Chronic Hepatitis C is One of The Major Causes of Liver Fibrosis

Chronic Hepatitis C is one of the major causes of liver fibrosis with distortion of the hepatic architecture and, ultimate progression to cirrhosis. Approximately more than 3% of the total world population are chronically infected with HCV and due to a gradual increase in the prevalence of HCV, future burden of Chronic HCV is predicted to raise at least 3-fold by the year 2020. Common causes of liver fibrosis are viral hepatitis and steato hepatitis with alcohol or obesity.

HCV is highly prevalent among individuals who are obese and have typr-2 diabetes mellitus with metabolic syndromes. Insulin resistance, is the mechanism of underlying metabolic syndrome and non-alcoholic steatohepatitis (NASH). Several HCV proteins have been shown to have direct oncogenic effect and to up regulatemutagenic process. Increased cell proliferation in asetting of oxidative stress leads to accumulation of DNA damage. Similar to nonalcoholic fatty liver disease(NAFLD),oxidative stress, steatisis and insulin resistance are involved in the pathogenesis of HCV infection .Some HCV nonstructural protein  have been shown to interfere with very low density lipoprotein(VLDL) secretion. HCV infection also up regulate lipid synthesis, inhibit fatty acid oxidation and increase release of fatty acid from adiposities. HCV have been shown to interfere with glucose homeostasis.

A number of studies have implicated a direct role of cellular lipid metabolism in the HCV life cycle and inhibitors of the mevalonate pathway have been demonstrated to result in an antiviral state within the host cell.

Epidemiological data indicate a strong risk for development of IR and ultimately over diabetes mellitus in patient with HCV infection .more over there is a evidence that liver fat can have an impact on the development of hepatic IR independently of changes in adipose tissue. IR play an important role in the development of metabolic syndrome which are the central obesity, elevated triglycerides, reduced high density lipoproteincholesterol, elevated blood pressure and elevated fasting plasma glucose.

Chronic HCV infection is the most common chronic blood born infection affecting approximately 2% of the population. However, ALT levels fluctuate in HCV and values may occasionally fall into the normal range. SinceHCV infection is frequently asymptomatic, ALT elevations noted upon routine blood testing often stimulate the work-up where by HCV infection is diagnosed. Sixty nine percent of 248 asymptomatic blood donors who tested positive for HCV antibody had elevated ALT activity. Sixty eight percent of patient positive for HCV RNA had elevated ALT level compared with 17% of those without detectable RNA. While ALT analysis is alone fail to detect minority of person infected with HCV, it is most effective in decting those persons whose liver disease is more severe. Such a characteristics enhances the value of ALT as screening tool for detection of clinically important liver disease. More over the senestivity of ALT analysis can be improved with serial measurements and long- term follow-up.