Hepatitis C

Hepatitis C

Introduction

Hepatitis C virus (HCV) infection poses a significant threat to public health. The infections continually emerge with increasing morbidity/mortality in the US affecting approximately 2.7-3.9 million people living with the infection. Most importantly, majority of the population is unaware of the infection status. Currently, the CDC guideline for laboratory testing and reporting does not provide a distinguishing factor between a previous infection and a current infection (Bornschlegel & Holtzman, 2013, pp. 357-361). The purpose of this paper is the large amount of patients tested positive for Hepatitis C in the correctional setting.

Discussion

Pathophysiology of Hepatitis C

The HCV is found in multiple sites of the body, such as liver, blood cells, CNS, epithelium; however, it replicates in hepatocytes only. However, in people having a normal immune system, the HCV infection is not hepatotoxic directly. The replication of the virus occurs through an RNA polymerase process that is RNA-dependent. The infected cells are recognized by the lymphocytes initiating an immune response in order to control the virus. In particular, the cytotoxic T lymphocytes and helper T cells develop a persistent, strong, virus-specific response for viral clearance. Due to the rapid evolution of the virus, a B cell response is generally inadequate to clear the virus from an infected person. This is the primary reason for slow progression of developing a vaccine to prevent the disease from occurring (Talal, Canchis, & Jacobson, 2002, pp. 15-22).

In addition, the inflammatory cytokines leads to liver parenchyma damage. The stellate cells, present in the liver parenchyma, are activated in response to persistent inflammatory mediators, resulting in varying degree of hepatic fibrosis, and eventually cirrhosis. It is unclear why progressive fibrosis and cirrhosis develop in some patients, while not in others. However, only a few predictors of progression are identified, which comprises of male gender, the age at the onset of the disease, as well as the use of alcohol (Talal, Canchis, & Jacobson, 2002, pp. 15-22).

Signs & Symptoms

Hepatitis C is more or less a silent disease, with approximately 75% of patients exhibiting no symptoms at first. The other 25% complains of flu-like symptoms, including fever, muscles aches, fatigue, and loss of appetite. In the early stages, the jaundice is a rare symptom, which occurs after the incubation period of 2 to 26-weeks. With time, as the infection becomes chronic, the patient begins to exhibit effects of persistent inflammation of the liver from the immune reaction. Liver damage is characterized by elevated levels of liver enzymes in the blood, which is the prime suggestion of an infection to be present. At this time, the patients frequently suffer from nonspecific symptoms and complain of easy fatigue (Nettleman, 2013).

As cirrhosis sets in, the patients complain of weakness, eight loss, and gynaecomastia in men, Palmar erythema, abnormal clotting, and telangiectasia. With advanced cirrhosis, the liver starts to fail, a life-threatening condition. This phase is characterized by confusion and encephalopathy. Furthermore, portal hypertension develops leading to ascites, esophageal varices, renal failure, splenomegaly, leukocytoclastic vasculitis, idiopathic pulmonary fibrosis, anemia, ...