Hepatitis C is an inflammatory disease of the liver, it develops under the influence of the hepatitis C virus. An effective vaccine that could protect against this virus so far does not exist in nature, and it will not appear soon.
It is of two kinds - acute and chronic. In 20% of cases, people with acute hepatitis have a good chance of recovering, and in 80% of the patient's body is unable to overcome the virus and the disease becomes chronic.
Transmission of the virus occurs through infection through the blood. Today in the world there are 150 million people who are carriers of chronic hepatitis C, and annually with a lethal outcome, hepatitis ends in 350,000 patients.
Basically, the first symptoms of hepatitis C appear after 30-90 days from the time of infection. That's why if you have poor health, lethargy, fatigue and other phenomena unusual for your body, then you'd better contact a doctor. This is necessary for the doctor to make an accurate diagnosis, and based on him chose the most effective treatment.
How is hepatitis C transmitted?
What is it? Infection occurs mainly in contact with the blood of an infected person. Hepatitis C is also transmitted during treatment procedures: collection and transfusion of blood, surgical operations, manipulations with the dentist.
The source of infection can be manicure instruments, devices for creating tattoos, needles, scissors, razors, etc. If the skin or mucous membranes are broken, infection may occur if it comes into contact with the blood of an infected person.
In rare cases, hepatitis C transmits during sexual intercourse. Pregnant women who are infected have a risk that the child is also infected with the virus during childbirth.
Hardest of all carry the course of the virus:
- persons who abuse alcohol.
- persons suffering from other chronic liver diseases, including other viral hepatitis.
- HIV-infected persons.
- older people and children.
Hepatitis C is not transmitted through household contacts through hugs, handshakes, it is possible to use common utensils and towels, but you can not use shared personal hygiene products( razors, manicure scissors, toothbrushes).The mechanism of disease transmission is only hematogenous.
Symptoms of hepatitis C
In most situations, viral hepatitis C proceeds slowly, without severe symptoms, for years remaining undiagnosed and manifesting itself even with significant destruction of liver tissue. Often for the first time patients are diagnosed with hepatitis C, when there are already signs of cirrhosis or hepatocellular liver cancer.
The incubation period of hepatitis lasts from 1 to 3 months. Even after the end of this period, the virus may not manifest itself in any way, until the liver lesions become too obvious.
After infection, 10-15% of patients undergo self-healing, the remaining 85-90% develop primary chronic hepatitis C without any specific symptoms( such as pain, jaundice, etc.).And only in rare cases, patients develop an acute form with jaundice and severe clinical manifestations, which, with adequate therapy, leads to a complete cure of the patient from hepatitis C.
The first signs of hepatitis C in women and men
For a long time, the symptoms practically do not bother the patients. In the acute period, the disease manifests itself only in weakness, fatigue, sometimes occurs under the mask of a respiratory-viral infection with pain in the muscles and joints. These may be the first signs of hepatitis C disease in women or men.
Jaundice and any clinical manifestations of hepatitis develop in a very small percentage of infected( the so-called icteric form of the disease).And this is actually excellent - patients immediately turn to specialists, and the disease has time to cure.
However, most of the infected carry hepatitis C on their feet: they do not notice anything at all, or write off the malaise for a cold.
Chronic hepatitis
The peculiarity of chronic hepatitis C is a latent or malosymptomatic course for many years, usually without jaundice. Increased activity of ALT and ACT, detection of anti-HCV and HCV RNA in the blood serum for at least 6 months are the main signs of chronic hepatitis C. Most often this category of patients is detected by chance, when examined before surgery, when undergoing medical examination, etc..
The course of chronic hepatitis C can accompany such immuno-mediated extrahepatic manifestations as mixed cryoglobulinemia, lichen planus, mesangiocapillary glomerulonephritis.late skin porphyria, rheumatoid symptoms.
Photo
In the photo, liver damage with prolonged course of hepatitis.
Forms
By the presence of jaundice in the acute phase of the disease:
- Jaundice.
- Without jaundiced.
According to the duration of the current.
- Acute( up to 3 months).
- Prolonged( more than 3 months).
- Chronic( more than 6 months).
By gravity.
- Light.
- Medium-Heavy.
- Heavy.
- Fulminant.
Complications.
- The hepatic coma.
Outcomes.
- Recovery.
- Chronic hepatitis C.
- Cirrhosis of the liver.
- Hepatocellular carcinoma.
According to the nature of the clinical manifestations of the acute phase of the disease, typical and atypical hepatitis C are distinguished. Typical cases include all cases with clinically apparent jaundice, and to atypical cases are jaundiced and subclinical forms.
Stages of
The disease is divided into several stages, depending on which treatment is prescribed.
- Acute - it is characterized by asymptomatic leakage. A person often does not even suspect that he is a carrier of the virus and a source of infection.
- Chronic - in the vast majority of cases( about 85%), following the acute stage, the chronic course of the disease begins.
- Cirrhosis of the - develops with further progression of pathology. This is a serious disease that threatens the life of the patient and in itself, and the fact that if there is a significant increase in the risk of other complications - in particular, liver cancer.
A distinctive feature of the virus is the ability to genetic mutations, due to which in the human body can simultaneously detect about 40 subspecies of HCV( within the same genotype).
Genotypes of the
virus The severity and course of the disease depends on the hepatitis C genotype that infected the body. At present six genotypes with several subtypes are known. The most common in the blood of patients are viruses 1, 2, and 3 genotypes. They cause the most pronounced manifestations of the disease.
In Russia, the most common genotype is 1b. Less commonly - 3, 2 and 1a. Hepatitis C, caused by the virus of the 1b-genotype, is characterized by a more severe course.
Diagnosis of hepatitis
The main method for diagnosing hepatitis is to determine the presence of antibodies to the hepatitis C virus( anti-HCV) and HCV-RNA.The positive results of both tests confirm the presence of infection. The presence of antibodies of IgM class( anti-HCV IgM) makes it possible to distinguish active hepatitis from carrier( when IgM antibodies are not present and ALT is normal).
The hepatitis C PCR test( polymerase chain reaction) allows to determine the presence of hepatitis C RNA in a patient's blood. Conducting PCR is mandatory for all patients with suspected viral hepatitis. This method is effective from the first days of infection and plays an important role in early diagnosis.
When is hepatitis C harder to treat?
According to statistics, it is more difficult to treat hepatitis C in men, people over 40 years of age, in patients with normal transaminase activity, with high viral load, in the 1b genotype of the virus. Of course, the presence of cirrhosis of the liver at the time the treatment begins worsens the prognosis.
The effectiveness of antiviral treatment depends on many factors. With prolonged course of hepatitis C, it is not easy to achieve complete eradication of the virus. The main task is to slow down the process of active multiplication of viruses.
This is possible in most cases when using modern antiviral therapy regimens. In the absence of active reproduction of viruses in the liver, the severity of inflammation decreases reliably, fibrosis does not progress.
Treatment of hepatitis C
In the case of hepatitis C, a combination therapy with interferon-alpha and ribavirin is the standard treatment. The first preparation is available as a hypodermic solution under the trade names Pegasys®( Pegasys®), PegIntron®( PegIntron®).Peginterferons are taken once a week. Ribavirin is produced under different brands and is taken in the form of tablets twice a day.
- Interferon-alfa is a protein that the body synthesizes on its own in response to a viral infection, i.e.this is actually a component of natural antiviral protection. In addition, interferon-alpha has antitumor activity.
- Ribavirin has low efficacy as an independent treatment, but when combined with interferon it significantly improves its effectiveness.
The duration of therapy can be from 16 to 72 weeks, depending on the genotype of the hepatitis C virus, the response to treatment, largely due to the individual characteristics of the patient, which are determined by its genome.
The course of antiviral therapy using the "gold standard" can cost the patient from $ 5000 to $ 30,000 depending on the choice of drugs and treatment regimen. The main costs are for interferon preparations. Pegylated interferons of foreign production are more expensive than conventional interferons of any manufacturer.
The effectiveness of hepatitis C treatment is assessed by biochemical blood parameters( decrease in transaminase activity) and the presence of HCV-RNA, to reduce the level of viral load.
New in the treatment of hepatitis
A new class of drugs for the treatment of HCV infection are protease inhibitors( Protease Inhibitors) - drugs that are directed directly at the hepatitis virus, with a so-called direct antiviral effect that suppresses or blocks key intracellular stages of virus multiplication.
Currently, two such drugs have been approved in the US and EU - Telaprevir( INCIVEK) and Bocepreviros( ViCTRELIS).
According to the results of clinical trials in May 2013, the effectiveness of these drugs is 90-95%, as for standard treatment, its effectiveness does not exceed 50-80%.
Side effects of antiviral therapy
If treatment with interferons is indicated, side effects can not be avoided, but they are predictable.
After the first injections of interferon, most people have ORVI syndrome. After 2-3 hours, the temperature increases to 38-39 0 C, there may be chills, pain in the muscles and joints, a noticeable weakness. The duration of this condition can be from a few hours to 2-3 days. Within 30 days the body is able to get used to the introduction of interferon, so by this time the flu-like syndrome disappears. There is weakness, fatigue, but this has to be tolerated.
As for Ribavirin, it is usually well tolerated. But quite often in the general analysis of blood, there are phenomena of easy hemolytic anemia. There may be a mild dyspepsia, rarely a headache, an increase in the level of uric acid in the blood, very rarely a drug is intolerant.
How many live with hepatitis C, if not treated
Tell uniquely how many live with hepatitis C, as well as with HIV infection, it is very difficult. In the average number of patients, cirrhosis of the liver can develop in about 20-30 years.
As a percentage, depending on the person's age, cirrhosis develops:
- in 2% of patients infected before the age of 20;
- in 6% of those who received the virus at the age of 21-30;
- in 10% of infected at 31-40 years of age;
- in 37% of patients aged 41-50 years;
- in 63% of those infected over 50 years of age.
Also, most studies have shown that the development of fibrosis depends on the sex. In men, this pathology develops much faster and in a more severe form, even if treated.