Hepatitis C virus

Definitions & Key takeaways

The hepatitis C virus (HCV) is an enveloped, single-stranded RNA virus of the Flaviviridae family. It infects the liver cells and causes chronic hepatitis. HCV is highly infectious and can be transmitted through contact with blood or body fluids from an infected person. HCV is most commonly spread through sharing contaminated needles or other injection equipment among people who inject drugs and from mother to child during birth. Hepatitis C infection can progress to cirrhosis and liver failure after many years, and it also poses a risk of developing hepatocellular carcinoma.

Watch video only
Hepatitis C virus is a part of the flaviviridae family, and it can be broken down in hepat- which refers to the liver, and -itis, which means inflammation.
So this virus affects the liver, causing hepatitis. Hepatitis C virus is enveloped, meaning that it is surrounded by a membrane.
It also has a lipoprotein envelope that’s very similar in structure to two lipoproteins that normally transport cholesterol through the blood: low density lipoprotein, or LDL and very-low-density lipoprotein, or VLDL.
Underneath the membrane, there’s an icosahedral capsid, which is a spherical protein shell made up of 20 equilateral triangular faces.
The capsid holds a single strand positive-sense RNA, meaning that it has positive polarity, which is why it can be used directly by the host ribosomes to synthesize viral proteins.Now, hepatitis C virus can be transmitted through contaminated blood or through sexual contact.
Once inside the body, hepatitis C virus circulates the blood and reaches the liver, where it infects the main liver cells called hepatocytes; and B lymphocytes, which are a type of immune cells that create antibodies.First, the virus binds to the cells using its envelope, which is very similar to LDL and VLDL, so it can attach to specific LDL receptors.
Then, the virus enters the cell by endocytosis, which is when it’s wrapped by the cell membrane and brought inside the cell in a bubble called an endosome.
Next, the viral membrane fuses with the endosome and releases the capsid which dissolves in the cytoplasm, leaving only viral RNA.
Then, viral RNA binds to the host ribosomes and is used to create structural and non-structural proteins. Structural proteins will be used to make the viral particle, while the non-structural proteins make the replication complex that contains an enzyme called RNA dependent RNA polymerase.
This enzyme uses the positive-sense viral RNA to create a negative-sense template. And the replication complex can use the newly made negative-sense template to create more copies of the positive-sense viral RNA, which can be packaged into viral particles, along with structural proteins, in the host cell endoplasmic reticulum.
However, RNA polymerase makes a lot of mistakes, so each viral particle is a bit different. This contributes to viral variability, and it’s what makes it so hard to create a vaccine against hepatitis C.
Finally, the viral particles exit the cell through exocytosis, which is like reverse endocytosis. About two thirds of affected people can develop complications like: cryoglobulinemia, when the blood contains temperature sensitive antibodies called cryoglobulins; autoimmune hemolytic anemia; glomerulonephritis, or inflammation of the kidneys’ glomeruli, leukocytoclastic vasculitis, which is an inflammation of the blood vessels; diabetes; hypothyroidism; and skin conditions like porphyria cutanea tarda and lichen planus.
It’s not clear why these complications arise; however, since hepatitis C virus infects B-lymphocytes, one explanation may be that it affects the production and function of antibodies.
Since hepatitis C is transmitted through blood or sexual contact, individuals at higher risk for infection include people who use intravenous drugs, individuals who have had tattoos and/or piercings done, recipients of transfusion and organ transplants; and individuals who have unprotected sex and multiple sexual partners.
The virus can’t be transferred from an infected pregnant individual to the baby during pregnancy, but there is a 1 in 20 chance to pass it to the baby during childbirth for both vaginal delivery and c-section.Hepatitis C virus causes three types of disease: most commonly, chronic hepatitis; but it can also cause acute hepatitis; and rarely fulminant hepatitis that quickly progresses to liver failure.
Chronic hepatitis usually has no symptoms, but sometimes fatigue may be present. Without treatment, it usually progresses to cirrhosis within 10 - 15 years, or liver failure after 20 years.
It also greatly increases the chances of getting a liver cancer called hepatocellular carcinoma.Symptoms of acute hepatitis are usually mild and include: fatigue, nausea, decreased appetite, and joint and muscle pain.
Unlike in other viral hepatitis, jaundice, which is a yellowish pigmentation of the skin, mucosa and whites of the eyes, is usually not present in hepatitis C.Tests for detecting antibodies against hepatitis C, or anti-HCV antibodies for short, are used to diagnose the disease.
Antibodies can be detected within 7 to 31 weeks of infection. If the first test is positive another confirmatory test is done using a different method.
Viral antigens can be detected in blood 1 to 3 weeks after exposure; up 4 to 6 months in acute disease; and longer than 10 years in chronic disease.
Finally, viral RNA can be detected by PCR to confirm the diagnosis, which is especially important in high risk individuals with negative anti-HCV antibodies.
A liver biopsy can also be done to determine the liver damage. It shows lymphoid infiltration, meaning there are lots of lymphocytes; which aggregate to form lymphoid follicles; and there may also be macrovesicular steatosis, or large fatty particles in the liver.The mainstay of treatment for hepatitis C used to be recombinant interferon-alpha and pegylated interferon with or without ribavirin.
However, they had a lot of adverse side effects - and today, newer medications called protease inhibitors, like boceprevir or telaprevir, are recommended.
Since viral variability makes it hard to develop a vaccine, prevention is done in other ways, like screening blood and organ donors for hepatitis C, practicing safe sex by using condoms for each sexual contact, and always using clean, sterile, single use needles.
##SummaryAll right, as a quick recap hepatitis C virus is a single strand positive-sense RNA virus, transmitted through blood or sexual contact.
It infects hepatocytes and B lymphocytes, and usually causes chronic hepatitis. There usually aren’t symptoms of hepatitis, but it can progress to cirrhosis and liver failure after many years, and it also greatly increases the risk of developing hepatocellular carcinoma.
It’s usually diagnosed by detecting anti-HCV antibodies or viral RNA in some cases, and a liver biopsy can be done to assess liver damage.
Protease inhibitors like boceprevir or telaprevir are the recommended treatment. Finally, prevention can be done by screening blood and organ donors for hepatitis C, using condoms, and always using clean, sterile, single use needles.