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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