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Published on: Oct 28, 2020
2 minute read
By: Dr Rajan ( Medical Second Opinion Cell)

Hepatitis C Nobel Prize

Earlier this month the Nobel Prize in Physiology and Medicine was jointly awarded to Harvey J Alter, Michael Houghton and Charles M Rice for the discovery of the Hepatitis C virus. This helped push our understanding of blood-borne hepatitis, a major global health problem that is one of the leading causes of cirrhosis and liver cancer alongside Hepatitis B. It led the way in introducing new tests for chronic hepatitis as well as new treatments that have saved the lives of millions.

HEPATITIS

Hepatitis is the inflammation of your liver, the largest solid organ in your body. Though there are numerous other causes of hepatitis, including alcohol abuse, drugs and toxins (including paracetamol overdose), and autoimmune disorders (such as Wilson’s disease), viral infections are the most common worldwide causes for hepatitis. Hepatitis A was the first to be discovered, transmitted by polluted food and water, and results in a short-term transient hepatitis. Hepatitis B on the other hand is transmitted through blood and is more of an issue as it can lead to chronic cirrhosis and possible liver cancer. It can remain indolent in a person, causing disease long after the initial infection.

Blood borne hepatitis was first discovered in the 1960s, when it was found that some patients would become ill after receiving blood transfusions. Despite this discovery and new tests for Hepatitis B reducing the number of transfusion related hepatitis, a large number of cases remained.

NOT A, NOT B

Harvey Alter, working at the US National Institute of Health, was studying the occurrence of hepatitis in blood transfusion patients. His team showed that blood from these infected patients could transmit the disease to chimpanzees, resulting in hepatitis. This agent had the properties of a virus, one that was “non-A, non B” hepatitis.

Further investigation into the virus would require the input of Michael Houghton, working for Chiron pharmaceutical. His team created a collection of DNA fragments found in the blood of infected chimpanzees. Though the majority of these fragments were from the chimpanzee, enough were from the virus. They were able to utilise this information to identify antibodies against the suspected virus, and ultimately identify it as the flavivirus Hepatitis C.

The final piece of the puzzle was shown by Charles M Rice, a researcher at Washington University, St Louis – could the virus alone cause hepatitis. He studied the RNA of Hepatitis C to identify regions that may be used for replication, and areas that might hinder replication. This was key as the virus can lay dormant for years, replicating at a slow rate before causing damage to the liver. For researchers, this was an issue as it was not feasible to wait years and see if the suspected virus caused hepatitis. By genetically engineering the viral genome, he developed a variant of Hepatitis C that would only multiple rapidly and have no mechanism to inactivate itself for dormancy. This strain caused rapid changes to the livers of infected chimpanzees; the same changes seen in hepatitis patients.

. ;.,hrvxzThe impact was significant. Prior to this, receiving a blood transfusion was like Russian Roulette. You were receiving life saving therapy, but it coZuld also be a hidden death sentence. Now that hepatitis had been discovered, it became possible to screen patients prior to donation, to screen blood transfusion bags, and to start developing treatments for the virus.

The fight is not over yet. There are still over 70 million people who still live with the virus, and it still kills around 400,000 a year. Its only very recently that we have found treatments that can reduce the viral load in patients to levels that they are considered cured. This treatment remains expensive, and we are very far away from eradication itself.

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why fatigue should not be ignored

Feeling tired occasionally is a normal response to physical exertion, lack of sleep or emotional stress. However, when fatigue becomes persistent, overwhelming or unexplained, it should not be dismissed. Fatigue is one of the most common symptoms reported in healthcare, yet it is also one of the most frequently ignored.

Understanding why fatigue should not be ignored is essential because it often acts as an early warning sign of deeper physical or mental health issues.

What Is Fatigue?

Fatigue is a state of ongoing physical, mental or emotional exhaustion that:

lasts longer than expected
interferes with daily activities
does not improve with rest or sleep

Unlike ordinary tiredness, fatigue affects motivation, concentration and overall functioning.

Why Fatigue Is Commonly Ignored

Fatigue is often dismissed because:

busy lifestyles normalise exhaustion
symptoms develop gradually
people attribute fatigue to stress or ageing
rest temporarily masks the issue

Ignoring fatigue allows underlying conditions to progress unnoticed.

Common Medical Causes of Persistent Fatigue

Nutritional Deficiencies

Deficiencies in:

iron
vitamin B12
vitamin D
magnesium

can significantly reduce energy levels and cause weakness.

Anaemia

Anaemia reduces oxygen delivery to tissues, leading to:

constant tiredness
breathlessness
dizziness

It is one of the most common yet underdiagnosed causes of fatigue.

Thyroid Disorders

Both underactive and overactive thyroid conditions affect metabolism.

Symptoms include:

fatigue
weight changes
cold or heat intolerance

Thyroid-related fatigue often persists despite rest.

Chronic Infections

Low-grade or unresolved infections keep the immune system activated, causing prolonged fatigue.

Hormonal Imbalance

Hormones regulate energy, sleep and metabolism.

Imbalance may lead to:

exhaustion
poor sleep
low motivation

Poor Sleep Quality

Even with sufficient sleep duration, poor sleep quality can cause fatigue due to:

sleep apnea
frequent awakenings
stress-related insomnia

Mental Health Conditions

Anxiety, depression and chronic stress commonly present with fatigue as a primary symptom.

Mental fatigue is as real and impactful as physical fatigue.

Lifestyle Factors That Worsen Fatigue

Certain habits intensify tiredness:

irregular meals
excessive caffeine
dehydration
lack of physical activity
prolonged screen use

Lifestyle-related fatigue often coexists with medical causes.

How Fatigue Affects Daily Life

Persistent fatigue impacts:

work performance
concentration and memory
emotional regulation
physical activity
social relationships

Over time, quality of life declines significantly.

Warning Signs That Fatigue Needs Medical Attention

Seek evaluation if fatigue:

lasts more than two weeks
worsens progressively
occurs with weight loss or fever
is associated with breathlessness
interferes with daily tasks

These signs suggest an underlying issue.

Why Early Evaluation Matters

Early identification of fatigue causes:

prevents disease progression
simplifies treatment
improves recovery time
restores normal energy levels

Delayed care often leads to chronic complications.

Diagnostic Evaluation for Fatigue

Assessment may include:

detailed history
blood tests
nutritional screening
hormonal evaluation
sleep assessment

Testing helps identify root causes rather than treating symptoms alone.

Can Fatigue Be Prevented?

Some preventive measures include:

balanced nutrition
adequate hydration
regular physical activity
consistent sleep routine
stress management

However, prevention does not replace evaluation when fatigue persists.

Fatigue and Chronic Disease Risk

Long-term fatigue may be linked to:

cardiovascular disease
metabolic disorders
immune dysfunction

This makes fatigue an important early health signal.

When Rest Is Not Enough

If energy does not return after:

adequate sleep
reduced workload
lifestyle changes

medical evaluation is essential.

The Cost of Ignoring Fatigue

Ignoring fatigue can lead to:

delayed diagnosis
worsening health conditions
reduced productivity
emotional burnout

Listening to the body early prevents long-term consequences.

Conclusion

Fatigue is not merely a sign of a busy life—it is often the body’s way of signalling imbalance or illness. Persistent tiredness that does not improve with rest should never be ignored. Whether caused by nutritional deficiencies, hormonal changes, chronic stress or underlying disease, fatigue deserves attention. Early evaluation and timely care can restore energy, prevent complications and significantly improve quality of life. Listening to fatigue is an act of self-care and preventive health.

References

Indian Council of Medical Research (ICMR) – Fatigue and Lifestyle Health Report
World Health Organization (WHO) – Chronic Fatigue and Health Guidelines
National Institute of Nutrition (NIN) – Nutrient Deficiency and Energy Research
Lancet – Fatigue as a Marker of Chronic Disease Studie
Indian Journal of Medicine – Persistent Fatigue and Diagnosis
Statista – Fatigue, Stress and Health Trend Analysis

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