Introduction:
The liver is one of the important organs for metabolism. Various functions like the production of bile, processing of hemoglobin, production of urea, and regulation of blood clotting are maintained liver. Any infectious condition is responsible for the impairment of the function of the liver. Hepatitis B and Hepatitis C are one of the common infectious conditions of the liver. In some rare cases, a person may be affected by both viruses.
What Is Hepatitis B?
It is a serious liver infection caused by hepatitis B virus. According to World Health Organization (WHO), it may lead to life-threatening liver disorders. This virus belongs to the Hepadnaviridae family. Such viruses are found in ground squirrels, tree squirrels, and woodchucks. Around 1.5 million people globally are affected by such viruses every year. Such viruses are categorized into eight genotypes.
1. Transmission:
The route or method of transmission of the hepatitis B virus can be divided into two ways:
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Horizontal transfer occurs through sexual contact or through mucosal contact. Unprotected sex, semen, saliva, blood, and vaginal secretions are responsible for such transmission. The use of contaminated needles is also responsible for virus transmission.
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In the case of vertical transmission, the transmission occurs from the mother to the fetus.
2. Structure of The Virus:
The transmissible form of the virus is known as a virion. The virion is composed of double-standard DNA (deoxyribonucleic acid) materials. The inner material is enveloped by the lipid membrane. Hepatitis B surface antigens are present on the surface of the lipid membrane. These surface antigens are nothing but proteins that are divided into three types S, L, and M type.
3. Pathophysiology:
The incubation period of the hepatitis virus is 30 to 180 days. The life cycle of the hepatitis B virus starts with binding with hepatocyte cells. The conformational change in the membrane helps in the binding of the virus to the cell surface. After this, the virus enters the cell via endocytosis. After this, the viral genome is released in the cell. The addition of viral antigens in the cell surface initiates an immune reaction. This causes activation of the T-lymphocytes. The action of the cytotoxic T-cells is responsible for the destruction of the liver cells.
What Is Hepatitis C?
Hepatitis C is another viral infection that is responsible for liver infections. Acute cases of hepatitis C infections are usually asymptomatic, and patients may be cured after six months. Chronic conditions may cause cirrhosis of the liver. A high incidence of this disease is seen in the Eastern Mediterranean region and European region. Around 1.5 million people globally are infected by this virus every year.
Transmission:
The transmission of the Hepatitis C virus mainly occurs through the blood and blood products. Blood transfusion is one of the key causes of such infections. Apart from this, the use of contaminated instruments in medical surgical procedures may cause transmission of such infections. The infection may be transmitted to the child via the mother. Blood contamination during sexual contact, especially who have multiple sexual contacts, increases the incidence of transmission of such viruses.
Structure:
Hepatitis C is a single-stranded RNA (ribonucleic acid) virus. It belongs to the family of Flaviviridae and the genus Hepacivirus. The viral genome is enclosed by an envelope with a diameter of 56 to 65 nanometers. The diameter of the core is about 45 nanometers. Spikes are present on the virus's outer surface, and the spike's length is 6 nanometers. These spikes are made up of glycoproteins.
Pathophysiology:
Specific molecules present on the hepatic cell surface help in the adhesion of the virus on their cell surface. The virus enters the cell via the endocytosis process. After entering into the cells, new viral RNA is formed through a complex procedure, and it is enclosed by glycoproteins. The mature virus exits the cell through exocytosis. The virus is detectable in the plasma within one to four weeks of exposure. The viremia reaches its peak within eight to twelve of the infection. The release of the virus in the extracellular environment and the release of the inflammatory mediators lead to the activation of the T- lymphocytes. These lymphocytes are responsible for damage to the liver cells.
What Is Hepatitis B and C Co-infection?
The presence of two or more replication organisms in the host's body is known as co-infection. The incidence of co-infection ranges from 1 to 15 percent worldwide. However, such incidence may vary in different geographical locations. The reason for the co-infection is not clear. Maybe it is linked to the common route of transmission. Blood transfusion and vertical transmission are the most common modes of transmission. Immunocompromised patients are susceptible to developing co-infections. Superinfection may be another cause of co-infection. In this case, the person already suffering from one infection is infected by another infection.
The site of the replication of the viruses is one of the main matters of concern. According to several studies, both viruses replicate in the same cell. According to some researchers, the replication rate of Hepatitis B is suppressed by Hepatitis C. Influence of the micro (mi)RNA also plays a pivotal role in the higher rate of replication of the Hepatitis C virus.
What Are the Clinical Conditions?
The types of hepatitis infections are:
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Acute Hepatitis B and Hepatitis C infections interact like chronic infections. The diagnosis of Hepatitis B infection in such cases may be delayed by six weeks. Decreased levels of alanine aminotransferases (ALT) are seen in such cases. Hepatitis B surface antigens appear for a shorter period of time in such cases.
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Due to the hepatitis C superinfection, replication of Hepatitis B is suppressed, and the surface antigen for Hepatitis B is reduced. Gradually patients develop chronic infections caused by Hepatitis C.
- Superinfection of Hepatitis B is very rare. This causes suppression of Hepatitis C infection.
- Superinfection caused by Hepatitis C leads to fulminant hepatitis (rapid destruction of liver cells).
- The rate of liver cirrhosis is higher in co-infection patients than in persons suffering from Hepatitis mono infections.
- The chances of the development of hepatic carcinoma increase tremendously in Hepatitis co-infections.
What Are the Treatment Options?
The treatment options in such cases depend upon the nature of the infections.
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In Hepatitis C dominant cases direct-acting anti-viral drugs like Ledipasvir, Sofosbuvir, and Sofosbuvir can be used. Also, Pegylated-interferon (PegIFN) and Ribavirin can be used for the treatment.
- In Hepatitis B dominant cases Pegylated-interferon (PegIFN) and nucleoside analogs can be used.
- In severe cases of liver fibrosis or cirrhosis of the liver cirrhosis liver transplantation can be done.
Conclusion:
Hepatitis b and Hepatitis C may cause serious liver problems. These viral infections cause the death of the liver cells and liver dysfunctions. Blood transfusion, unprotected sex, and contaminated food are the prime mood of viral transmission. In some rare cases, patients may infect by both Hepatitis B and C infection. This co-infection may lead to liver failure or carcinoma of the liver. Anti-viral drugs can be used for the treatment of such conditions.
