<prompt> Evaluation of specimen from a patient with hepatocellular carcinoma demonstrates presence of single strand RNA virus. Which of the following is the most probable etiological agent -Hepatitis A virusHepatitis B virusHepatitis C virusHepatitis E virus  <response>: Ans. is c i.e., Hepatitis C virus Following table enumerates the factors associated with increased risk of hepatocellular carcinomaFactors associated with an Increased risk of developing HCCCommonUnusualCirrhosis from any causeHepatitis B or C chronic infectionEthanol chronic consumptionNASHNAFLAFLATOXIN B1 or other mycotoxinsPrimary biliary cirrhosisHemochromatosisal Antitrypsin deficiencyGlycogen storage diseasesCitulinemia Porphyria cutanea tordaHereditary tyrosinemiaWilsons disease From the options given, chronic infection with either Hepatitis B or Hepatitis C is associated with increased risk of hepatocellular carcinoma. Hepatitis B virus is a DNA virus either double stranded or single stranded Hepatits C virus is RNA virus single stranded. Thus isolation of single stranded RNA virus from the specimen points to Hepatitis C virus as the etiological agent for this particular patient. HAVHBVHCVHDVHEVCommon nameInfectious hepatitisSerum hepatitisNon A non B or Post transfusion hepatitisDelta agentNon A non B enteric transmitted hepatitisFamilyEntero 72HepadnaFlavi viridaeViroid likeCalci viridaeAgeChildren, young adultsYoung adults, babies, toddlersAny age, but more common in adultsAny age similar to HBVYoung adult 20- 40 yearsRouteFaeco-oral MC blood - sexual -Blood MC Sexual, verticalBlood MC sexual - vertical -Blood MC sexual -H- vertical Faeco-oralI.P days15-45, mean 3030-180, mean 60-9015-160, mean 5030-180, mean 60-9014-60, mean 40OnsetAcuteInsidiousInsidiousInsidiousAcuteFulminant0.10.1-10.15-20Usually 1 -2 and pregnancy 20-40CarrierNone01-301-5-3 2VariableNoneChronicityNoneOccasional 1- 10 90 of neonatesCommon 85CommonNoneOncogenicNilPresent neonatePresent-NilAssociated other featureSecondary attack rate 10-20HCC, cirrhosis, autoimmune disorder like AGN, arthritis PANHCC, cirrhosis, autoimmune- AGN arthritis, cryoglobulinemiaHCC, cirrhosis, fulminant hepatitisSecondary attack rate 1-2 not seen western countriesPrognosisExcellentWorse with age, debilityModerateAcute-good chronic-poorGoodProphylaxisIG, Inactivated vaccineHBIG, recombinant vaccineNoneHBV vaccine none for HBV carriersRecombinant vaccineTharapyNoneInterferon lamivudine adefovir entecavirPegylated interferon plus boceprevirInterferon - ribavirin talaprevitNone 