- How does
- become infected How
- is manifested
- disease Diagnosis of the disease
- Related videos
To date, there are 7 types of hepatitis, which for convenience are indicated by the letters of the Latin alphabet from A to G. According to WHO statistics, chronic hepatitis C is diagnosedmore than 70 million people and about 399,000 of them die every year from complications of the disease( cirrhosis, carcinoma).
Today, with the help of antiviral drugs, 95% of patients with hepatitis C can be cured, however, treatment is expensive and therefore not affordable. In Russia, the most common hepatitis C is genotype 1b, it also lends itself to therapy, albeit more prolonged.
How does infection with the
virus occur? It is possible to infect with hepatitis C virus:
- with blood transfusion( blood or plasma);
- for invasive interventions( micro-trauma on the skin);
- rarely transmits the virus from the mother to the child during pregnancy and during childbirth;
- at sexual intercourse.
is manifested From the time of infection to the virus before the onset of the first symptoms of the disease on average runs from 7-8 weeks( with massive infection) to 26 weeks. According to statistical data, 80% of the infected do not make any complaints, because the disease is asymptomatic.
In the acute course of the disease, asthenovegetative and dyspeptic symptoms( lethargy, nausea, general deterioration of well-being, subfebrile body temperature, myalgia) are observed in the patient. Probable abdominal pain and vomiting. With palpation, the liver, and sometimes the spleen, is enlarged. Skin discoloration and sclera occur only in 15-40% of cases.
If there is no jaundice, then the main signs of hepatitis C are malaise, asthenia, hepatomegaly( enlargement of the liver)
A person can act as a carrier of the hepatitis C virus. That is, the virus does not affect the activity of hepatocytes, but it can be transmitted to other people or activated under certain conditions, for example, with immunodeficiency. The patient can be a carrier of the virus from six months to several years, then recovery comes.
In the latent phase, the virus in the body destroys the liver cells, but there are no symptoms of the disease. The patient does not have signs indicating the presence of hepatitis, however, there may be extrahepatic manifestations( malaise, weakness).
Diagnosis of the disease
It is not possible to detect the virus immediately after infection because the immune system does not respond to it for 6-8 weeks, there are no markers in the blood that can determine the presence of pathogenic RNA.That is why often the infection comes from donor blood.
A laboratory blood test shows increased activity of ALT and ACAT, in some cases, outside the norm, there are indicators of total bilirubin, there is rarely a decrease in prothrombin and disproteinemia( a violation of blood composition).Functional liver tests show the extent of the lesion of the gland and the stage of its inflammation.
The diagnosis is based on the specific antibodies produced in the patient's blood, produced by immunity in response to the presence of structural or non-structural proteins of the virus( ELISA method is used), or after isolation of the virus RNA( PCR method).
Once a virus has been detected in a patient, laboratory tests are performed to establish the genotype of the strain. There are 6 genotypes of hepatitis C, which have different pathogenetic properties and respond to different treatments. In turn, genotypes are divided into subtypes, since they are able to mutate quickly, changing their structure.
More genotypes of hepatitis C are found on the territory of CIS countries - genotype 1b( there are 3 subgroups of genotype 1: 1a, 1b and 1c in total).The degree of damage to the liver and the genotype of the virus are taken into account when prescribing pathogenetic therapy. A person can be infected with several viruses, which significantly complicates the process of treatment.
To identify the genotype, venous blood is taken. Then, using the polymerase chain reaction( PCR), the virus RNA is released, and a fragment is found that is inherent in a certain genotype. The type of virus is not determined if the viral load is less than 750 IU / ml.
About 15-45% of those infected with hepatitis C get rid of the virus without therapy for six months, in others, the disease becomes chronic. Hepatitis C genotype 1b is harder than others to be medicated, because it is capable of mutating.
People with chronic hepatitis C have a higher risk of developing cirrhosis( the disease develops in 15-30% of patients for 20 years).
Genotype 1b differs from other subtypes in that:
- is more often infected through the blood;
- , he responds slowly to treatment, so long-term therapy is required;
- most often recurs;
- clinical picture is limited to asthenovegetative syndrome;
- causes such complications as hepatocellular carcinoma.
Treatment of acute hepatitis C involves hospitalization and:
- basic therapy( bed or half-bed regime, diet, drinking up to 2-3 liters a day, bowel evacuation once a day, refusal of additional loads on the liver, refusal of medications, if sothere are no absolute indications);
- antiviral therapy( sometimes delayed for several weeks in anticipation of self-healing);
- restoration of the liver( the use of hepatoprotectors).
Protocol for diagnosis and treatment of patients with viral hepatitis B and C "is a guide for physicians
Until recently, if a patient with hepatitis underwent therapy for the first time, the treatment regimens included the appointment of Peginterferon, Ribavirin, and inhibitors of proteases Boceprivir and Telaprevir. The duration of the course was 24-72 weeks. Boceprevir and Telaprevir could not be prescribed if there was no fibrosis, and the virimia indices( blood concentration in the blood) were low.
But today Telaprevir and Boceprevir are considered first-generation direct-acting drugs that should not be used in the treatment of hepatitis C, since their administration often leads to undesirable effects( anemia, skin itching) and they are less effective than the newest drugs.
According to the recommendations of 2017, the World Health Organization advises the use of direct-acting drugs for the treatment of hepatitis C with genotype 1b, which according to the studies provides a cure for 95% of patients. The regimen includes Sofosbuvir, Daklatasvir, and the combined Sofosbuvir and Ladipasvir.
And yet, WHO recognizes that, in certain cases, Interferon and Ribovirin continues to retain its significance, for example, in the treatment of patients with infection of genotype 5 and 6, as well as patients with genotype 3 and cirrhosis.
For the treatment of hepatitis C with genotype 1b, two antiviral drugs( Sofosbuvir + Daklataswir( or Simeprivir) or 4( Dasabuvir, Ombitasvir, Paritaprevir, Ritonavir) can be used.)
The most effective means are
- Sofosbuvir .Suppresses the synthesis of RNA polymerase, which the virus uses to construct its own RNA.On sale from 2013.It is used to treat the 1,2,3,4 genotype of hepatitis C. It is produced in 400 mg tablets. It is effective only in complex therapy( simultaneously with Ribavirin and interferon alpha or in combination with Ledipasvir).One tablet a day is taken with meals. Possible side effects: sleep disturbances, headaches, convulsions, diarrhea or constipation, vomiting, nausea, lack of appetite, depression, fever, visual impairment, etc. Analogues: Viropak( Egypt), Grateziano( Egypt), Hepcinat( India),Hopetavir( Bangladesh);
- Ladipasvir .The active substance is lepidavir( 90 mg) and sophosbuvir( 400 mg).It is taken to treat hepatitis C genotypes 1 and 4. Duration of therapy in the absence of cirrhosis up to 12 weeks, with the presence of up to 24 weeks. A medication is prescribed only after a thorough examination of the patient;
- Daklataswir .It is an inhibitor of protein 5A, a protein necessary for the replication of the virus, hence it interrupts the life cycle of the virus and the assembly of the virion. In hepatitis C with genotype 1b is administered together with Asunoprovir. Duration of therapy is 24 weeks;
- Ribavirin .Penetrates into cells infected with the virus, inhibits the synthesis of viral RNA and protein, thereby inhibiting the replication of virions and reducing viral load, while not affecting the normally functioning cells. When hepatitis C is administered with interferon alfa. Produced in capsules and tablets of 200 mg. It is taken with meals twice a day for 1-1.2 grams( the dosage increases depending on the weight).Possible side effects: anemia, leukopenia, bronchospasm, anaphylaxis, angioedema, arterial hypotension.
The cost of these funds is high, which reduces their availability for most patients. Therapy with original drugs in the US will cost about 94 thousand dollars, and in Europe at 50 thousand euros, the course generics there costs about a thousand dollars. In Russia, the cost of a course of a drug from its developer is one million rubles.
Generics are several times cheaper( a course of two drugs about a thousand dollars).Studies were conducted to determine the effectiveness of generics, and they showed that the drugs were almost as good as the original drugs( after 4 weeks of taking the drug, the viral load decreased by more than 90%).
Since not all patients for financial reasons can undergo antiviral therapy with direct-acting drugs, they are forced to fight not directly with the virus itself, but to reduce liver damage and help it fulfill the barrier function.
Ursosan slows the process of premature aging and death of hepatocytes
Ursodeoxycholic acid( Ursosan) is a hepatoprotector. It has choleretic, hypodipidemic, cholelitolitic, hypocholesterolemic, and immunomodulating action. The drug is able to be included in the membrane of the liver cells and make them resistant to the action of cytotoxic micelles.
Acid reduces the concentration of bile acids, toxic to liver cells, and stimulates bile secretion, thereby contributing to the resolution of intrahepatic cholestasis. The drug is administered simultaneously with interferons, and separately at a dosage of 10-15 mg / kg per day, a course of therapy from three months to a year.
The course of the disease is affected not only by the genotype of the virus, but also by other factors:
- Age. The young organism copes more quickly.
- Liver condition. The less damaged the iron, the better the chances of recovery. On the condition of the liver affects the lifestyle, the use of alcohol and medication.
- Concentration of the virus.
- Concomitant diseases. With obesity, cirrhosis, diabetes, the disease is more difficult to treat.
Therapy is considered effective if there is persistent remission, and there is no RNA of the virus in the blood and within the normal range of the transaminase. Determine whether the cure was possible only six months after the end of the drug course.
As studies show, when applying new regimens for hepatitis C with genotype 1b, 70-95% of
Get rid of hepatitis C probably in a few months, taking just two tablets a day. Drug therapy with drugs of direct action, which in the near future will be more accessible, gives a chance for recovery to those patients for whom the regimens used today are not effective.
Therapy is less prolonged with minimal liver damage. Therefore, if hepatitis C is detected, it is necessary to refrain from alcohol intake, maintain a sparing diet, agree on the intake of any medication with the doctor in charge, and take hepatoprotectors.