosis and hepatocellular carcinoma. Furthermore, HCV plays a role in a wide range of extrahepatic manifestations, including lipid and glucose metabolic imbalances. Therefore, the clinical and prognostic impact of HCV infection depends not only on liver-related complications and death, but also on extrahepatic manifestations. Although viral replication occurs primarily in the liver, HCV is able to infect and replicate into most human cells and tissues causing local and systemic inflammation. Consequently, HCV infection is considered a systemic disease. In recent years, direct-acting antiviral agents have been approved and these drugs are able to achieve HCV clearance in up to 98% of cases with a positive clinical impact on hepatic and extrahepatic manifestations. This favorable therapeutic scenario has allowed the World Health Organization to hope for the global eradication of viral hepatitis C by 2030.

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Author information

Authors and Affiliations

  1. Department of Advanced Medical and Surgical Sciences, University of Campania “L. Vanvitelli”, Naples, Italy

    Luigi Elio Adinolfi, Aldo Marrone, Rosa Zampino & Luca Rinaldi

  2. Department of Precision Medicine, University of Campania “L. Vanvitelli”, Naples, Italy

    Emanuele Durante Mangoni

Authors
  1. Luigi Elio Adinolfi
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  2. Emanuele Durante Mangoni
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  3. Aldo Marrone
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  4. Rosa Zampino
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  5. Luca Rinaldi
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Corresponding author

Correspondence to Luigi Elio Adinolfi .

Editor information

Editors and Affiliations

  1. Faculty of Medicine, “Titu Maiorescu” University, Central Military Emergency University Hospital “Dr. Carol Davila”, Bucharest, Romania

    Florentina Radu-Ionita

  2. New Jersey Medical School, Rutgers University New Jersey Medical School, Newark, NJ, USA

    Nikolaos T. Pyrsopoulos

  3. Carol Davila University of Medicine and Pharmacy, Central Military Emergency University Hospital “Dr. Carol Davila”, Bucharest, Romania

    Mariana Jinga

  4. Faculty of Medicine, “Titu Maiorescu” University, Central Military Emergency University Hospital “Dr. Carol Davila”, Bucharest, Romania

    Ion C. Tintoiu

  5. Medical Radiation Sciences, Curtin University, Perth, WA, Australia

    Zhonghua Sun

  6. “Prof. C.C. Iliescu” Emergency Institute for Cardiovascular Diseases, Bucharest, Romania

    Ecaterina Bontas

Self Study

Self Study

1.1 Questions

  1. 1.

    What is the basis of HCV persistence?

  2. 2.

    What is the relevance of HCV genotypes?

  3. 3.

    Is the detection of anti-HCV antibodies sufficient to diagnose HCV infection and start antiviral therapy with DAAs?

  4. 4.

    What is the role of anti-HCV IgM and the anti-HCV avidity test for the diagnosis of AHC?

1.2 Answers

  1. 1.

    HCV persists in the host because of its high genetic variability, allowing the escape of the virus from the immune system. Genetic variability is a consequence of the high rate of spontaneous mutations that accumulate within the HCV genome due of the lack of proofreading activity of the HCV RNA polymerase. By continuously modifying its antigens, HCV escapes immune response. Furthermore, the inclusion of HCV in lipoviroparticles also alters antiviral response. Finally, HCV is able to spread directly from infected to non-infected hepatocytes without passing through the extracellular compartment.

  2. 2.

    HCV genotypes are associated with peculiar epidemiological, pathophysiological and therapeutic characteristics. Genotype 1 is more common in older patients, often has nosocomial transmission and is associated with progression to cirrhosis and HCC. Genotype 2 is prevalent in Africa and East Asia and among younger subjects, it is often transmitted by transfusion and associated with cryoglobulinemia. Genotype 3 is closely associated with the use of illicit drugs in industrialized countries and causes a severe form of hepatic steatosis associated with hypocholesterolemia. Not all DAAs are effective against all HCV genotypes and treatment outcomes may differ according to the actual genotype.

  3. 3.

    The detection of anti-HCV antibodies is not sufficient to diagnose an active HCV infection, but it is necessary to highlight the presence of serum HCV-RNA, therefore, treatment with DAA should only be initiated in HCV RNA positive patients.

  4. 4.

    IgM antibodies are not diagnostic for AHC because they can be detected both during the acute and chronic stages of the disease. Instead, the avidity test of antibodies to the anti-HCV IgG and IgM anti-HCV antibodies makes a correct diagnosis of AHC in 90% of cases.

Glossary

AHC

Acute hepatitis C

ALT

Alanine aminotransferase

AST

Aspartate aminotransferase

CHC

Chronic hepatitis C

DAAs

Direct-acting antivirals

DBS

Dry blood spot

EGDS

Esophagogastroduodenoscopy

EIA

Enzyme immunoassays

ER

Endoplasmic reticulum

HCC

Hepatocellular carcinoma

HCV

Hepatitis C virus

IR

Insulin resistance

LVP

Lipoviroparticles

MC

Mixed cryoglobulinemia

MTP

Microsomal triglyceride transfer protein

NS

Non-structural proteins

NSBB

Non-selective beta blockers

POC

Point of care

SBP

Spontaneous bacterial peritonitis

SVR

Sustained virological response

T2DM

Type 2 diabetes mellitus

TIPS

Transjugular intrahepatic portosystemic shunt

VLDL

Very low-density lipoprotein

WHO

World Health Organization

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Adinolfi, L.E., Mangoni, E.D., Marrone, A., Zampino, R., Rinaldi, L. (2020). Viral Hepatitis C. In: Radu-Ionita, F., Pyrsopoulos, N., Jinga, M., Tintoiu, I., Sun, Z., Bontas, E. (eds) Liver Diseases. Springer, Cham. https://doi.org/10.1007/978-3-030-24432-3_17

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  • DOI: https://doi.org/10.1007/978-3-030-24432-3_17

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  • Online ISBN: 978-3-030-24432-3

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