Hepatitis means "inflammation of the liver."  Hepatitis may be caused by viruses (A, B, C, etc.), toxins (alcohol), and other pathogens.  Hepatitis C virus (HCV) and its immunological events will be discussed in this article.

 

Hepatitis C is caused by forward (not retro-) RNA virus spread through infected blood.  In recent decades the disease spreads mostly through illicit IV drug injection. 

 

Tooth brushing, coitus, shaving and other potential methods of spread contribute little of the disease burden.  In 1989 an antigen identifying viral infection was found.  Before the discovery, blood transfusions accounted for much of what then was called "non-A, non-B" hepatitis.

 

Upon entry into the blood stream, virions (HCV)  attach to hepatocytes (liver cells).  They empty RNA into the liver cells, which turning the cell's machinery into factories producing HCV.

 

Symptomatic silence marks the first days and weeks of the infection. 

As liver cell destruction proceeds over months and years, a positive liver enzyme test may be found at blood donation or physical exam, leading to a diagnosis of hepatitis C. 

 

Viral load can be measured, with a high load indicating poorer prognosis.  When indicated, interferon or other antiviral medication may be prescribed.  In some cases complete clearing of viral and liver enzyme indicators may occur.  HCR Type 1 tends not to respond so well.

 

Persistence of infection may lead to cirrhosis, a scarring, fibrotic condition of the liver.  Pressure rises in the veins leading from the GI tract to the liver, potentially causing bleeding, spleen enlargement, jaundice, seepage of bacteria from the intestines into the blood stream-fluid builds in the abdominal cavity.

 

Pressure increases in lung blood vessels, leading to pulmonary hypertension and heart failure.  Metabolic malfunction of liver and kidney, may occur.  Vascular shunts,  liver transplantation, and lung/heart transplantation may be required.

 

Surface membranes of infected liver cells manifest "new" antigens spawned by viral infestation.  Immune system surveillance may catch sight of the new antigens and consider them "non-self," attacking  as "foreign tissue."  Auto antibodies are secreted, and killer T-cells armed.  Autoimmune rejection of liver cells is called AIH (AutoImmune Hepatitis).

 

Autoimmune hepatitis is treated with immunosuppressant medication, such as corticosteroids.  In a patient with hepatitis C and AIH, attempts to suppress the autoimmune response may enhance the viral attack.  Perhaps suppression of the virus and autoimmunity simultaneously would help.

 

 

 

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Notes: Sarcoidosis presenting with granulomatous uveitis induced by pegylated interferon and ribavirin therapy for Hepatitis C. Intern Med J. 2008; 38(3):207-10 (ISSN: 1445-5994) Yan KK; Dinihan I; Freiman J; Zekry A Department of Gastroenterology, St

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