ACUTE: the rapid-onset, short-term initial stage of a disease. Contrast with chronic.

ACUTE HEPATITIS: the initial stage of viral hepatitis following infection. In HCV, acute hepatitis refers to the first six months of infection.

ADVERSE EVENT: an undesired reaction or side effect of treatment.

ALOPECIA: hair loss.

ALT (formerly SGPT): abbreviation for alanine aminotransferase. ALT is an enzyme produced inside liver cells. It is frequently elevated in people with chronic HCV infection because of a breakdown of the membranes of liver cells due to inflammation. Serum ALT levels are measured using a common blood test.

ANEMIA: reduced number of red blood cells or reduced ability of blood to carry oxygen. There are several types of anemia, all with different causes. Symptoms may include fatigue, weakness, pale skin, and difficulty breathing.

ANTIBODY: a protein produced by the immune system when a foreign substance enters the body. The presence of antibodies is an indicator of a past or possibly current infection. HCV antibodies are written as “anti-HCV." The test for anti-HCV is often the first step in diagnosing chronic HCV infection. A positive anti-HCV test must be followed by other laboratory tests to confirm the diagnosis. The antibody test alone is not sufficient to make a diagnosis of chronic HCV infection.

ANTIBODY TEST test can determine whether you have been exposed to the hepatitis C virus, A positive screen test means that you have hepatitis C antibodies in your blood. This does not always mean that you have hepatitis C.

ARTHRALGIA: joint pain.

AST (formerly SGOT): abbreviation for aspartate aminotransferase. AST is an enzyme produced in the liver. When liver cells are damaged, AST is released. Elevated levels may indicate liver disease, but are also seen in people with other conditions.

AUTOIMMUNE RESPONSE (AUTOIMMUNITY): a condition in which a person’s immune system produces antibodies that attack the body’s own tissues. Several conditions associated with hepatitis C appear to have an autoimmune aspect.

BID: taken twice a day.

BILIRUBIN: a yellowish pigment released when red blood cells are broken down. Normally bilirubin is processed and excreted by the liver. Hyperbilirubi-nemia (an excess level of bilirubin in the blood) indicates liver damage, and can lead to jaundice (yellowing of the skin and whites of the eyes), pale-colored stools, and dark urine.

BIOCHEMICAL RESPONSE: how a person’s serum ALT responds to treatment. When a person’s elevated serum ALT level becomes normal after HCV therapy has been initiated, this is considered a biochemical response.

BIOPSY: a procedure in which a sample of cells or tissue is taken to examine in a laboratory. In HCV, liver biopsies are used to assess the health of the liver.

BLOOD-BORNE: transmitted through direct blood-to-blood contact, for example, through sharing needles or through a blood transfusion.

BRAIN FOG: mental confusion, memory loss, and/or lack of alertness. Not to be confused with encephalo-pathy.

CHRONIC: long-term or persistent disease. Contrast with acute.

CIRRHOSIS: liver damage in which normal liver cells are replaced with scar tissue. In compensated cirrhosis, the liver is damaged but can still function. In decompensated cirrhosis, liver function is severely impaired and scar tissue interferes with normal blood flow through the liver, potentially leading to bleeding varices, ascites, mental confusion, and other symptoms.

COAGULOPATHY Coagulopathy is a medical term for a defect in the body's mechanism for blood clotting. Hemophilia is one type of congenital disease characterized by coagulopathy; these are examples of severe lack of blood clotting. Acquired causes of coagulopathy include anticoagulation with warfarin, liver failure, and disseminated intravascular coagulation.

 

COINFECTION: concurrent infection with more than one disease-causing organism (e.g., HCV and HIV).

CYTOPENIA: low levels of blood cells.

EDEMA: swelling caused by the accumulation of fluid in body tissues.

EFFICACY: effectiveness; the ability to achieve a desired effect.

ENCEPHALOPATHY: disease of the brain. Hepatic encephalopathy, associated with advanced cirrhosis, is characterized by reduced cognitive function, confusion, and memory loss.

END OF TREATMENT (EOT) RESPONSE: the disappearance of detectable HCV RNA from the blood at the end of a course of treatment.

EXTRAHEPATIC: outside the liver.

FDA: abbreviation for the Food and Drug Administration. This U.S. federal government agency has many functions, including the responsibility for granting or denying approval for drugs to be sold to the public.

FIBROSIS (adjective FIBROTIC): liver damage that involves the development of fibrous scar tissue.

FULMINANT HEPATITIS: a severe, life-threatening form of hepatitis.

GASTROENTEROLOGIST: A physician who specializes in the diagnosis and treatment of disorders of the gastrointestinal tract, including the esophagus, stomach, small intestine, large intestine, pancreas, liver, gallbladder, and biliary system.

GENOTYPE: genetic variation in the structure of HCV. There are six major genotypes, designated by the numbers 1 through 6. There are also many subtypes, e.g., 1a, 1b, 2a, etc. In the U.S., genotype 1 is predominant (approximately 70–75% of those infected).

HAEMOLYTIC ANAEMIA: is a rare form of anaemia in which red blood cells are destroyed (haemolysed) and removed from the bloodstream before their usual lifespan is up.Common signs and symptoms of haemolytic anaemia are feeling weak and fatigued (very tired) and having shortness of breath. People with haemolytic anaemia may be jaundiced (have a yellow discoloration of the skin or eyes), have dark urine, or have an enlarged spleen. RIBAVIRIN and HAEMOLYTIC ANAEMIA Regular monitoring of full blood count to detect haemolytic anaemia is needed in order to judge whether to reduce or cease ribavirin treatment.

HCV RNA: the genetic material of the hepatitis C virus. HCV is a single-stranded ribonucleic acid (RNA) virus.

HEMOLYSIS (or haemolysis)—from the Greek Hemo-, Greek ??µa meaning blood, -lysis, meaning to break open—is the breaking open of red blood cells and the release of hemoglobin into the surrounding fluid (plasma, in vivo).

HEPATIC: relating to the liver.

HEPATITIS: inflammation of the liver. Hepatitis may have various causes, including viruses, toxins, and heavy alcohol consumption.

HEPATOCELLULAR CARCINOMA (HCC): a type of primary liver cancer seen in some people with long-term liver damage due to chronic hepatitis C or hepatitis B.

HEPATOLOGY (also HEPATOLOGIST): the medical specialty that deals with the liver; a hepatologist treats liver disease.

HEPATOTOXICITY (adjective HEPATOTOXIC): toxic or poisonous to the liver.

HISTOLOGICAL: refers to bodily tissue. In HCV, histological improvement means improvement in liver tissue, either reduced inflammation or reduced fibrosis, when comparing pretreatment biopsies with biopsies obtained typically six months after HCV therapy.

INCUBATION PERIOD: the period of time between initial exposure to an infectious microorganism and the development of disease symptoms.

INTERFERON (IFN): a naturally occurring protein in the human body produced by the immune system. Interferon interferes with viral replication. Genetically engineered products based on the natural protein have been developed by several pharmaceutical companies, and are approved for the treatment of chronic HCV infection.

JAUNDICE: yellowing of the skin and whites of the eyes due to high bilirubin levels in the blood. Jaundice is often a sign of liver damage or gallbladder disease.

LIVER: a large organ on the upper right side of the abdomen that plays an important role in the metabolism of sugars and fats, synthesizes several proteins, and filters toxins from the blood.

MALAISE: a generalized feeling of illness and discomfort; a flu-like feeling. Monotherapy: use of a single drug for treatment. Traditionally, monotherapy for chronic HCV infection is interferon alone.

METAVIR classification for staging of hepatitis C liver disease :

Fibrosis Scale and Grading

Stage 0 No Fibrosis - No scarring

Stage 1 Portal fibrosis - Minimal scarring

Stage 2 Extraportal fibrosis - Scarring has occurred and extends outside the areas in the liver that contains blood vessels

Stage 3 Bridging fibrosis is spreading and connecting to other areas that contain fibrosis

Stage 4 Cirrhosis or advanced scarring of the liver

MYALGIA: muscle pain.

NEUTROPENIA: an abnormally low number of neutrophils, resulting in increased susceptibility to infection.

NEUTROPENIA: (adjective neutropenic), from Latin prefix neutro- and Greek suffix -pe??a (deficiency) is a hematological disorder characterized by an abnormally low number of a type of white blood cell called a neutrophil. Neutrophils usually make up 50-70% of circulating white blood cells and serve as the primary defense against infections by destroying bacteria in the blood. Hence, patients with neutropenia are more susceptible to bacterial infections and, without prompt medical attention, the condition may become life-threatening (neutropenic sepsis).

NEUTROPHIL: the most common type of immune system white blood cell. Neutrophils are phagocytes that engulf and destroy invading organisms such as bacteria and fungi.

NONRESPONDER: a person who does not show sufficient improvement while undergoing treatment. In HCV, a nonresponder is a person who does not experience a normalization of ALT levels or disappearance of HCV RNA.

PCR TEST: (Polymerase Chain Reaction) is used to detect the presence of the virus in the blood. If the PCR test is positive then you have hepatitis C

PEGYLATED INTERFERON (PEG-INTRON, PEGASYS): a form of interferon that has a long half-life in the body and can be injected less often (typically once per week). Pegylated interferon is approved for the treatment of HCV.

PERCuTANEOUS: through the skin.

PERINATAL TRANSMISSION (VERTICAL TRANSMISSION): transmission from a mother to a fetus or newborn. Vertical transmission may occur in utero (in the womb), intrapartum (during birth), or postpartum (e.g., via breast-feeding).

PHARMAC, the Pharmaceutical Management Agency of New Zealand. objective is to secure for eligible people in need of pharmaceuticals, the best health outcomes that are reasonably achievable from pharmaceutical treatment and from within the funding provided.

PLATELET: see thrombocyte.

PRURITUS (adjective PRURITIC): itchiness.

QUALITATIVE: relating to, or expressed in terms of, quality. A qualitative viral load test measures the presence of a virus.

QUANTITATIVE: relating to, or expressed in terms of, quantity. A quantitative viral load test measures the amount of viral genetic material.

QUASISPECIES: individual genetic variants of HCV. Within a single genotype there may be multiple quasispecies.

RELAPSE: recurrence of disease symptoms following a period of improvement. In HCV, relapse can refer to an increase in viral load after it has been suppressed by antiviral treatment.

RESPONSE TO TREATMENT: how a disease responds to drug therapy. The term can refer to a biological, histological, or virological response.

RETINOPATHY: is a general term that refers to some form of non-inflammatory damage to the retina of the eye. Most commonly it is a problem with the blood supply that is the cause for this condition. Frequently, retinopathy is an ocular manifestation of systemic disease.

RIBAVIRIN (COPEGUS, REBETOL): an antiviral medication that is used in combination with interferon for treatment of chronic HCV infection.

STEATOSIS: buildup of fat in the liver.

SUBCUTANEOUS (SQ): underneath the skin; usually refers to a drug injected under the skin.

SUSTAINED RESONDER: a person who maintains a long-term response to treatment. In HCV, a sustained responder has a long-term beneficial result from HCV treatment (usual endpoints are normal ALT and undetectable HCV RNA) that persists after treatment has been stopped (six months is the generally accepted time interval).

SUSTAINED VIROLOGICAL RESPONSE (SVR): see virological response.

THROMBOCYTE (PLATELET): a type of blood cell responsible for normal blood clotting.

THROMBOCYTOPENIA: an abnormally low number of platelets, which may result in abnormal bleeding and bruising.

THYROID GLAND: an organ at the base of the neck that produces thyroxin and other hormones involved in regulating metabolism.

TREATMENT-NAIVE: a person who has not had prior treatment for a particular condition.

VACCINE: a preparation administered to stimulate an immune response to protect a person from illness. A vaccine typically includes a small amount of a killed or inactivated microorganism, or genetically engineered pieces. A therapeutic (treatment) vaccine is given after infection and is intended to reduce or stop disease progression. A preventive (prophylactic) vaccine is intended to prevent initial infection.

VARICES (adjective VARICEAL): an abnormally dilated or swollen vein, artery, or lymph vessel resulting from portal hypertension.

VIRAL LOAD: the amount of virus (e.g., the HCV RNA level) that can be measured, usually in the blood.

VIRAL REPLICATION: the ability of a virus to reproduce copies of itself.

VIROLOGICAL RESPONSE: how a person’s viral load level responds to treatment. In HCV, when a person’s HCV RNA becomes undetectable after HCV therapy has been initiated, this is considered a virological response. If the HCV RNA remains undetectable beyond six months, the term sustained virological response (SVR) is used.

VIRUS: a microscopic, infectious organism that invades a living host and makes copies of itself (viral replication).

WINDOW PERIOD: the time between exposure to a microorganism and the production of sufficient antibodies to be detected in a test.