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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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Yellow Eyes and Skin Symptoms: Causes, Warning Signs and When to Seek Care

Yellowing of the eyes and skin is one of the most noticeable physical changes a person can experience. Often referred to as jaundice, this symptom is not a disease by itself but a sign of underlying health conditions. Understanding yellow eyes and skin symptoms is essential because they frequently indicate problems involving the liver, blood or bile ducts and may require urgent medical attention.

In India, jaundice is a common presentation across age groups due to infections, liver disease and metabolic disorders.

What Does Yellowing of Eyes and Skin Mean?

The yellow colour appears due to excess bilirubin in the blood.

Bilirubin is:

a yellow pigment
produced from the breakdown of red blood cells
processed and removed by the liver

When bilirubin builds up, it deposits in tissues, causing yellow discoloration.

Why the Eyes Turn Yellow First

The sclera, or white part of the eyes, contains elastic tissue that binds bilirubin easily.

This makes yellowing:

more visible in eyes
detectable before skin changes

Yellow eyes are often the earliest sign of jaundice.

Common Causes of Yellow Eyes and Skin

Liver-Related Causes

The liver plays a central role in bilirubin metabolism.

Common liver causes include:

viral hepatitis (A, B, C, E)
fatty liver disease
alcoholic liver disease
liver cirrhosis
drug-induced liver injury

ICMR reports viral hepatitis as a major cause of jaundice in India.

Bile Duct Obstruction

Blocked bile flow prevents bilirubin excretion.

Causes include:

gallstones
bile duct strictures
pancreatic or bile duct tumours

This type of jaundice is often associated with itching and pale stools.

Blood Disorders

Excess breakdown of red blood cells increases bilirubin production.

Conditions include:

hemolytic anemia
malaria
inherited blood disorders

The liver may be overwhelmed despite being healthy.

Infections

Certain infections directly affect liver function.

Examples include:

hepatitis viruses
leptospirosis
severe sepsis

WHO data highlights hepatitis as a leading infectious cause of jaundice globally.

Newborn and Pregnancy-Related Causes

While common in newborns, jaundice in adults always needs evaluation.

Pregnancy-related liver disorders can also cause yellowing.

Associated Symptoms That Provide Clues

Yellow eyes and skin are often accompanied by:

dark yellow or tea-coloured urine
pale or clay-coloured stools
itching
fatigue
abdominal pain
loss of appetite

These symptoms help identify the underlying cause.

When Yellowing Becomes Dangerous

Seek urgent medical care if yellowing is accompanied by:

high fever
severe abdominal pain
confusion or drowsiness
vomiting
rapid worsening of colour

These signs suggest severe liver or systemic disease.

Jaundice and Liver Function

The liver normally:

conjugates bilirubin
excretes it into bile

When liver cells are damaged, bilirubin accumulates.

Lancet studies confirm jaundice as a key marker of liver dysfunction.

Diagnostic Evaluation

Doctors evaluate jaundice using:

blood tests for bilirubin levels
liver function tests
viral markers
ultrasound or CT scans
additional tests based on findings

Early testing identifies reversible causes.

Impact on Daily Life

Persistent jaundice can affect:

energy levels
digestion
mental clarity
work performance

Untreated liver disease can progress silently.

Treatment Depends on the Cause

There is no single treatment for jaundice.

Management focuses on:

treating infection
relieving bile obstruction
stopping harmful medications
managing chronic liver disease

Self-medication can worsen liver injury.

Role of Preventive Healthcare

Preventive measures include:

hepatitis vaccination
safe drinking water
limiting alcohol intake
regular health checkups

NITI Aayog emphasises liver health in preventive care strategies.

Lifestyle Factors That Affect Liver Health

Risk factors include:

excessive alcohol
obesity
high-fat diets
unsafe injections

Addressing these reduces jaundice risk.

Importance of Early Detection

Early diagnosis:

prevents complications
improves recovery
reduces hospitalisation

Delays increase the risk of liver failure.

Jaundice Is a Symptom, Not a Diagnosis

Understanding this distinction is crucial.

Treating the symptom alone:

does not resolve the disease
may mask serious conditions

Medical evaluation is essential.

Conclusion

Yellow eyes and skin symptoms are visible warning signs that should never be ignored. Most often linked to jaundice, they reflect underlying problems involving the liver, bile ducts or blood. Early medical evaluation, accurate diagnosis and timely treatment are critical to prevent serious complications. Recognising these symptoms and seeking care promptly can protect liver health and save lives.

References

Indian Council of Medical Research (ICMR) – Hepatitis and Liver Disease Reports
World Health Organization (WHO) – Jaundice and Hepatitis Guidelines
National Family Health Survey (NFHS-5) – Liver and Metabolic Health Indicators
Lancet – Liver Function and Bilirubin Research
NITI Aayog – Non-Communicable Diseases and Liver Health
Statista – Liver Disease and Hepatitis Trends

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