Hcv Infection And Cns Inflammatory Disorders
CNS involvement in chronic HCV infection may also result from encephalic and/or meningeal inflammation.
Cases of leukoencephalitis associated with HCV infection have been reported. Different clinical patterns have been described, ranging from a rapidly evolving form with perivascular T cells infiltrates and microglial nodules to progressive encephalomyelitis associated with neuronal loss and perivascular lymphocyte infiltrates. Spastic quadriparesis, sphincter dysfunction, and sensory loss have been reported to dominate the clinical scenario. As HCV genome in brain tissue has been reportedly detected at post-mortem evaluation, a possible correlation may be theorized.
Evidence of an association between HCV and transverse myelitis, with attending motor, sensitive, and autonomic dysfunction has been reported. Acute demyelination, with parenchymal and perivascular T cell infiltration, has been described on pathological analysis of spinal cord biopsy. Disease onset may be characterized by symptoms indicative of transverse myelitis or acute partial transverse myelopathy, or else by spastic paraplegia or sensory ataxia. A recurrent course and multisegmental spinal involvement have been frequently reported. Since these cases tested positive for anti-HCV antibodies in the liquor, with no evidence of virus in tissue biopsies, an immune-mediated pathogenesis was hypothesized to explain disease pathogenesis.
What Is The Relationship Between Drug Use And Viral Hepatitis
Drug and alcohol use places people at particular risk for contracting viral hepatitis. Engaging in risky sexual behavior that often accompanies drug use increases the risk of contracting HBV and, less frequently, HCV. People who inject drugs are at high risk for contracting HBV and HCV from shared needles and other drug preparation equipment, which exposes them to bodily fluids from other infected people. Because drug use often impairs judgement, PWID repeatedly engage in these unsafe behaviors, which can increase their risk of contracting viral hepatitis. One study reported that each person who injects drugs infected with HCV is likely to infect about 20 others, and that this rapid transmission of the disease occurs within the first 3 years of initial infection.4 Drug and alcohol use can also directly damage the liver, increasing risk for chronic liver disease and cancer among those infected with hepatitis. This underscores that early detection and treatment of hepatitis infections in PWID and other people who use drugs is paramount to protecting both the health of the person and that of the community.
The Effects Of Hepatitis C On Your Body
You may have seen numerous literature and commercials about chronic hepatitis C and for good reason. According to the Centers for Disease Control and Prevention , up to 3.9 million people in the United States may have the chronic form of this virus. According to the World Health Organization , over 70 million people are affected worldwide.
What exactly is chronic HCV? In a nutshell, it refers to ongoing inflammation of your liver. But it can lead to symptoms throughout your body. Over time, living with this condition can cause your body to be especially vulnerable to serious health complications.
HCV is transmitted through contact with the blood. Its rarely transmitted through sexual contact from someone infected with the virus. Ultimately, this infection leads to liver inflammation and a host of other issues that can severely damage your health.
The virus has two stages, acute and chronic. The acute stage happens within six months of being exposed to the virus. For some, this is a short-term illness. But according to the CDC, most people about 75 to 80 percent will develop chronic HCV. This means it can be lifelong. Most people dont realize they have the virus until other symptoms within their body start.
Although the hepatitis A, B, and C viruses all cause hepatitis, they are three different and distinct viruses.
Don’t Miss: Is Hepatitis C Contagious Sexually
How Can You Get Hepatitis C
Hepatitis C is a blood-borne disease. The main source of infection is from blood from an infected person.
- Most cases are caused by using contaminated needles or injecting equipment to inject drugs . Even a tiny amount of an infected person’s blood left on a needle is enough to cause spread to others.
- Some people who received blood transfusions or blood prior to 1991 were infected with hepatitis C from some donor blood. Since 1991 all blood and blood products donated in the UK are screened for HCV.
- There is also a risk of contracting hepatitis C from needlestick accidents, or other injuries involving blood spillage from infected people.
- There is a small risk of contracting the virus from sharing toothbrushes, razors and other such items which may be contaminated with infected blood.
- There is even a small risk from inhaling drugs like cocaine, as these can make the inside of your nose bleed. If that happens, tiny spots of blood can fall on to the note you are using and, if that is used by someone else, your blood can travel up their nose and into their bloodstream.
- There is also a small risk from re-used equipment used for tattooing, body piercing, acupuncture, etc.
- There is a small risk that an infected mother can pass on the infection to her baby.
- There is a small risk that an infected person can pass on the virus whilst having sex.
The virus is not passed on during normal social contact, such as holding hands, hugging, or sharing cups or crockery.
Bleeding In The Digestive Tract
Think of the liver as a sponge, Dr. Block says. Blood from the spleen, pancreas, and intestines all go into it, so theres a really large volume of blood flow through the organ. When the liver becomes cirrhotic, its stiffer and harder but the same amount of blood still has to go through. This creates backpressure, or hypertension, in nearby veins. In turn, this hypertension can cause vessels in areas like the esophagus, stomach, and rectum to enlarge and spontaneously rupture and bleed, Dr. Block explains.
Read Also: Chronic Viral Hepatitis B Without Delta Agent
Hcv Infection And Psychiatric Disorders
Psychiatric symptoms such as brain fog, fatigue, weakness, depression, and anxiety have been reported with high frequency in patients with chronic HCV infection, causing interference with patient ability to perform daily activities and impairment of quality of life. Mere knowledge of HCV serological status is itself an important reason for poor health-related quality of life, due to impairment of intimate and family relationships, changes in dietary habits, reduced sense of well-being because of fear of contagion and prognosis, social marginalization, fatigue, anger, hopelessness, depression, and stigma. Moreover, the possible relation between HCV and psychiatric disorders is further strengthened by the results of studies comparing health-related quality of life between HBV and HCV patients. Specifically, a strong relationship between HCV infection and impaired physical health, as well as an inverse correlation between levels of brain-derived neurotrophic factor and physical health, has been documented in patients with HCV but not in those with HBV infection.
One report suggested that HCV genotype 3 infected patients might be at increased risk of depression. However, it should be remembered that such patients are often drug users, which itself puts them at risk of depression. Moreover, depression was independently associated with perceived barriers to accessing HCV care, thus creating a vicious circle.
What Do I Do If I Find Out I Have Viral Hepatitis
After learning from your doctor that you have hepatitis, your first step will be to learn more about the virus. Read government resources, like the websites listed below, to find current, scientific information. Adopting a healthy lifestyle is important to prevent the virus from becoming serious. Dont drink or misuse drugs because they are hard on your liver. Get plenty of rest, eat healthy foods, and exercise. Work to protect others by not donating blood or participating in risky behaviors, including sharing needles when using drugs or having unprotected sex.
Recommended Reading: Where Can I Get A Hepatitis B Booster
Cocaine Use And Hepatitis C Infection: Whats The Link
Although the World Health Organization has set a goal to significantly reduce hepatitis C virus -related morbidity and mortality rates by 2030, HCV continues to pose a major public health threat.1 In 2016, an estimated 18,000 deaths were attributed to HCV infection.2 The demographics of this disease, however, including who is being infected and the mode of infection, have shifted. Before the 1990s, HCV infection was commonly found in older adults who became infected following blood transfusions or organ transplantations.3,4 Once testing for the HCV antibody in the blood became routine in the early 1990s, there was a sharp decline in incident HCV cases until 2005, when the next wave of HCV transmission began as a result of the opioid epidemic and, subsequently, an increase in illicit drug use.3,4 Today, injection drug use is the greatest risk factor for HCV infection, and some data suggest that people who use cocaine may be at particularly high risk compared with other drug users.5 However, this increased risk appears to extend to those who do not inject drugs, which has led to initiatives to better understand the association between cocaine use and HCV transmission and clearance and strategies for prevention.
Injection Cocaine Use and HCV Risk
Noninjection Cocaine Use andHCV Risk
Drug Use Setting, Cocaine, andHCV Risk
The Many Difficulties And Subtleties In The Cognitive Assessment Of Chronic Hepatitis C Infection
Jefferson Abrantes
1Department of Neurology, Federal University of the State of Rio de Janeiro, Rua Mariz e Barros, 775 – Tijuca, Rio de Janeiro 20270-004, Brazil
2Department of Gastroenterology, Federal University of the State of Rio de Janeiro, Brazil
Abstract
Since the discovery of HCV in 1989, several diseases have been related to chronic infection by this virus. Often, patients with hepatitis C virus complain of cognitive impairment even before the development of hepatic cirrhosis, which they described as brain fog. Several studies have proposed a link between chronic HCV infection and the development of cognitive alterations, but the inclusion of confounding factors in their samples significantly limits the analysis of the results. In this article, we will give an overview about cognitive dysfunction in patients with HCV.
1. Introduction
The occurrence of cognitive alterations in patients with chronic liver disease is extensively documented in cases of hepatic encephalopathy and minimal hepatic encephalopathy resulting from the development of cirrhosis and its subsequent evolution to hepatic insufficiency. However, with the onset of hepatitis C virus infection, complaints of cognitive changes in patients without cirrhosis or significant hepatic impairment have been reported .
2. Pathophysiology of Cognitive Impairment
3. Evidence of Cognitive Dysfunction in Patients with HCV
| Study |
You May Like: Hepatitis B Vaccine Schedule For Adults
Assessing The Severity Of The Infection
If you are found to have virus present then other tests may be advised to check on the extent of inflammation or damage to the liver. For example:
- Blood tests called liver function tests. These measure the activity of chemicals and other substances made in the liver. This gives a general guide as to whether the liver is inflamed and how well it is working. See the separate leaflet called Liver Function Tests. Other blood tests will also be done for various reasons. For example, tests to check for other illnesses which can be passed on in the same way, such as HIV or hepatitis B. Also tests of other functions of the liver, such as the ability of blood to clot properly, and levels of iron stores.
- An ultrasound scan of the liver.
- Other tests may be done if cirrhosis or other complications develop.
- There are other specialised blood tests being developed which assess the development and severity of cirrhosis.
- A small sample of the liver taken to look at under the microscope used to be recommended before considering treatment. However, this is no longer routine prior to treatment. See the separate leaflet called Liver Biopsy.
Hepatitis C Virus Can Damage Brain Cells
Hepatitis C virus can damage not only the liver but also the brain, according to a new Canadian study.
“It has been a question for a long time,” said study co-author Pornpun Vivithanaporn, a post-doctoral fellow in the University of Alberta’s Faculty of Medicine and Dentistry. “It proves the virus has implications on neurological disease.”
The study showed HCV “gets in , it infects, and it replicates,” said lead author Dr. Christopher Power, a neurologist at the university. A buildup of HCV proteins in healthy brain cells eventually damages and kills the cells, as if the cells were drowning in their own refuse, he said.
“HCV core protein exposure caused neuronal injury through suppression of neuronal autophagy in addition to neuroimmune activation,” the study concluded. “The additive neurotoxic effects of HCV- and HIV-encoded proteins highlight extrahepatic mechanisms by which HCV infection worsens the disease course of HIV infection.”
Researchers already knew that severe liver damage can affect the patient’s brain. The new findings support other studies showing that even when serious liver damage has not occurred, HCV patients might develop memory loss, trouble concentrating, apathy, and depression.
“It tells us we need to be vigilant for neurological problems for people who have hepatitis C,” Power said. An HCV patient’s treatment team might need to include a neurologist and a psychologist, as well as the liver specialist, he said.
Also Check: What Is Hepatic Metastatic Disease
What Is Hepatitis C
Hepatitis means inflammation of the liver. There are many causes of hepatitis, of which the hepatitis C virus is only one. Please read the separate leaflet called Hepatitis for more information about what the liver is, what it does, and the other causes of hepatitis.
One virus that causes hepatitis is called the hepatitis C virus . This leaflet is only about hepatitis C. See separate leaflets called Hepatitis A and Hepatitis B, which are caused by different viruses. Hepatitis C is also sometimes called ‘hep C’. Hepatitis C was only discovered in the 1980s so it is still a relatively new disease some aspects of this disease are still not completely understood.
Hepatitis C is a virus which is carried in the bloodstream to the liver. It can then affect and damage your liver. However, this virus can also affect other parts of the body, including the digestive system, the immune system and the brain.
There are six types of the hepatitis C virus. These different types are called genotypes and they are numbered 1 to 6. The most common subtypes of hepatitis C in the UK are genotypes 1 and 3. It is important to know which type you have, as different types respond differently to treatment. It is possible to be infected with more than one type of hepatitis C at the same time.
Factors Contributing To Brain Fog
Fatigue – Fatigue is one of the most common and most pervasive symptoms of HCV. Patients also undergoing interferon or ribavirin therapies can experience insomnia or sleep disturbances, those sleep disturbances often lead to headaches or moodiness, which can worsen symptoms of brain fog.
Anxiety – Often, those who are diagnosed with hepatitis C experience anxiety about the infection, symptoms, and/or treatment. That anxiety can cause a patient to feel edgy or irritable, which can worsen symptoms of brain fog.
Sadness or Depression – Sadness or depression are common symptoms of being diagnosed with and/or undergoing treatment for hepatitis C, and its also a common side effect of many HCV treatment regimens, which can worsen symptoms of brain fog. While those feelings typically subside soon after treatment ends and an SVR is achieved, its important you talk to your doctor if you are sad or depressed, because they may be able to prescribe antidepressants or suggest alternative therapies.
Also Check: What Is Hepatitis C And What Causes It
Life Expectancy And Prognosis
Can you die from hepatitis? Technically, the complications of chronic hepatitis C are fatal. About 30,000 people in the U.S. die each year from cirrhosis.
How long can you live with untreated hep C? The disease affects everyone differently, so thereâs no rule. But about 70% to 80% of people with will get chronic help C. Within 20 years, about 20% to 30% of those people will get cirrhosis. From there, it depends on what type of cirrhosis you have, your treatment, and if you can get a liver transplant.
Can hepatitis C go away on its own? Yes. From 15% to 20% of people with hep C clear it from their bodies without treatment. Itâs more likely to happen in women and people who have symptoms. But it usually happens between 4 and 18 months after symptoms start.
American Liver Foundation Hep C 123: âFrequently Asked Questions.â
Gastroenterology: âExtrahepatic morbidity and mortality of chronic hepatitis C.â
National Institute of Diabetes and Digestive and Kidney Diseases: âHepatitis C.â
Therapeutic Advances in Infectious Disease: âExtrahepatic Manifestations of Chronic Hepatitis C Virus Infection.â
The Hepatitis C Support Project: âAn Overview of Extrahepatic Manifestations of Hepatitis C.â
BioDrugs: âManagement of hepatitis C virus-related arthritis.â
Frontiers in Endocrinology: âDiabetes and Hepatitis C: A Two-Way Association.â
U.S. National Library of Medicine: âAtherosclerosis,â âPreventing Hepatitis B or C.â
Replication Of Hcv In Brain
HCV, though primarily infecting the liver, is frequently associated with CNS abnormalities. Neurocognitive defects in chronic HCV infection independent of hepatic encephalopathy is increasingly reported in several studies. It is however unclear if the CNS itself supports the viral replication. A recent study has shown the expression of HCV receptors in the brain microvascular endothelial cells. Interestingly, the microvascular endothelia are the only cells in the neuronal pool to bear the receptors for HCV. Microvascular endothelial cells, that form integral components of blood brain barrier , are thus assumed to play critical role in the transit of HCV into CNS.
Quantification of HCV RNA in the brain, liver and plasma have shown a 1000-10000 fold lower load in brain compared to the liver. The HCV RNA was detected in a minimum of one region of the brain of four HCV infected subjects, independent of human immunodeficiency virus co-infection status. The viral RNA quantities from the brain and liver – however significantly varied between clinical samples, which may be due to a higher postmortem interval resulting in the degradation of RNA in some sample. The E1 and 5 untranslated region sequences of HCV also varies between the liver, brain and plasma, further reinforcing the hypothesis of HCV replication and involvement in the brain.
Recommended Reading: Where To Get Hepatitis B Test