After entering the hepatocyte, the DNA of the hepatitis virus is uncoated and brought to the nucleus. Once there, the DNA is transcribed and the resulting mRNA is transported to the cytoplasm. The viral genetic material is replicated by reverse transcriptase and viral proteins are synthesized. The viral DNA and proteins are assembled and enveloped before exocytosis. The resulting viremia can lead to either an acute viral hepatitis (with or without fulminant hepatic necrosis) or a chronic necro-inflammatory process. The individual's immune response determines the level of injury from the viremia. Patients with a rapid viral clearance from a massive immune response typically develop signs and symptoms of viral hepatitis and subsequent failure. An example:
Acute hepatitis C
Acute hepatitis C refers to the first 6 months after infection with HCV. In the minority of patients who experience acute phase symptoms, the symptoms are generally mild and non-specific (decreased appetite, fatigue, abdominal pain, jaundice, itching, and flu-like symptoms). Chronic hepatitis C
Chronic hepatitis C is defined
as infection with the hepatitis C virus persisting for more than six months. Clinically, it is often asymptomatic (without jaundice) and is mostly discovered accidentally. Among untreated patients, roughly one-third progress to liver cirrhosis in less than 20 years. Hepatitis C is a systemic disease and patients may experience a wide spectrum of clinical manifestations, ranging from an absence of symptoms to a more symptomatic illness prior to the development of advanced liver disease. Generalized signs and symptoms include fatigue, marked weight loss, flu-like symptoms, muscle pain, joint pain, intermittent low-grade fevers, itching, sleep disturbances, abdominal pain and GI problems, appetite changes, cognitive changes, depression, headaches, and mood swings. Once chronic hepatitis C has progressed to cirrhosis, signs and symptoms may appear that are generally caused by either decreased liver function, such as portal hypertension, ascites, bruising and bleeding tendency, bone pain, oesophagal varices, steatorrhoea, jaundice, and encephalopathy.
Serology of hepatitis A, B and C infection:
Which of the following is true of infection with hepatitis B?