Tazama chanzo cha Homanyongo C

[[Picha:HCV EM picture 2.png|thumbnail|right|200px|Homanyongo C]]

''<sup>Kwa ugonjwa tofauti ambao wakati mwingine jina lake linachanganywa tazama [[Homa ya manjano]]</sup>''
{{Infobox disease
|  Name           = Homa ya nyongo C (Hepatitis C)
|  Image          = HCV EM picture 2.png
|  Caption        = [[Electron micrograph]] of [[hepatitis C virus]] purified from cell culture (scale = 50&nbsp;[[nanometers]])
|  DiseasesDB     = 5783
|  ICD10          = {{ICD10|B|17|1|b|15}}, {{ICD10|B|18|2|b|15}}
|  ICD9           = {{ICD9|070.70}},{{ICD9|070.4}}, {{ICD9|070.5}}
|  OMIM           = 609532
|  MedlinePlus    = 000284
|  eMedicineSubj  = med
|  eMedicineTopic = 993
|  eMedicine_mult = {{EMedicine2|ped|979}}
|  MeshID         = D006526
}}

'''Homa ya nyongo C'''<ref>Wakati mwingine homa ya nyongo inaitwa "homa ya manjano" lakini hii ni ugonjwa tofauti. Taz [[homa ya manjano]] (ing. Yellow fever)</ref> (pia '''homanyongo C''', kwa [[Kiingereza]] '''Hepatitis C''') ni [[ugonjwa wa kuambukiza]] unaoshambulia zaidi [[ini]]. 

[[Virusi]] vya Homanyongo C ndivyo vinavyosababisha [[ugonjwa]] huu wa ini. <ref name=Sherris>{{cite book | title = Sherris Medical Microbiology | url = https://archive.org/details/sherrismedicalmi0000unse_q1i3 | edition = 4th | publisher = McGraw Hill | year = 2004 | pages=[https://archive.org/details/sherrismedicalmi0000unse_q1i3/page/551 551]–2 | isbn = 0838585299 | editor = Ryan KJ, Ray CG (editors) }}</ref> 

Kwa kawaida Homa ya nyongo C haionyeshi [[dalili]] zozote kwenye hatua za awali, lakini ugonjwa ukiendelea unaweza ukasababisha makovu katika maini, na baada ya miaka mingi ini linapata vidonda (cirrhosis). Kwa wagonjwa wengine vidonda hivi vinaweza kusababisha ini kukosa kufanya kazi, [[saratani]] ya ini, au [[mishipa]] iliyovimba sana ya [[umio]] na [[tumbo]], ambayo yanaweza kufanya [[mtu]] avuje [[damu]] hadi kufa.<ref name=Sherris/>

Watu wanaambukizwa [[virusi vya Homa ya nyongo C]] kwa kupitia [[mkondo wa damu]] kwa njia ya kujidunga [[sindano]] za [[dawa za kulevya]], kutumia vifaa vichafu vya [[hospitali]], na kuongezewa damu. 

Kadri ya watu [[milioni]] 130–170 wameathirika na Homa ya nyongo C. [[Wataalamu]] walianza kuchunguza HCV katika [[miaka ya 1970]], na walithibitisha kuwepo kwa ugonjwa huo mnamo mwaka [[1989]].<ref name="pmid19781804">{{cite journal |author=Houghton M |title=The long and winding road leading to the identification of the hepatitis C virus |journal=Journal of Hepatology |volume=51 |issue=5 |pages=939–48 |year=2009|month=Novemba |pmid=19781804 |doi=10.1016/j.jhep.2009.08.004 |url=}}</ref>  Haijulikani kama ugonjwa huu unawaambukiza [[wanyama]].

Peginterferon na ribavirin ndizo [[dawa]] pekee zinazotumika sana dhidi ya HCV. Kati ya wagonjwa [[asilimia]] 50-80 wanaotibiwa huwa wanapona. Watu wanaopata uharibifu mkubwa na [[kovu]] kwa ini (cirrhosis) au [[saratani ya ini]] wanaweza kuhitaji ini la kupandikizwa, lakini virusi huwa vinarejea baada ya kupandikiza.<ref name=NEJM2011/> hakuna chanjo ya kuzuia Homa ya nyongo C.
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== Viashiria na dalili ==
Homa ya nyongo C inasababisha dalili katika wagonjwa asilimia 15 tu,<ref>{{cite journal|last=Maheshwari|first=A|coauthors=Ray, S, Thuluvath, PJ|title=Acute hepatitis C.|journal=Lancet|date=2008-07-26|volume=372|issue=9635|pages=321–32|pmid=18657711|doi=10.1016/S0140-6736(08)61116-2}}</ref> mara nyingi zaidi agonjwa hawaonyeshi dalili zozote. 

Dalili ni kama zifuatazo: kupungua [[hamu ya kula]], [[uchovu]], [[kichefuchefu]], [[maumivu]] ya [[viungo]] au [[misuli]], kupungua [[uzito wa mwili]].<ref name=AFP2010/> Ni wagonjwa wachache ambao ni mahtuti na wanapata homa ya manjano.<ref name=Book2011p4>{{cite book|title=Chronic Hepatitis C Virus Advances in Treatment, Promise for the Future.|year=2011|publisher=Springer Verlag|isbn=9781461411918|page=4|url=http://books.google.ca/books?id=6G7mff5DnBQC&pg=PA4}}</ref> 

Kadri ya wagonjwa asilimia 10 hadi 50 wanapona bila kupata matibabu, na kati ya hao wengi ni [[wasichana]] wadogo.<ref name=Book2011p4/>

=== Uambukizo sugu ===
Asilimia themanini ya watu walioambukizwa virusi wanapata madhara ya [[uambukizo sugu]].<ref name=Lancet2011/> Wagonjwa wengi hawaonyeshi dalili zozote kwenye hatua za awali za ugonjwa huo, <ref name=Book2011/> ingawa uambukizo sugu wa Homa ya nyongo C unasababisha uchovu.<ref name=ID2010/>  Homa ya nyongo C ni chanzo kikubwa cha ini kupata vidonda pamoja na saratani ya ini kwa watu ambao wameathirika na ugonjwa huu kwa muda mrefu.<ref name=NEJM2011>{{cite journal|last=Rosen|first=HR|title=Clinical practice. Chronic hepatitis C infection.|journal=The New England journal of medicine|date=2011-06-23|volume=364|issue=25|pages=2429–38|pmid=21696309|url=http://www.casemedicine.com/ambulatory/Continuity%20Clinic/Clinic%20Articles/1)%20July/2)Week%20of%20July%2025th/chronic%20hep%20c.NEJM.pdf|access-date=2012-10-05|archive-date=2012-12-15|archive-url=https://web.archive.org/web/20121215035840/http://www.casemedicine.com/ambulatory/Continuity%20Clinic/Clinic%20Articles/1)%20July/2)Week%20of%20July%2025th/chronic%20hep%20c.NEJM.pdf|dead-url=yes}}</ref> Kati ya asilimia 10–30 ya watu wameambukizwa baada ya miaka 30 ya kuwa na vidonda katika ini.<ref name=NEJM2011/><ref name=AFP2010/> Pia watu wenye HomanyongoB au UKIMWI, walevi sugu, na wanaumme huwa wanapata vidonda katika ini.<ref name=AFP2010/> Kwa watu wenye vidonda katika ini uwezekano wa kupata saratani ya ini ni mara ishirini zaidi ya kawaida, kiasi cha asilimia 1 hadi 3 kwa mwaka.<ref name=NEJM2011/><ref name=AFP2010/> Kwa walevi sugu, uwezekano wa kupata ugonjwa ni mara 100 zaidi ya kawaida.<ref>{{cite journal|last=Mueller|first=S|coauthors=Millonig, G, Seitz, HK|title=Alcoholic liver disease and hepatitis C: a frequently underestimated combination.|journal=World journal of gastroenterology : WJG|date=2009-07-28|volume=15|issue=28|pages=3462–71|pmid=19630099}}</ref> Homa ya nyongo C inasababisha vidonda vya ini katika asilimia 27 ya wagonjwa na inasababisha saratani ya ini kati ya asilimia 25 ya wagonjwa.<ref name=World2007>{{cite journal|last=Alter|first=MJ|title=Epidemiology of hepatitis C virus infection.|journal=World journal of gastroenterology : WJG|date=2007-05-07|volume=13|issue=17|pages=2436–41|pmid=17552026}}</ref>

Vidonda vya ini vinaweza kusababisha msukumo mkubwa wa damu katika mishipa iliyoungana na ini, [[kujaa maji tumboni]], kuumia kirahisi au [[kuvuja damu]], mishipa kuvimba, hasa tumboni na kwenye umio, [[homa ya nyongo]] ([[ngozi]] inakuwa ya [[manjano]]), na [[jeraha|majeraha]] katika [[ubongo]].<ref name=Tah2009>{{cite journal|last=Ozaras|first=R|coauthors=Tahan, V|title=Acute Homa ya nyongo C: prevention and treatment.|journal=Expert review of anti-infective therapy|date=2009 Apr|volume=7|issue=3|pages=351–61|pmid=19344247}}</ref>

=== Athari nje ya ini ===
Homa ya nyongo C mara chache inasababisha ugonjwa unaojulikana kama Sjögren's syndrome (madhara dhidi ya kinga ya mwili), upungufu sio kawaida wa idadi ya blood platelets, magonjwa sugu ya ngozi, kisukari, pamoja na aina Fulani ya aina saratani ya damu iitwayo non-Hodgkin lymphomas.<ref name=Extrahepatic>{{cite journal |author=Zignego AL, Ferri C, Pileri SA, Caini P, Bianchi FB |title=Extrahepatic manifestations of Hepatitis C Virus infection: a general overview and guidelines for a clinical approach |journal=Digestive and Liver Disease |volume=39 |issue=1 |pages=2–17 |year=2007 |month=Januari |pmid=16884964 |doi=10.1016/j.dld.2006.06.008}}</ref><ref>{{cite journal|last=Louie|first=KS|coauthors=Micallef, JM, Pimenta, JM, Forssen, UM|title=Prevalence of thrombocytopenia among patients with chronic hepatitis C: a systematic review.|journal=Journal of viral hepatitis|date=2011 Jan|volume=18|issue=1|pages=1–7|pmid=20796208}}</ref>

== Chanzo ==
Virusi vya Homa ya nyongo C ni vidogo, vilivyo ndani ya kibahasha, na kiuzi kimoja, vina [[RNA]] yenye virusi.<ref name=NEJM2011/> Ni jamii ya ''hepacivirus'' ya [[familia]] iitwayo ''Flaviviridae''.<ref name=ID2010>{{cite book|last=Dolin|first=[edited by] Gerald L. Mandell, John E. Bennett, Raphael|title=Mandell, Douglas, and Bennett's principles and practice of infectious diseases|year=2010|publisher=Churchill Livingstone/Elsevier|location=Philadelphia, PA|isbn=978-0443068393|pages=Chapter 154|edition=7th ed.}}</ref> Kuna aina saba muhimu za genotypes of HCV.<ref name=Nakano2011>{{cite journal |author=Nakano T, Lau GM, Lau GM, Sugiyama M, Mizokami M|title=An updated analysis of hepatitis C virus genotypes and subtypes based on the complete coding region |journal=Liver Int. |year=2011|month=Desemba |pmid=22142261 |doi=10.1111/j.1478-3231.2011.02684.x }}</ref> Nchini Marekani, genotype 1 inasababisha asilimia 70 ya magonjwa, genotype 2 inasababisha asilimia 20 ya magonjwa, na kila aina ya genotypes zingine zinasababisha asilimia 1. <ref name=AFP2010/> Genotype 1 ndio inayojulikana zaidi katika nchi za Amerika ya Kusini na Ulaya.<ref name=NEJM2011/>

=== Maambukizi ===
Njia ya kawaida ya uambukizaji katika nchi zilizoendelea ni kutumia madawa ya kulevya kwa kujidunga sindano.  Katika nchi zinazoendelea njia za kawaida za utoaji damu na utaratibu usio salama wa kimatibabu <ref name=Mah2010>{{cite journal|last=Maheshwari|first=A|coauthors=Thuluvath, PJ|title=Management of acute Homa ya nyongo C.|journal=Clinics in liver disease|date=2010 Feb|volume=14|issue=1|pages=169–76; x|pmid=20123448}}</ref> Katika asilimia 20% ya wagonjwa, chanzo cha uambukizaji hakijulikani;<ref name=Pon2011>{{cite journal|last=Pondé|first=RA|coauthors=Mikhaĭlova, A|title=Hidden hazards of HCV transmission.|journal=Medical microbiology and immunology|date=2011 Feb|volume=200|issue=1|pages=7–11|pmid=20461405}}</ref> lakini vyanzo vingi vinaweza kuwa ni matumizi ya dawa ya kulevya kwa kujidunga sindano.<ref name=Book2011p4/>

==== Madawa ya kulevya kwa kujidunga sindano ====
Matumizi ya madawa ya kulevya kwa kujidunga sindano ndiyo sababu kubwa ya kusambaza Homa ya nyongo C katika nchi nyingi duniani.<ref name=China2008>{{cite journal|last=Xia|first=X|coauthors=Luo, J, Bai, J, Yu, R|title=Epidemiology of HCV infection among injection drug users in China: systematic review and meta-analysis.|url=https://archive.org/details/sim_public-health_2008-10_122_10/page/990|journal=Public health|date=2008 Oct|volume=122|issue=10|pages=990–1003|pmid=18486955|doi=10.1016/j.puhe.2008.01.014}}</ref> Uchunguzi uliofanya katika nchi 77 zimeonyesha kwamba katika nchi 25 ambayo Marekani ni mojawapo, asilimia ya watu wanaopata Homa ya nyongo C kwa kutumia madawa ya kulevya kwa kujidunga sindano ni asilimia 60 hadi 80 <ref name=Lancet2011>{{cite journal|last=Nelson|first=PK|coauthors=Mathers, BM, Cowie, B, Hagan, H, Des Jarlais, D, Horyniak, D, Degenhardt, L|title=Global epidemiology of hepatitis B and hepatitis C in people who inject drugs: results of systematic reviews.|journal=Lancet|date=2011-08-13|volume=378|issue=9791|pages=571–83|pmid=21802134|doi=10.1016/S0140-6736(11)61097-0}}</ref> na Uchina. <ref name=China2008/> Nchi kumi na mbili zina zaidi ya asilimia 80.<ref name=Lancet2011/> Zaidi ya milioni kumi ya watumizi wa madawa ya kulevya kwa kujidunga sindano wameambukizwa na Homa ya nyongo C; Uchina (milioni 1.6), Marekani (milioni 1.5), na Urusi(milioni 1.3) jumla ya wagonjwa walioambukizwa ni wengi sana.<ref name=Lancet2011/> Kiasi kikubwa cha wafungwa Marekani wana Homa ya nyongo C uwezekano wa kupata ugonjwa ni mara kumi hadi ishirini zaidi ya kiwango cha kawaida cha idadi ya watu, na utafiti umeonyesha hii inasababishwa na tabia za hatari za kutumia madawa ya kulevya kwa kujidunga sindano au kujichora chale na sindano ambazo sio safi.<ref name=Jail2010>{{cite journal|last=Imperial|first=JC|title=Chronic hepatitis C in the state prison system: insights into the problems and possible solutions.|journal=Expert review of gastroenterology & hepatology|date=2010 Jun|volume=4|issue=3|pages=355–64|pmid=20528122}}</ref><ref>{{cite journal|last=Vescio|first=MF|coauthors=Longo, B, Babudieri, S, Starnini, G, Carbonara, S, Rezza, G, Monarca, R|title=Correlates of hepatitis C virus seropositivity in prison inmates: a meta-analysis.|journal=Journal of epidemiology and community health|date=2008 Apr|volume=62|issue=4|pages=305–13|pmid=18339822}}</ref>

==== Maambukizi kupitia huduma za afya ====
Utoaji wa damu, [[mazao ya damu]], na upandikizi wa viungo vya mwili bila kuchunguza HCV ndizo zinazoleta matatizo makubwa ya uambukizaji.<ref name=AFP2010/> [[Marekani]] ilirasimisha [[uchunguzi]] mnamo mwaka [[1992]]. "Tangu wakati huo kiwango cha maambukizi imepungua kuanzia kati ya mmoja kati ya 200 kwa kila kipimo cha damu<ref name=Rosen2011>{{cite book |title=Rosen's emergency medicine: concepts and clinical practice 7th edition |last=Marx |first=John |authorlink= |coauthors=|year=2010 |publisher=Mosby/Elsevier|location=Philadelphia, PA |isbn=9780323054720 |page=[https://archive.org/details/rosensemergencym00mdjo/page/n1176 1154] |url=https://archive.org/details/rosensemergencym00mdjo}}</ref> hadi moja kati ya 10,000 mpaka 10,000,000 kwa kila kipimo cha damu.<ref name=Book2011p4/><ref name=Pon2011/> Kuna upungufu wa maambukizi kwa sababu kuna kipindi cha siku 11 hadi 70 ambazo ni siku ambazo  mtoaji damu mtarajiwa anayepata Homa ya nyongo C na damu yao kuonyesha kwamba imeambukizwa.<ref name=Pon2011/> Nchi zingine bado hazifanyi uchunguzi wa Homa ya nyongo C kwa sababu ya gharama.<ref name=World2007/>

Mtu mwenye jeraha la sindano kutoka kwa mtu aliyeathiriwa na HCV ana uwezo wa asilimia 1.8 ya kupata ugonjwa <ref name=AFP2010/> Hatari inaongezeka kama sindano inayotumika ina shimo kubwa na jeraha ni kubwa.<ref name=World2007/> Kuna hatari kutoka kwa mfichuo wa kamasi hadi kwa damu; ingawa kiwango cha hatari hii ni ndogo, na hakuna hatari yoyote kama damu ikigusa ngozi isiyokuwa na jeraha.<ref name=World2007/>

Vifaa vya hospitali pia vinaweza kuambukiza Homa ya nyongo C kama vile: kutumia mara kwa mara sindano na pini,mifuko ya kujaza, na vifaa visivyo visafi vya hospitali.<ref name=World2007/> Hali mbaya ya hospitali au za kliniki za madaktari wa meno ndio sababu kubwa za maambukizi ya HCV nchini Misri, ni nchi yenye kiasi kikubwa cha maambukizi duniani.<ref>{{cite web |url=http://www1.albawaba.com/en/news/highest-rates-hepatitis-c-virus-transmission-found-egypt |title=Highest Rates of Hepatitis C Virus Transmission Found in Egypt |publisher=Al Bawaba |date=2010-08-09 |accessdate=2010-08-27 |archivedate=2012-05-15 |archiveurl=https://web.archive.org/web/20120515221938/http://www.albawaba.com/news/highest-rates-hepatitis-c-virus-transmission-found-egypt }}</ref>

==== Uhusiano wa kimapenzi ====
Haijulikani kama shughuli za [[ngono]] zinaweza kuleta maambukizi ya Homa ya nyongo C.<ref name=Sex2010>{{cite journal|author=Tohme RA, Holmberg SD |title=Is sexual contact a major mode of hepatitis C virus transmission? |journal=Hepatology |volume= 52|issue= 4|pages= 1497–505|year=2010|month=Juni|pmid=20635398 |doi=10.1002/hep.23808}}</ref> Ingawa kuna uhusiano kati ya njia za hatari za kufanya ngono na Homa ya nyongo C, si wazi kama maambukizi ya ugonjwa huo yanatokana na matumizi ya madawa ya kulevya ambayo hayakutajwa au ngono yenyewe. <ref name=AFP2010/> Ushahidi unaonyesha kwamba hakuna hatari ya maambukizi kwa wapenzi wa jinsia tofauti ambao hawana mapenzi na watu wengine.<ref name=Sex2010/> 

Shughuli za ngono zinazoleta viwango vya juu vya majeraha ndani ya mfereji wa mkundu, kama vile kupenyeza mkunduni, au inayotokea wakati wa maambukizo ya zinaa kama yale yanayotokea wakati wa maambukizo ya zinaa, ikiwa ni pamoja na VVU au vidonda sehemu ya siri, zote hizi zinaleta hatari ya maambukizo.<ref name=Sex2010/> 

Serikali ya Marekani inapendekeza matumizi ya [[kondomu]] kama njia pekee ya kuzuia maambukizi ya Homa ya nyongo C kwa watu wenye wapenzi wengi.< ref>{{cite web|title=Hepatitis C Group Education Class|url=http://www.hepatitis.va.gov/products/HCV-education-class-script.asp|work=United States Department of Veteran Affairs|accessdate=2012-10-05|archive-date=2011-11-09|archive-url=https://web.archive.org/web/20111109105344/http://www.hepatitis.va.gov/products/HCV-education-class-script.asp|url-status=dead}}</ref>

==== Kutoboa mwili ====
[[Uchoraji wa mwili]] unaongeza hatari mara mbili au tatu zaidi ya kupata Homa ya nyongo C.<ref name=Tato2010>{{cite journal|last=Jafari|first=S|coauthors=Copes, R, Baharlou, S, Etminan, M, Buxton, J|title=Tattooing and the risk of transmission of hepatitis C: a systematic review and meta-analysis.|journal=International journal of infectious diseases : IJID : official publication of the International Society for Infectious Diseases|date=2010 Nov|volume=14|issue=11|pages=e928-40|pmid=20678951|url=http://natap.org/2010/HCV/tatoohcv.pdf}}</ref> Hii inaweza kuwa kwa sababu vifaa vinavyotumiwa sio visafi au kuambukizwa na rangi iliyotumika.<ref name=Tato2010/> 

Uchoraji au kujitoboa mwili kama shughuli hizi zilifanywa kabla ya miaka ya kati-1980 au ilifanywa na mtu asiye na ujuzi hasa inaleta wasiwasi, kwa sababu uwezekano wa kusafisha vifaa ni ndogo sana. Hatari ya kuambukizwa inaongezeka mara mbili zaidi kama mchoro ni mkubwa.<ref name=Tato2010/> Karibu nusu ya wafungwa wanatumia kwa pamoja vifaa vya kujichora ambavyo sio visafi. <ref name=Tato2010/> Ni mara chache uchoraji unafanywa katika sehemu zilizosajiliwa kuambukizwa na ugonjwa wa HCV.<ref>{{cite web|title=Hepatitis C|url=http://www.cdc.gov/hepatitis/HCV/PDFs/HepCGeneralFactSheet.pdf|work=Center for Disease Control and Prevention|accessdate=2 Januari 2012}}</ref>

==== Kugusa damu ====
Vifaa vya maangalizi binafsi kama vile mashine ya kunyolea, mswaki, na mashine ya kukata kucha yanaweza kuwa na damu. Kama zikitumiwa za zaidi ya mtu mmoja uwezekano ni mkubwa wa kuambukizana HCV.<ref name="pmid16907842">{{cite journal |author=Lock G, Dirscherl M, Obermeier F, ''et al.'' |title=Hepatitis C —contamination of toothbrushes: myth or reality? |journal=J. Viral Hepat. |volume=13 |issue=9 |pages=571–3 |year=2006 |month=Septemba |pmid=16907842|doi=10.1111/j.1365-2893.2006.00735.x |url=}}</ref><ref name=CDC12/> Watu wanatakiwa wawe waangalifu na mikwaruzo na vidonda au uvujaji wa damu.<ref name=CDC12/> HCV haimbukizwi kwa kushikana kama vile kukumbatiana, kupeana busu, au kula kwa pamoja au kutumia kwa pamoja vyombo vya kulia chakula.<ref name=CDC12>{{cite web |url= http://www.cdc.gov/hepatitis/HCV/HCVfaq.htm#section2|title=Hepatitis C |work=FAQ – CDC Viral Hepatitis |accessdate=2 Jan 2012}}</ref>

==== Maambukizi kutoka kwa mama hadi kwa mtoto ====
Maambukizi ya Homa ya nyongo C kutoka kwa [[mama]] hadi kwa [[mtoto]] hutokea kwa asilimia 10 za [[mimba]].<ref name=Preg10>{{cite journal|last=Lam|first=NC|coauthors=Gotsch, PB, Langan, RC|title=Caring for pregnant women and newborns with hepatitis B or C.|journal=American family physician|date=2010-11-15|volume=82|issue=10|pages=1225–9|pmid=21121533}}</ref> Hakuna njia yoyote ya kupunguza hatari hii<ref name=Preg10/> wakati wa kuzaa.<ref name=Pon2011/> 

Hatari ya kuambukiza inaongezeka kama muda wa [[uchungu wa uzazi]] ni mrefu.<ref name=World2007/> Hakuna ushahidi wowote unaosema mtoto akinyonyeshwa [[maziwa]] ataambukizwa HCV; lakini, mama aliyeathiriwa hatakiwi amnyonyeshe mtoto kama [[chuchu]] zake zina mpasuko au zinavuja,<ref>{{cite journal |author=Mast EE |title=Mother-to-infant hepatitis C virus transmission and breastfeeding |journal=Advances in Experimental Medicine and Biology|volume=554 |pages=211–6|year=2004|pmid=15384578}}</ref> au kama ana kiwango kikubwa cha virusi.<ref name=Pon2011/>

== Uchunguzi wa ugonjwa ==
[[Picha:Hepatitis C serology.png|thumb|250px|Serologic profile of Homa ya nyongo C infection]]
Uchunguzi wa Homa ya nyongo C unaangalia yafuatayo: HCV kingamwili, ELISA, Western blot, pamoja na idadi ya HCV RNA.<ref name=AFP2010/> Polymerase chain reaction (PCR) inagundua HCV RNA wiki mmoja au mbili baada ya kuambukizwa, wakati vikinga mwili huchukua muda mrefu kutengenezwa na kuonekana.<ref name=Tah2009/>

Maambukizo ya muda mrefu ya Homa ya nyongo C, yanayoletwa na virusi vya Homa ya nyongo C ambavyo vinaweza kuishi mwilini kwa muda unaoweza kuzidi miezi sita kama RNA ipo au haipo.<ref name=Book2011>{{cite book|title=Chronic Hepatitis C Virus Advances in Treatment, Promise for the Future.|year=2011|publisher=Springer Verlag|isbn=9781461411918|pages=103–104|url=http://books.google.ca/books?id=6G7mff5DnBQC&pg=PA104}}</ref> Kwa sababu ugonjwa huu kali hauonyeshi dalili zozote kwa muda mrefu,<ref name=Book2011/> madaktari huwa kwa kawaida wanagudua ugonjwa huu wanapofanya uchunguzi wa maini au wakati wanapofanya utaratibu wa kawaida wa kuchunguza afya za watu walio hatarini. Uchunguzi hauwezi kutofautisha kati ya ugonjwa mahututi na ugonjwa sugu wa maini.<ref name=World2007/>

=== Upimaji damu ===
Upimaji wa Homa ya nyongo C kwa kawaida huanza na vipimo vya damu ili kugundua uwepo wa kingamwili kwa HCV kwa kutumia kimeng'enya immunoassay.<ref name=AFP2010/> Kama upimaji huu ni chanya, kipimo cha itafanywa ili  kuthibitisha immunoassay na kuamua ukali.<ref name=AFP2010/> Uchanganuzi wa recombinant immunoblot inathibitisha immunoassay, na mmenyuko wa HCV RNA polimeresi huamua ukali.<ref name=AFP2010/> Kama hakuna RNA na immunoblot ni chanya, mtu alikuwa na maambukizi ya awali lakini ikaisha na aidha kwa matibabu au yenyewe; kama immunoblot ni hasi, immunoassay ilikuwa na makosa.<ref name=AFP2010/> Inachukua wiki sita hadi nane kwa kufuatia maambukizi kabla ya vipimo vya immunoassay kuonekana kuwa yako.<ref name=ID2010/>

Vimeng'enya vya ini hubadilika wakati wa sehemu ya awali ya maambukizi;<ref name=Book2011/> kwa wastani huanza kupanda katika wiki ya saba baada ya kuambukizwa.<ref name=ID2010/> Ini za vimeng'enya huhusiana vibaya na ukali wa ugonjwa.<ref name=ID2010/>

=== Biopsi ===
[[Biopsi]] za ini zinaweza kuamua kiwango cha uharibifu wa ini, lakini kuna hatari kutokana na utaratibu huo.<ref name=NEJM2011/> Mabadiliko ya kawaida biopsi hutambua ni lymphocytes ndani ya tishu ya ini, vinyeleo vya limfu katika triad portal, na mabadiliko kwa vichirizi vya nyongo.<ref name=NEJM2011/> Kuna idadi ya vipimo vya damu vinavyopatikana ambavyo vinajaribu kuamua kiwango cha uharibifu na kupunguza haja ya biopsi.<ref name=NEJM2011/>

=== Uchunguzi ===
Watu wachache, kama asilimia 5-50 walioambukizwa nchini Marekani na [[Canada]], wanafahamu hali yao.<ref name=Tato2010/> Kupima inapendekezwa kwa watu walio na hatari ya juu, ambao ni pamoja na watu wenye chale .<ref name=Tato2010/> Uchunguzi pia inapendekezwa kwa watu wenye muinuko wa kimeng'enya ya ini kwani hii ni ishara ya pekee ya homanyongosugu ya mara kwa mara.<ref>{{cite journal|last=Senadhi|first=V|title=A paradigm shift in the outpatient approach to liver function tests.|url=https://archive.org/details/sim_southern-medical-journal_2011-07_104_7/page/521|journal=Southern medical journal|date=2011 Jul|volume=104|issue=7|pages=521–5|pmid=21886053}}</ref> Uchunguzi wa mara kwa mara hapendekezwi nchini Marekani.<ref name=AFP2010>{{cite journal|last=Wilkins|first=T|coauthors=Malcolm, JK, Raina, D, Schade, RR|title=Hepatitis C: diagnosis and treatment.|journal=American family physician|date=2010-06-01|volume=81|issue=11|pages=1351–7|pmid=20521755|url=http://www.aafp.org/afp/2010/0601/p1351.html }}</ref>

== Kinga ==
Kufikia mwaka 2011, hakuna [[chanjo]] iliyopatikana kwa homa ya nyongo C. Chanjo zinatengenezwa, na baadhi zimeonyesha matokeo ya kutia moyo.<ref>{{cite journal|last=Halliday|first=J|coauthors=Klenerman, P, Barnes, E|title=Vaccination for hepatitis C virus: closing in on an evasive target.|journal=Expert review of vaccines|date=2011 Mei|volume=10|issue=5|pages=659–72|pmid=21604986|doi=10.1586/erv.11.55}}</ref> Mchanganyiko wa mikakati ya kuzuia, kama vile mipango ya kubadilishana sindano na matibabu ya matumizi mabaya ya  madawa ya kulevya, hupunguza hatari ya homa ya nyongo C katika watumiaji wa madawa ya kujindunga kwa mishipa kwa karibu asilimia 75.<ref>{{cite journal|last=Hagan|first=H|coauthors=Pouget, ER, Des Jarlais, DC|title=A systematic review and meta-analysis of interventions to prevent hepatitis C virus infection in people who inject drugs.|journal=The Journal of infectious diseases|date=2011-07-01|volume=204|issue=1|pages=74–83|pmid=21628661}}</ref> Kuwachunguza watoaji damu ni muhimu katika kiwango cha  kitaifa, kama ni kufuata tahadhari za  ulimwenguni ndani ya vituo vya afya.<ref name=ID2010/> Katika nchi ambako kuna ugavi usiotosha wa sindano hasi, watoa huduma wanapaswa kupeana madawa kwa mdomo badala ya kupitia sindano.<ref name=World2007/>

== Matibabu ==
HCV inasababisha maambukizi sugu katika asilimia 50-80 ya watu walioambukizwa. Takriban asilimia 40-80 ya kesi hizi humalizika kwa matibabu.<ref>{{cite journal|last=Torresi|first=J|coauthors=Johnson, D, Wedemeyer, H|title=Progress in the development of preventive and therapeutic vaccines for hepatitis C virus.|journal=Journal of hepatology|date=2011 Jun|volume=54|issue=6|pages=1273–85|pmid=21236312|doi=10.1016/j.jhep.2010.09.040}}</ref><ref>{{cite journal|last=Ilyas|first=JA|coauthors=Vierling, JM|title=An overview of emerging therapies for the treatment of chronic hepatitis C.|journal=Clinics in liver disease|date=2011 Aug|volume=15|issue=3|pages=515–36|pmid=21867934}}</ref> 

Katika matukio machache, maambukizi yanaweza kuisha bila ya tiba.<ref name=Book2011p4/> Watu wenye homa ya nyongo C sugu ni lazima wajiepushe pombe na madawa yaa sumu kwa ini,<ref name=AFP2010/> na wanapaswa kupatiwa chanjo ya homa y a manjano A na homanyongoB <ref name=AFP2010/> Watu walio na cirrhosis wanapaswa kuwa na vipimo vya ultrasound vya saratani ya ini.<ref name=AFP2010/>

=== Madawa ===
Watu wenye maambukizi ya ini ya HCV yaliyothibitika yasiyo ya kawaida wanapaswa kutafuta matibabu. <ref name=AFP2010/> Matibabu ya sasa ni mchanganyiko wa pegylated interferon  na madawa ya kupunguza makali ya ukimwi ribavirin kwa muda wa wiki 24 au 48, kulingana na aina ya HCV .<ref name=AFP2010/> Matokeo bora hutokea kwa asilimia 50-60% ya watu waliotibiwa. <ref name=AFP2010/> Kuchanganya ama boceprevir au telaprevir na ribavirin na peginterferon alfa inaboresha matokeo ya homa ya nyongo C genotype 1.<ref name="pmid21828346">{{cite journal | author = Foote BS, Spooner LM, Belliveau PP | title = Boceprevir: a protease inhibitor for the treatment of chronic hepatitis C | url = https://archive.org/details/sim_annals-of-pharmacotherapy_2011-09_45_9/page/1085 | journal = Ann Pharmacother | volume = 45| issue = 9 | pages = 1085–93 | year = 2011 | month = Septemba | pmid = 21828346 | doi = 10.1345/aph.1P744 }}</ref><ref name="pmid21558488">{{cite journal | author = Smith LS, Nelson M, Naik S, Woten J | title = Telaprevir: an NS3/4A protease inhibitor for the treatment of chronic hepatitis C | url = https://archive.org/details/sim_annals-of-pharmacotherapy_2011-05_45_5/page/639 |journal = Ann Pharmacother | volume = 45 | issue = 5 | pages = 639–48 | year = 2011 | month = Mei | pmid = 21558488 | doi = 10.1345/aph.1P430}}</ref><ref name="pmid21898493">{{cite journal | author = Ghany MG, Nelson DR, Strader DB, Thomas DL, Seeff LB | title = An update on treatment of genotype 1 chronic hepatitis C virus infection: 2011 practice guideline by the American Association for the Study of Liver Diseases | journal = Hepatology | volume = 54 | issue = 4 | pages = 1433–44 | year = 2011 | month = Oktoba | pmid = 21898493 | pmc = 3229841 | doi = 10.1002/hep.24641}}</ref> Madhara kwa matibabu ni ya kawaida, nusu ya watu wanaotibiwa hupata dalili kama homa ya mafua, na theluthi ya watu hupata matatizo ya mhemuko.<ref name=AFP2010/> Tiba katika miezi sita za kwanza ni bora zaidi kuliko baada ya homa ya nyongo C kuwa sugu.<ref name=Tah2009/> Kama mtu anapata maambukizi mapya na haijaisha baada ya wiki nane hadi kumi na mbili, wiki 24 ya  pegylated interferon inapendekezwa.<ref name=Tah2009/> Kwa watu wenye thalasemia (ugonjwa wa damu), ribavirin inaonekana kuwa muhimu, lakini huongeza haja ya upaji wa damu.<ref>{{cite journal |author=Alavian SM, Tabatabaei SV |title=Treatment of chronic hepatitis C in polytransfused thalassaemic patients: a meta-analysis |journal=J. Viral Hepat.|volume=17 |issue=4 |pages=236–44 |year=2010 |month=Aprili |pmid=19638104|doi=10.1111/j.1365-2893.2009.01170.x }}</ref>

<!--===Alternative medicine===  -->
Watetezi wanadai tiba kadhaa mbadala kuwa na manufaa kwa homa ya nyongo C ikiwa ni pamoja na maziwa mbigili, ginseng, na colloidal silver <ref name=NCCAM>[http://nccam.nih.gov/health/providers/digest/hepatitisC-science.htm?nav=cd Hepatitis C and CAM: What the Science Says] {{Wayback|url=http://nccam.nih.gov/health/providers/digest/hepatitisC-science.htm?nav=cd |date=20130513220534 }}. ''[[NCCAM]]'' Machi 2011. (Retrieved 7 Machi 2011)</ref> Hata hivyo, hakuna tiba mbadala imeonekana kuboresha matokeo katika homa manjano C, na hakuna ushahidi upo ambao tiba mbadala ina athari yoyote kwenye virusi wakati wote .<ref name=NCCAM/><ref>{{cite journal|last=Liu|first=J|coauthors=Manheimer, E, Tsutani, K, Gluud, C|title=Medicinal herbs for hepatitis C virus infection: a Cochrane hepatobiliary systematic review of randomized trials.|url=https://archive.org/details/sim_american-journal-of-gastroenterology_2003-03_98_3/page/538|journal=The American journal of gastroenterology|date=2003 Mar|volume=98|issue=3|pages=538–44|pmid=12650784}}</ref><ref>{{cite journal|last=Rambaldi|first=A|coauthors=Jacobs, BP, Gluud, C|title=Milk thistle for alcoholic and/or hepatitis B or C virus liver diseases.|journal=Cochrane database of systematic reviews (Online)|date=2007-10-17|issue=4|pages=CD003620|pmid=17943794}}</ref>

== Ubashiri ==
Majibu ya matibabu hutofautiana kulingana na genotype. Majibu endelevu ni kadiri asilimia 40-50 kwa watu wenye HCV genotype 1 kwa muda wa wiki 48 ya matibabu.<ref name=NEJM2011/> Majibu endelevu hutokea katika asilimia 70-80 kwa watu walio na genotypes HCV 2 na 3 kwa muda wa wiki 24 ya matibabu.<ref name=NEJM2011/> Majibu endelevu ni kadiri ya asilimia 65 kwa watu wenye genotype 4 kwa muda wa wiki 48 ya matibabu. Ushahidi wa matibabu katika ugonjwa genotype 6 kwa sasa ni chache, na ushahidi uliopo ni wa muda wa wiki 48 ya tiba katika vipimo sawa na ugonjwa wa genotype 1.<ref>{{cite journal |author=Fung J, Lai CL, Hung I, ''et al.'' |title=Chronic hepatitis C virus genotype 6 infection: response to pegylated interferon and ribavirin |journal=The Journal of Infectious Diseases |volume=198 |issue=6|pages=808–12 |year=2008 |month=Septemba |pmid=18657036 |doi=10.1086/591252}}</ref>

== Uenezi ==
[[Picha:HCV prevalence 1999.png|thumb| Maambukizi ya homa ya nyongo C duniani kote mwaka 1999]]
[[Picha:Hepatitis C world map - DALY - WHO2004.svg|thumb|[[Disability-adjusted life year]] ya homa ya nyongo C mwaka 2004 kwa kila wakazi 100,000

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Kati ya watu milioni 130 na 170, au ~ asilimia 3 ya idadi ya watu duniani, wanaishi na homa ya nyongo C sugu.<ref name=WHO2011/> Kati ya watu milioni 3-4 huambukizwa kwa mwaka, na zaidi ya watu 350,000 hufariki kila mwaka kutokana na magonjwa-husiana na homa ya nyongo C.<ref name=WHO2011/> Viwango vimeongezeka pakubwa katika karne ya 20 kutokana na mchanganyiko wa IDU na madawa ya kujidunga katika mishipa au vifaa vya matibabu visivyokifishwa.<ref name="World2007"/>

Nchini Marekani, kadiri ya asilimia 2 ya watu wana homa ya nyongo C,<ref name=AFP2010/> pamoja na kesi mpya 35,000 hadi 185,000 kwa mwaka. Viwango vimepungua katika nchi za Magharibi tangu miaka ya 1990 kutokana na uchunguzi wa kuboresha damu kabla ya utoaji.<ref name=Tah2009/> Vifo vya kila mwaka kutokana na HCV nchini Marekani ni kadiri kutoka 8,000 hadi 10,000. Matarajio ni kwamba kiwango hiki cha vifo itaongezeka wakati watu walioathirika kwa utoaji damu kabla ya kupimwa HCV kuwa wagonjwa na kufa.<ref>{{cite book|last=Colacino|first=ed. by J. M.|title=Hepatitis prevention and treatment|year=2004|publisher=Birkhäuser|location=Basel|isbn=9783764359560|pages=32|url=http://books.google.ca/books?id=KwSWN_QtVLUC&pg=PA32|coauthors=Heinz, B. A.}}</ref>

Viwango vya maambukizi viko juu katika baadhi ya nchi za Afrika na Asia.<ref>{{cite book|last=al.]|first=edited by Gary W. Brunette  ... [et|title=CDC health information for international travel : the Yellow Book 2012|publisher=Oxford University|location=New York|isbn=9780199769018|pages=231|url=http://books.google.ca/books?id=597F4ZVu7eQC&pg=PT231}}</ref> Nchi zilizi na viwango vya juu sana vya maambukizi ni  Misri (asilimia 22), Pakistani (asilimia 4.8) na Uchina (asilimia 3.2).<ref name=WHO2011>{{cite web | title=WHO Hepatitis C factsheet|url=http://www.who.int/mediacentre/factsheets/fs164/en/index.html | year=2011 |accessdate=2011-07-13}}</ref> Kiwango cha juu nchini Misri inahusishwa na kampeni ya umma ya matibabu ya sasa-iliyositishwa ya schistosomiasis, kwa kutumia sindano za kioo zisizokifishwa vizuri.<ref name=World2007/>

== Historia ==
Katika miaka ya 1970 katikati, Harvey J. Alter, Mkuu wa Sehemu ya Magonjwa ya Maambukizi katika Idara ya Madawa ya Kujidunga kwa mishii katika Taasisi ya Kitaifa ya Afya, na timu yake ya utafiti walionyesha kuwa kesi nyingi za utoaji  wa baada-damu ya homanyongohazikutokana na viruzi vya homanyongoA au B. Licha ya ugunduzi huu, jitihada za utafiti wa kimataifa za kutambua virusi zilishindiana kwa miaka kumi ifuatayo. Mwaka 1987, Michael Houghton, qui-Lim Choo, na George Kuo katika Shirika la Chiron, wakishirikiana na Dkt. DW Bradley kutoka Kituo cha Kudhibiti na Kuzuia Magonjwa, walitumia mbinu mpya ya molecular cloning ya kubaini kiumbe kisichojulikana na kukuza uchunguzi wa ubainishaji..<ref name = Boyer>{{cite book | isbn = 9780792387602 | last = Boyer | first = JL | title = Liver cirrhosis and its development: proceedings of the Falk Symposium 115  | pages = [http://books.google.ca/books?id=n5P696E7T0wC&pg=PA344#v=onepage&q&f=false 344] | publisher =[[Springer Science+Business Media|Springer]] | year = 2001 }}</ref> Mwaka 1988, Alter alithibitisha virusi kwa kuthibitisha uwepo wao katika jopo la vielelezo vya homanyongozisizo A zisizo B. Mwezi Aprili 1989, ugunduzi wa HCV ulichapishwa katika makala mbili katika jarida la "Sayansi".<ref name="choo">{{cite journal|author=Choo QL, Kuo G, Weiner AJ, Overby LR, Bradley DW, Houghton M |title=Isolation of a cDNA clone derived from a blood-borne non-A, non-B viral hepatitis genome |journal=Science |volume=244 |issue=4902 |pages=359–62 |year=1989 |month=Aprili |pmid=2523562 |doi=10.1126/science.2523562}}</ref><ref name="kuo">{{cite journal |author=Kuo G, Choo QL, Alter HJ, ''et al.'' |title=An assay for circulating antibodies to a major etiologic virus of human non-A, non-B hepatitis |journal=Science |volume=244 |issue=4902 |pages=362–4 |year=1989 |month=Aprili |pmid=2496467 |doi=10.1126/science.2496467}}</ref> Ugunduzi ulisababisha mafanikio makubwa katika utambuzi na kuboresha matibabu ya kupunguza makali ya virusi.<ref name = Boyer/> Mwaka 2000, Dkt. Alter na Houghton walitukuzwa na Tuzo ya Lasker ya Utafiti wa Kitabibu ya Hospitali ya "kuongoza kazi inayosababisha ugunduzi wa virusi vinavyosababisha homa ya nyongo C na mbinu za kukuza uchunguzi ambazo zilipunguza hatari ya utoaji damu-ilihusisha homa y a manjano nchini Marekani kutoka asilimia 30 mwaka 1970 hadi karibu sifuri mwaka 2000."<ref>[https://web.archive.org/web/20080225184627/http://www.laskerfoundation.org/awards/library/2000clinical.shtml2000 Winners Albert Lasker Award for Clinical Medical Research], The Lasker Foundation. Retrieved 20 Februari 2008.</ref>

Chiron aliwasilisha hataza kadhaa kuhusu virusi na uchunguzi wake.<ref name="houghton">Houghton, M., Q.-L. Choo, and G. Kuo. ''NANBV Diagnostics and Vaccines.''  European Patent No. EP-0-3 18-216-A1. European Patent Office (filed 18 Novemba 1988, published 31 Mei 1989).</ref> Maombi ya mashindano ya hataza na CDC ilikuwa imeshuka mwaka 1990 baada ya Chiron kulipa dola milioni 1,900,000 kwa CDC na dola 337,500 kwa Bradley. Mwaka 1994, Bradley alimshtaki Chiron, wakitaka kubatilisha hataza, alitaka yeye mwenyewe ajumuishwe kama mbunifu mshiriki, na kupokea mapato ya uharibifu na ya mrahaba. Alisitisha mashtaka  mwaka 1998 baada ya kupoteza mbele ya mahakama ya rufaa.<ref>{{cite web|last=Wilken|first=Judge|title=United States Court of Appeals for the Federal Circuit|url=http://www.ll.georgetown.edu/federal/judicial/fed/opinions/96opinions/96-1536.html|work=United States Court of Appeals for the Federal Circuit|accessdate=11 Januari 2012}}</ref>

== Jamii na utamaduni ==
Mwungano wa Dunia wa Homanyongo inaratibu siku ya Dunia ya Homa ya nyongo, hufanyika kila mwaka tarehe 28 mwezi Julai.<ref>{{cite journal|last=Eurosurveillance editorial|first=team|title=World Hepatitis Day 2011.|journal=Euro surveillance : bulletin europeen sur les maladies transmissibles = European communicable disease bulletin|date=2011-07-28|volume=16|issue=30|pmid=21813077}}</ref> Gharama za kiuchumi za homa ya nyongo C ni muhimu kwa mtu binafsi na kwa jamii kijumla. Nchini Marekani wastani ya gharama ya maisha ya ugonjwa huo ilikadiriwa kuwa dola 33,407 za marekani mwaka 2003,<ref name=Cost2006>{{cite journal|last=Wong|first=JB|title=Hepatitis C: cost of illness and considerations for the economic evaluation of antiviral therapies.|journal=PharmacoEconomics|year=2006|volume=24|issue=7|pages=661–72|pmid=16802842}}</ref> na gharama ya kupandikiza ini ni takriban dola 200,000 za Marekani kufikia mwaka 2011.<ref name=Cost2011/> Nchini Canada gharama ya matibabu ya kupambana na virusi yalikuwa juu kama dola 30,000 za Canada mwaka 2003,<ref>{{cite web|title=Hepatitis C Prevention, Support and Research ProgramHealth Canada|url=http://www.phac-aspc.gc.ca/hepc/pubs/psrpmideval-ppsrevalinter/i_problem-eng.php|work=Public Health Agency of Canada|accessdate=10 Januari 2012|month=Nov|year=2003}}</ref> wakati Marekani gharama ni kati ya dola 9200 na 17,600 za Marekani mwaka 1998.<ref name=Cost2006/> Katika maeneo mengi ya dunia watu wanashindwa kumudu matibabu na madawa ya kupunguza makali ya virusi kwa sababu ya kukosa bima au bima waliyo nayo haitalipa madawa ya kupunguza makali ya virusi.<ref>{{cite book|last=Zuckerman|first=edited by Howard Thomas, Stanley Lemon, Arie|title=Viral Hepatitis.|year=2008|publisher=John Wiley & Sons|location=Oxford|isbn=9781405143882|pages=532|url=http://books.google.ca/books?id=nT2dauLXoYAC&pg=PA532|edition=3rd ed.}}</ref>

== Utafiti ==
Kufikia mwaka 2011, karibu madawa mia moja yanakuzwa kwa ajili ya homa ya nyongo C.<ref name=Cost2011>{{cite journal|last=El Khoury|first=A. C.|coauthors=Klimack, W. K., Wallace, C., Razavi, H.|title=Economic burden of hepatitis C-associated diseases in the United States|journal=Journal of Viral Hepatitis|date=1 Desemba 2011|doi=10.1111/j.1365-2893.2011.01563.x}}</ref> Dawa hizi ni pamoja na chanjo za kutibu homa ya manjano, immunomodulators, na vizuia vya cyclophilin.<ref>{{cite journal|last=Ahn|first=J|coauthors=Flamm, SL|title=Hepatitis C therapy: other players in the game|journal=Clinics in liver disease|date=2011 Aug|volume=15|issue=3|pages=641–56|pmid=21867942|doi=10.1016/j.cld.2011.05.008}}</ref> Uwezekano wa matibabu haya mapya yamekuja kutokana na uelewa mzuri wa virusi vya homa ya nyongo C.<ref>{{cite journal|last=Vermehren|first=J|coauthors=Sarrazin, C|title=New HCV therapies on the horizon.|journal=Clinical microbiology and infection : the official publication of the European Society of Clinical Microbiology and Infectious Diseases|date=2011 Feb|volume=17|issue=2|pages=122–34|pmid=21087349}}</ref>

== References ==
{{Marejeo|colwidth=30em}}

[[Jamii:Magonjwa]]
[[Jamii:Ini]]
[[Jamii:Tiba]]