Wirusowe Zapalenie Wątroby

typu C /WZW C/ - etiologia,
diagnostyka, profilaktyka.

Dr n.med. Witold Wrodycki

Klinika Chorób Zakaźnych i Hepatologii UM w

Łodzi

Hepatitis C Virus -?

Hepatitis C Virus -?

Epidemiologia HCV

• 0,2 - 1,5% zakażonych krwiodawców

w USA i Japonii

• W Polsce – ok. 1% krwiodawców
• Duży odsetek zakażonych

narkomanów (dożylnych)

• Systematyczny wzrost liczby

zakażonych (brak szczepionki!)

1..1.......
....,

m

m

Geographic Distribution

of

Chronic HCV Infection

Geographic Distribution

of

Chronic HCV Infection

HBsAg Prevalence

8% = High

2%-7% = Intermediate

<2% = Low

Wirusowe zapalenie

wątroby w Polsce

1961 – 57 088 przyp. zgony 102,
1970 – 70 355 przyp. zgony 369
2000 HAV 262 przyp. (25,5 % w wieku 0-

14) zgony 0

HBV 2825 przyp.(10,3% w wieku 0-

14) zgony 0

HCV 2086 przyp. (5,7 % w wieku 0-

14) zgony 0

2011r HCV 1854 przyp.  ostre?

Features of Hepatitis C

Features of Hepatitis C

Virus Infection

Virus Infection

Incubation period

Incubation period

Average 6-7

Average 6-7

weeks

weeks

Range 2-26

Range 2-26

weeks

weeks

Acute illness (jaundice)

Acute illness (jaundice)

Mild (

Mild (

<

<

20%)

20%)

Case fatality rate

Case fatality rate

Low

Low

Chronic infection

Chronic infection

75%-85%

75%-85%

Chronic hepatitis

Chronic hepatitis

70% (most

70% (most

asx)

asx)

Cirrhosis

Cirrhosis

10%-20%

10%-20%

Mortality from CLD

Mortality from CLD

1%-5%

1%-5%

Chronic Hepatitis C

Factors Promoting Progression or

Severity

• Increased alcohol intake

• e > 40 years at time of infection

• HIV co-infection

• ?Other

– Male gender

– Other co-infections (e.g., HBV)

Serologic Pattern of Acute HCV

Infection with Recovery

Symptoms

+/-

Time after

Exposure

T

it

e

r

anti-

HCV

ALT

Norma

l

0

1 2 3

4

5

6

1

2

3

4

Years

Month

s

HCV RNA

Serologic Pattern of Acute HCV

Infection with Progression to

Chronic Infection

Symptoms

+/-

Time after

Exposure

T

it

e

r

anti-

HCV

ALT

Norma

l

0

1

2 3

4

5

6

1

2

3

4

Years

Month

s

HCV RNA

*95% Confidence Interval

Hepatitis C Virus Infection,

Hepatitis C Virus Infection,

United States

United States

New infections (cases)/year 1985-89 242,000

(42,000)

1998

40,000 (6,500)

Deaths from acute liver failure

Rare

Persons ever infected (1.8%)

3.9 million

(3.1-4.8)*

Persons with chronic infection

2.7 million

(2.4-3.0)*

Of chronic liver disease - HCV-related 40% - 60%

Deaths from chronic disease/year

8,000-10,000

.

Transmission of HCV

• Permucosal

– Perinatal

– Sexual

• Percutaneous

– Injecting drug use
– Clotting factors before viral inactivation
– Transfusion, transplant from infected donor
– Therapeutic (contaminated equipment,

unsafe injection practices)

– Occupational (needlestick)

Reported Cases of Acute Hepatitis C by

Reported Cases of Acute Hepatitis C by

Selected Risk Factors, United States, 1983-1998*

Selected Risk Factors, United States, 1983-1998*

0

10

20

30

40

50

60

70

80

83-84

85-86

87-88

89-90

91-92

93-94

95-96

97-98

Year

P

er

ce

nt

ag

e

of

C

as

es

Injecting drug use

Sexual

Health related work

Transfusion

*

1983-1990 based on non-A, non-B hepatitis

Sources of Infection for

Persons with Hepatitis C

Sexual
15%

Other* 5%

Unknown 10%

Injecting drug
use 60%

Transfusion 10%

(before screening)

*Nosocomial; Health-care work; Perinatal

*Nosocomial; Health-care work;
Perinatal

* Reported in U.S.

Nosocomial Transmission of HCV

• Recognized primarily in context of outbreaks
• Contaminated equipment

– hemodialysis*
– endoscopy

• Unsafe injection practices

– plasmapheresis,* phlebotomy
– multiple dose medication vials
– therapeutic injections

Estimated Incidence of Acute

HCV Infection United States,

1960-1999

0

20

40

60

80

100

120

140

1960 1965 1970 1975 1980 1985 1989 1995 1999

Year

N

ew

I

nf

ec

ti

on

s/

10

0,

00

0

Decline in

transfusioDecline in

transfusion recipients

n recipients

DeclineDecline in injection

drug users

in injection

drug users

Source: Hepatology 2000;31:777-82; Hepatology 1997;26:62S-65S

Sexual Transmission of HCV

• Occurs, but efficiency is low

– Rare between long-term steady partners
– Factors that facilitate transmission between

partners unknown (e.g., viral titer)

• Accounts for 15-20% of acute and

chronic infections in the United States

– Sex is a common behavior
– Large chronic reservoir provides multiple

opportunities for exposure to potentially

infectious partners

Antibodies to the virus
• Anti-HCV

Severity of liver

damage

• Bilirubin
• Albumin
• Prothrombin time

Markers of the virus
• HCV-RNA

Markers of liver

damage

• ALT
• AST
• Bilirubin

Hepatitis C – Diagnostic

Tools

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