Hcv Review Article Text

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background:

over the past several years, hepatitis c therapy has been pegylated interferon and ribavirin based. Although protease inhibitor based therapy has enhanced response rates in genotype 1, the recent advances in therapy have demonstrated a challenge in genotype 3, a highly prevalent infection globally. To provide a comprehensive summary of the literature evaluating the unique characteristics and evolving therapies in genotype 3. A structured search in pubmed, the cochrane library and embase was performed using defined key words, including only full text papers and abstracts in english.

Furthermore, it interferes with lipid and glucose metabolism, and the natural history involves a more rapid progression of liver disease and a higher incidence of hepatocellular carcinoma hcc. New therapies with protease inhibitors have focused on genotype 1 largely and have demonstrated enhanced responses, but have limited activity against genotype 3. Thus far, in clinical trials, ns5b and ns5a inhibitors have performed more poorly in genotype 3, while a cyclophilin inhibitor, alisporivir, has shown promise.

conclusions:

as treatments for hcv have evolved, genotype 3 has become the most difficult to treat. Furthermore, genotype 3 has special characteristics, such as insulin resistance and alterations in lipid metabolism, which may partly explain the lower treatment responses.

A great deal of emphasis on advancing therapy is needed in this population that appears to have a more rapid progression of liver disease and a higher incidence of hcc.

corresponding author: mercy j karoney, mbchb, moi university clinical research center, ampath center at mtrh, nandi road, p. Box 4606 – 30100, eldoret, kenya [email protected]

hepatitis c virus hcv infection in africa: a review mercy jelagat karoney 1, amp.

Abraham mosigisi siika 2 1 moi university clinical research center, eldoret, kenya, 2 department of medicine, school of medicine, college of health sciences, moi university, eldoret kenya hepatitis c virus hcv is a viral pandemic and a leading cause of chronic liver disease. We searched for articles on medline using the terms, hepatitis c , prevalence , epidemiology , africa and treatment. While treatment with peginterferon and ribavirin is recommended for patients with chronic hcv, no data were found on their use in africa. Neither were there any data on definitive management liver transplantation for those with end stage disease. Limited data exist in literature on hcv in africa background hepatitis c virus hcv is a rna virus known to infect humans and chimpanzees, causing similar disease in these 2 species. Hcv is most often transmitted parenterally but is also transmitted vertically and sexually 1 .

The world health organization who estimates that 170 million people are infected with hcv globally and 3. 4 million new infections occur each year 5 , making it one of the leading public health problems in the world. With a prevalence of 5.3% and an estimated 32 million people infected with hcv, sub saharan africa has the highest burden of the disease in the world 6 . Other who regions with a high prevalence of hcv include eastern mediterranean prevalence 4.6% and western pacific prevalence 3.9%. Despite its high prevalence and highly infectious nature, hcv remains under diagnosed and underreported in africa with the exception of egypt. Because of such paucity in available data, little attention has been given to hcv in africa. We therefore set out to review available medical literature on hcv in africa with a view to determining the prevalence, disease burden and common transmission modes.

We searched medical literature in biomedical databases pubmed, ovid and google scholar using the following key words: hepatitis c , prevalence , epidemiology , africa , and treatment. These were articles that had data on prevalence, transmission and disease burden of hcv in africa diagnosis and treatment guidelines. This was a meta analysis that entailed systematic review of all articles in africa with relevant hcv information. We gathered detailed data from relevant articles that met the criteria and organized them into a database. The studies were categorized by country and the variable of interest, prevalence, presented in tables and figures. We also gathered articles with guidelines on diagnosis, treatment and prevention of hcv and presented a summary of the findings. Current status of knowledge disease burden and distribution the estimated prevalence of hcv in africa is 5.3% 7 .

Egypt?s unusually high prevalence is attributable to the history of unsterile injection equipment use for mass treatment of the general population with parenteral antischistosomal therapy pat from the 1920s to the 1980s 8 ,9 . The prevalence of hcv increases with age, with the highest rate being reported in the age group older than 40 years. However, based on the general trends for most other diseases, it is possible that these indicators may be worse than the who reports of 75% of hcv infected individuals developing chronic liver disease. Of those hcv infected patients who develop chronic liver disease 1.6% progress to hepatocellular carcinoma hcc , a condition with a mortality rate >80%. The prevalence of hcv in the general population in africa ranges between 0.1% and 17.5%, depending on the country. The countries with the highest prevalence include egypt 17.5% , cameroon 13.8% and burundi 11.3%.

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The countries with the lowest prevalence include zambia, kenya, malawi and south africa all with a prevalence 18 years positive hcv antibody and serum hcv rna test results compensated liver disease e.g. No hepatic encephalopathy or ascites acceptable hematologic and biochemical indices hemoglobin at least 13 g/dl for men and 12 g/dl for women neutrophil count >1500/mm3, serum creatinine 800,0 iu/ml and only 24 weeks of therapy for patients with those with a low pretreatment viral load hepatitis c is a major cause of chronic liver disease. It has been recognized as a global health problem because of the progression to cirrhosis and hepatocellular cancer. Chronic hepatitis c is usually asymptomatic but can cause considerable liver damage before its recognition.

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This review discusses the natural history, clinical features, diagnosis, therapy, treatment responses and the side effects associated with the treatment of hepatitis c. 19 , the number of acute hcv cases has fallen by more than 80% wasley and alter, 20 . However, hepatitis c is still a major health burden because 60 x02013 80% of infected people progress to chronic infection di bisceglie, 20 . Hcv is a single stranded rna virus belonging to the flaviviridae family lindenbach and rice, 2005 . The major routes of transmission are injection drug use, blood transfusion, hemodialysis, organ transplantation and less frequently sexual intercourse. Six major genotypes 1 x02013 6 of hcv have been identified, and they have varying geographical distribution.

Genotypes 1, 2 and 3 are distributed worldwide with genotype 1 accounting for 40 x02013 80% of all cases. Genotype 4 is found in the middle east and egypt, genotype 5 in south africa and genotype 6 in south east asia wasley and alter, 20 . Symptomatic acute hcv has a mild clinical course with x03c 25% of patients presenting with jaundice. About 60 x02013 80% people with acute infection develop chronic infection hoofnagle, 2002 .

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