Viral hepatitis C

In 2014, the European Congress of Hepatologists announced the possibility of a complete cure for hepatitis C, which means victory over an insidious virus. Viral hepatitis C( in Russian is pronounced "hepatitis ts") takes a specialposition among inflammatory liver diseases. It is characterized by increased danger, prolonged asymptomatic course, transition to a chronic process and cirrhosis.

High incidence of hepatitis C accompanies social insecurity of the population, economic crises. The resulting conditions support the pathways of infection. With hepatitis C, the number of asymptomatic forms is 5 times greater than cases with clinical manifestations.

According to Rospotrebnadzor, the incidence of acute hepatitis C in Russia in 2016 was 1.24 per 100 000 population. Chronic forms are registered much higher - 18 per 100,000. But this is the lowest indicators for many years of observation. The "peak" prevalence was in 2000.

Characteristics of the causative agent

The hepatitis C virus contains in the nucleus a single strand of RNA in which the amino acid parts of the chain can be quickly replaced. This property provides the ability for mutations, genetic impermanence. It turns out that as long as the human immune system tries to protect itself by producing antibodies to the virus, it has already changed the composition of the antigens.

The number of genotypes reaches 40, in addition, subtypes are important. Practically important are 5 genotypes of the virus: 1a, 1b, 2a, 2b and 3a. As it turned out, they are connected with certain territories of the globe. Resistance to environmental factors in the hepatitis C virus is less pronounced than in the hepatitis B virus.

It is rapidly destroyed by ultraviolet rays under the influence of disinfectants, it loses its activity after boiling after 2 minutes, at room temperature it lives no more than four days. But it tolerates low temperatures: for years it can be stored frozen, in preparations from blood.

Mean values ​​differ from structure in different countries

Pathways of infection

By methods of infection, viral hepatitis C is similar to hepatitis B( type "A" is transmitted by fecal-oral route).Not for nothing is the old name of the pathogen - "the virus is neither B nor A".The main way of transmission of virus C is the use of non-sterile needles and syringes for intravenous drug use, if before this procedure was performed to a sick person or carrier.

The cause of the disease is the conditions of contact of contaminated blood with damage to the skin or mucous of a healthy person. A person may accidentally become infected in a medical facility:

• with intravenous medication, transfusion of blood that has not been properly checked;
• in the office of a dentist, gynecologist;
• for cosmetic procedures, manicure, pedicure, tattooing, if bleeding or micro-injury occurred;
• for hemodialysis( it is recommended to vaccinate against at least hepatitis B as a preparation), patients usually have a dramatically reduced immunity and under such conditions the disease develops violently and heavily.

Transmission of a virus with a single injection is unlikely, because it requires a relatively higher volume of infectious blood than with viral hepatitis B. There are numerous cases of infection with tissue and organ transplantation.

In the home, infection with hepatitis occurs:

• with sexual contact if partners have lesions on the mucous membrane of the genital organs;
• if used for shaving common with a sick razor, someone else's toothbrush brush your teeth.

Aboriginal ritual tradition is higher than the fear of infection

A hobby for oral sex creates a possibility for infection through the gastrointestinal tract, the oral mucosa. Therefore, the oral-fecal route of infection is not excluded, as with viral hepatitis type A and E. A certain risk of transmission with saliva is also available with a kiss, endoscopic studies.

It is unlikely to be infected with household contact with hepatitis. But doctors warn of increased danger when using someone else's towels, dishes. Some infectious disease specialists defend the opinion about the possibility of transmissible transmission of the pathogen during the bite of bloodsucking insects( mosquitoes, bugs, mosquitoes).

Pregnancy creates conditions for the transmission of the virus from a diseased maternal organism to the fetus. Such a path is called vertical. The causative agent enters through the vessels of the placenta, during childbirth( the newborn closely contacts the mucous membrane of the genital tract of the mother), if the child receives a small scratch.

Breastfeeding is theoretically possible, but the concentration of the virus in it is very small. Infection spreads through carriers. These include people who do not have clinical symptoms of hepatitis C. These can be those who have undergone pathology in mild form or those who do not know about their disease at all.

Unlike the latent flow, the virus does not cause any harm to the body of the carrier, but when it is transferred to another person it activates and shows all its pathogenic properties. Scientists believe that the number of infected individuals with the hepatitis C virus is significantly higher than the number of carriers of HBsAg. In 25% of adult patients and 46% of children, it is not possible to establish the exact cause of the disease.

Which populations are at greatest risk?

The risk groups include:

• addicts using the intravenous route of drug injection( infection reaches 60-80%);
• patients with blood diseases requiring frequent transfusion with hemophilia, thalassemia, von Willebrand disease, leukemia( the proportion infected with hepatitis C virus can reach 100%);
• patients in hemodialysis centers( probable infection rate is 20%).

Medical workers, especially surgical departments and offices, blood transfusion stations, police, social institutions, are exposed to occupational hazards.

Classification of hepatitis C

Like the whole group of viral inflammations of the liver, hepatitis C is subdivided in clinical form: into the manifest( icteric), subclinical( latent, jaundiced, erased) variants. By severity of light, moderate, severe and fulminant hepatitis( fulminant).With the flow, there are: acute cyclic or protracted( progressive), chronic.

Hemodialysis procedure puts patients at risk of

infection How does hepatitis C manifest?

Symptoms of hepatitis C in adults are weaker than in children. The incubation period lasts from two weeks to six months. Duration depends on the defenses of a particular organism. With immunodeficiency, the period is minimal. At this time, the RNA of the virus acts on the receptors of the surface of the liver cells and penetrates into the hepatocytes. Here the virus multiplies.

Any signs of hepatitis may be absent in latent flow, an inactive agent. Clinical manifestations differ little from other viral hepatitis. In acute course, there are:

• complaints of the patient for fatigue, weakness;
• apathy and depression;
• decreased or no appetite;
• dyspepsia disorder( nausea, sometimes vomiting);
• blunt pains or a feeling of heaviness in the epigastrium and hypochondria on the right;
• joint pain;
• urine becomes dark, and the feces change color to gray;
• first jaundice appears on the sclera and oral mucosa, then the skin turns yellow.

Upon examination, the doctor discovers a liver enlargement, moderate soreness( hepatomegaly), less often - a spleen( splenomegaly).It is at this stage that the patient can still be cured using modern hepatitis C treatment.

The formation of chronic course is accompanied by the appearance of signs of increasing cirrhosis of the liver, loss of functional fullness of the organ, portal hypertension. Pain in the right upper quadrant is worse. She is especially worried after a violation of diet, alcohol intake, lifting weights.

The patient's abdomen is enlarged due to the accumulation of stagnant fluid in the peritoneal cavity( ascites).Appears edema on the feet and legs. In the liver, the synthesis of vitamin K is reduced, which is manifested by a decrease in clotting and bleeding from the stomach and intestines, nose, gums, in women from the uterus.

On the skin around the navel, the enlarged veins that form the

ring become prominent. Palpation is determined by palpation, possibly tuberosity, enlarged spleen. With fibrogastroscopic examination, the enlargement of the esophagus and stomach is noted.

Diagnosis

Some diagnostic methods are not specific for hepatitis C, but they are necessary because they reflect the extent of damage to the liver and other internal organs. Specific methods should detect the virus or the immune response caused by it in the form of antibodies and complexes( antigen + antibody).

The functioning of the liver is judged by the changes:

• In the general analysis of blood - signs of anemia( decrease in the number of red blood cells, hemoglobin and color index), signs of inflammation( mild leukocytosis).
• In urine - increased urobilin, protein, on the development of autoimmune glomerulonephritis indicates the appearance of red blood cells, cylinders.
• In feces analysis, sterbilin is lowered, undigested food fibers may be present due to digestion, Gergersen's reaction to latent blood is positive even with gum bleeding.
• Biochemical blood indices show a significant increase in the activity of aspartic and alanine transferases, alkaline phosphatase, growth of thymol sample, direct bilirubin, cholesterol, triglycerides, and a decrease in protein.

To confirm the presence of the hepatitis C virus in the blood, enzyme-linked immunosorbent assays are used. They provide an opportunity to register a positive result in the presence of HBsAg. Even in a very small amount, the genetic material is determined by polymerase chain reaction( PCR).Thus, carriage, the presence of the virus is confirmed.

Immune methods help not only in diagnosis, but also in the selection of medications, if after the course of therapy there is no improvement and the question arises, what can be done without damaging the patient to replace the drug.

One of the variants of the information received - antibodies to the hepatitis C virus are detected, but the virus itself is not present. If the possibility of false positive results associated with the abnormal research technology is excluded, it can be argued that the patient's own immunity managed to cope with the virus( self-healing in the absence of therapy).

ultrasound, computed tomography is performed to determine the size of the liver, tissue structure, blood circulation in the liver. A histological method is used after a biopsy piece of tissue from the liver. After a special coloring, it gives an opportunity to see the results of the destructive activity of the virus( necrotic cells, proliferation of fibrous tissue).

Treatment problems of

International conferences and forums are devoted to the treatment of hepatitis C.This shows the seriousness of the problem for all countries in the world. Created new pharmacological preparations are not capable to kill a virus, but they so suppress its possibility to reproduction and defeat of hepatic cells that it is possible to prevent irreversible changes, transition in cirrhosis with the subsequent development of hepatic insufficiency.

Begin therapy with compliance with dietary restrictions

The diet is designed to categorically exclude unnecessary strain on the liver. Therefore, it is advised to give up alcohol in all types, fried and fatty dishes, spicy seasonings and sauces, confectionery. It is necessary to eat more vegetables and fruits. Patients should stop heavy work, arrange enough rest.

The main drugs used in therapy are:

• group of interferons( Viferon, Alfaferon);
• means that block the RNA of the virus( Sofosbuvir, Ribavirin);
• protease inhibitors( bocepreviir, simeprevir, telaprevir).

To enhance the effect, the drugs combine. It is necessary to treat a patient from four to eighteen months. The cost of therapy is quite high. Therefore, the drugs are distributed at the request of infectious diseases. Delay in supplies leads to the need to purchase medicines on their own, which is expensive for relatives.

To combat the virus, immunomodulators with Transfer Factor are used. Their stimulating effect on immunity cells is tens of times higher than that known to all aloe, echinacea. Complexes of vitamins are necessary to provide the body with coenzymes in biochemical reactions, restore metabolism.

Do you need to take hepatoprotectors?

Hepatoprotectors activate the restoration of still living liver cells, help them to perform the "work" of the affected areas. Not all drugs available in the pharmacy have proven effectiveness.

To not recommended means of animal origin are Sirepard and Hepatosan - contain the extract of pig liver, amino acids, vitamin B12.Differ high allergic organism. From the group of phospholipids proposed:

• Phospholip - based on lecithin, normalizes fat metabolism;
• Phosphontsiale - active components of silamarin and phospholipids, prevents cells from degenerating into cirrhosis;
• Essel-Forte - contains a combination of vitamins E, group B, nicotinamide with phospholipids.
• Essentiale H - synthesized from soybean phospholipids, possible use in injections.

Hepa-Mertz, Heptor and Heptral - consist of essential amino acids. Heptral is given in injections. From plant hepatoprotectors, funds are recommended that restore the formation of bile and the dynamics of progress in the bile ducts. These include: Ursofalk and Ursosan, Hofitol, Gepabene, Karsil.

What is known about new drugs?

There continues to be controversy over the use of generics( copies of licensed drugs) produced in India, China, Egypt. This applies to drugs Sofosbuvira and Daklatasvira. They are officially authorized in Russia in 2016, registered in accordance with the laws of the country. Prior to this, advertising forced patients to spend significant funds to purchase from obscure manufacturers.

As well as the baseline drug is not recommended in conjunction with interferon-alpha, this simplifies the optimal choice of therapy

An effective analogue - the generic drug Hepcinat lp - is obtained from the certified antiviral drug Harvoni of American company Gilead Sciences. It is a combination of Ledipasvira( 90 mg) and Sofosbuvira( 400 mg).Effective with two genotypes of the virus( first and fourth).

Drugs are used for acute and chronic forms of the disease. Not yet recommended in the treatment of children, because there is not enough experimental base. Possible use against renal and hepatic insufficiency.

Restrictions apply to:

• cases of an allergic reaction to the drug components;
• of women during pregnancy and lactation;
• children and adolescents under 18 years.

It is forbidden to simultaneously prescribe inhibitors of the proton pump, Rifampicin, Carbamazepine, Rosuvastatin, St. John's wort, Phenytoin, Tipranavir. These remedies are resistant to therapeutic effects. Currently, doctors have identified cases of resistant strains of the virus in patients who are taking these drugs on their own.

Therefore, infectious diseases warn of harm to health, the need for treatment of hepatitis only by proven means. Recurrences of hepatitis C, after the course of treatment, are expressed in the recurrence of symptoms. They are possible if the dieter's recommendations are not followed, the course of treatment is broken and the treatment is incomplete.

Forecast

How many people live after acute form of hepatitis C or in chronic course, many are interested. With the timely initiation of acute stage therapy, the recovery prognosis is favorable.

In a chronic course, the process goes on in individuals with existing other pathologies of the liver, alcoholics and drug addicts. Unfortunately, organ damage reaches such a stage that the appearance of irreversible cirrhosis can not be resisted even if a person completely abandons bad habits.

Twenty per cent of chronicles expect liver failure after 10 to 30 years( unless they die from bleeding, joining other infections, cardiac decompensation, renal failure, severe pneumonia).Taking into account that people of young age( up to 30 years) are identified, it will be difficult to live to them up to 60 years of age. A significant spread in patients was liver cancer.

Prevention of

Hepatitis C vaccines do not exist, therefore the basis of prevention is knowledge of the ways of possible infection and the ratio of the appropriateness of their actions with the likelihood of getting sick. Do not reuse syringes, needles, unprocessed cosmetology tools.

Make manicures and pedicures better with their kits or attend masters in good salons and hairdressing salons, there is more confidence in the correct processing of skin wounds, tools

Medical workers are required to work in disposable gloves. In case of accidental contact with body fluids, treat the hands in accordance with the instructions. Using a condom in an intimate life is recommended for the protection and exclusion of sexual infection.

Women planning to conceive and pregnant at an early stage need to conduct routine diagnostics in order to timely identify the infection. It can not be denied that viral hepatitis C is a serious disease, but one should not treat a diagnosis as a sentence. The main obstacle is the late detection and high cost of treatment. It must be remembered that it is possible to reduce the activity of hepatitis, slow the course of the disease.