Hepatitis C: symptoms, treatment as hepatitis C is transmitted and what is it?

Hepatitis - liver damage is one of the major internal organs. There are many infections that affect his work. Lifestyle, diet and excessive alcohol consumption also play an important role in the destruction of normal, healthy liver. Hepatitis A, B and C, the most common hepatitis viruses, of pathogens dangerous because it is a special group of viruses.

Against hepatitis A and B vaccinations have been invented and are often recommended to make babies. Vaccinated against hepatitis C newborns do. The fact that the virus itself was discovered relatively recently, little more than twenty years ago, and he is so volatile that choose an effective vaccine is still not possible. At this stage known six major genotypes of hepatitis C virus (HCV), and more than fifty subtypes (1, 1b, etc.). Scientific studies of the issue are continuing.

What it is?

Hepatitis C, abbreviated to HS - virus, an infectious disease, which develops in the liver as a result of infection with hepatitis B virus (HCV). Virus spreads through contact with an infected person, and it is through blood. Infectious hepatitis c has acute and chronic.

HCV - small chain ribonucleic (RNA) viral shells which uses propagation material hepatic cells. The mechanism of RNA activity triggers inflammation in the liver, gradually destroys liver cells (cytolysis process) starts the immune mechanism synthesising specific antibodies, autoimmune aggression body protection functions with respect to inflammatory processes hepatocytes (attack on healthy cells of the immune system).

How is hepatitis C.

In the world about 150 million people are chronically infected with hepatitis C virus and are at risk of developing liver cirrhosis and / or liver cancer. Every year more than 350,000 people die from hepatitis C-related liver diseases. Every year 3-4 million people are infected with hepatitis C. Today we know 7 genotypes.

How is hepatitis C? The source of infection are patients with active hepatitis C and latent patients - carriers of the virus. HCV-infection is an infection with parenteral mechanism of infection - through infected blood and its components, as well as through semen and vaginal secretions (about 3%). Infection is possible with parenteral manipulations, including in health care facilities, including the provision of dental services through injecting equipment in acupuncture, body piercing, tattooing, in providing a range of services in hairdressing, but during sexual intercourse more likely to get hepatitis C is much less than with hepatitis B, and is reduced to a minimum indicators. In 20% of cases not possible to establish a method of transmitting the virus.

Infected with hepatitis C should not be:

• when using some appliances (excluding shaving, nail and other accessories, in which traces of blood may be present);
• by shaking hands, arms;
• kissing;
• by sharing a meal.

The most dangerous from the point of view of the source, patients with chronic hepatitis C.

genotypes

The genotypes have a specific spatial distribution. In respect of the same genotypes of different areas have uniform treatment guidelines. They are identified by Arabic numerals (one to six) and kvazitipy or subtypes represent the Latin alphabet (a, b, c, d, e) and so forth:

1. The first genotype. Distributed everywhere, marked with three kvazitipa (1a, 1b, 1c). Upon confirmation of the genotype should be calculated on a long-term treatment for one year or more.
2. The second genotype. Characteristically ubiquitous genotype and four kvazitipa (2 a, b, c, d). The duration of treatment is usually not more than six months.
3. The third genotype. It is widespread. Proven is the presence of six kvazitipov (3 a, b, c, d, e, f). For this genotype characteristic fatty degeneration (infiltration) parenchymal liver - steatosis. The treatment time depends on the quality of diagnosis. The average treatment time is limited to six months.
4. The fourth genotype. It is widespread in the Middle East and Central Africa. In the conditions of Russia little studied. Allocated ten kvazitipov (4a, b, c, d, e, f, g, h, i, j).
5. The fifth genotype. First registered in South Africa. It has one kvazitip. In the conditions of our country remains poorly understood disease.
6. Sixth genotype. Joined in Asian countries, it has one kvazitip. In the conditions of Russia little studied.

The term "genotype" refers to differences of virus at the molecular (genetic) level.

Symptoms of hepatitis C in women and men

The incubation period of the disease until the first signs lasts from 1.5 to 6 months (average - 2-3). Acute hepatitis C (see. photo) has a benign course, the state quickly returned to normal, the symptoms are mild or moderate:

• unexpressed dyspeptic symptoms (1-2-fold vomiting, heaviness or a dull arching pain in the right upper quadrant, unstable stool, nausea, loss of appetite, feeling of bitterness in the mouth);
• rise in body temperature to subfebrile (say about one third of patients), high fever is uncharacteristic;
• liver enlargement;
• icteric staining of the skin and visible mucous membranes, sclera ikterichnost;
• dark urine staining, discoloration of feces.

Characteristically, the severity of the disease in acute hepatitis C is less pronounced than with other forms of viral hepatitis. Recovery against the backdrop of an acute process occurs in 15-35% of infected individuals, in other cases, the disease becomes chronic and lasts for many years or even decades.

The symptoms of chronic hepatitis C

Unfortunately, 70-80% of cases of hepatitis C has a primary chronic. For many years the disease runs hidden, almost without showing itself. A man unaware of his illness, leading a normal life, drinking alcohol, adding to his fortune, has unprotected sex and infect others. liver function in hepatitis C for a long time is compensated, but often it ends up seeming well-being of acute liver failure.

What are the indirect signs can touch up on the idea of ​​human liver dysfunction?

1. Dull pain below the right rib, intermittent nausea, taste disturbance. It is important to understand that the gradual destruction of liver cells remaining tissue mass compensatory increases. Liver increases in size and stretches the liver capsule, there is pain. As this takes place gradually, for cirrhosis hepatitis on a background not characterized by sharp or acute pain.
2. Weakness, lethargy and sleepiness. Extremely non-specific symptoms characteristic of many diseases, however, patients with hepatitis often characterize their weakness as "horrific". "I can not open my eyes", "ready to sleep for 20 hours a day", "legs give way" - these characteristics are often heard infectious disease physicians.
3. Periodic yellowing of the skin and mucous membranes. In chronic hepatitis with jaundice appears and disappears. Often patients report a slight yellowing of the skin or sclera in the morning after a celebratory dinner with an abundance of fatty foods, meat and alcohol. Thus, in ordinary days liver copes with the exchange of bilirubin, but after the "double" strike fatty foods and alcohol temporarily fails.
4. Joint pain are also unspecific symptoms of hepatitis, but there often enough.
5. Bruising, hematoma, spider veins, excessive gum bleeding, heavy menstruation in women indicate deficiency of coagulation factors, which are responsible for the liver.
6. Dry and pale skin, hair loss, brittle nails, and lamination are the consequences of a lack of vitamins and iron metabolism disorders, under the responsibility of the liver. Often in patients with hepatitis observed a pronounced lack of B vitamins and iron, leading to anemia (anemia).
7. Impotence and infertility are often observed in patients with hepatitis C. Inability to conceive a child, habitual miscarriage is often observed in female carriers of hepatitis C. Basic "sex," hepatitis C symptoms in men: impotence and impaired spermatogenesis. This is due to the errors of metabolism of sex hormones, which must pass its transformation in the liver.
8. Edematous syndrome and its extreme manifestation - ascites. Swelling occur due to insufficient amounts of protein and nutrients in the blood. Ascites - this accumulation of fluid in the abdominal cavity with a proportional increase in the abdomen, which is sick and notices. This is due to impaired blood flow in the abdominal vessels. This symptom is characteristic of cirrhosis in the background of hepatitis. Sometimes abdominal accumulates up to 20 liters of liquid.

The most common (about 70% of cases) any symptoms of both acute and (later) in chronic hepatitis are absent for many years, infected person concerned fatigue, recurring heaviness in the right hypochondrium, intolerance to intense physical loads. In this case, the carrier of the virus is determined by chance during routine inspections, hospitalization or attempt to donate blood as a donor.

How to treat?

In the treatment of chronic hepatitis C there is no uniform standard of care, each case is individual. Comprehensive treatment is administered after a thorough analysis of the following factors:

1. Degree of liver damage;
2. Likelihood of success;
3. Willingness of the patient to begin therapy;
4. Presence of concomitant diseases;
5. Potential risks of adverse events.

The most effective to date treatment of viral hepatitis C involves performing complex antiviral therapy with ribavirin and interferon. These drugs are obschegenotipicheskimi, that is effective against all genotypes.

The complexity of the treatment lies in the fact that some patients can not tolerate interferon, and this drug is not widely available. The cost of treating hepatitis C can afford is not for everyone, so many patients simply do not lead to the end of treatment and the virus develops resistance to taking the drug. If the patient later starts a new course of therapy with resistance to the antiviral effect of the treatment will be.

More chances for positive signs of response to the combination therapy of hepatitis C in persons:

1. European race;
2. Female;
3. Weight less than 75 kg;
4. Age younger than 40 years;
5. Low insulin resistance;
6. No signs expressed cirrhosis.

Most doctors use a combination regimen of hepatitis B, the so-called dual therapy - a combination of interferon, which is actively fighting the virus and ribavirin, which enhances the action of interferon.

Patient every day, or once every three days, injected short-acting interferon, and once a week - interferon long-acting (pegylated interferon) combined with ribavirin (used as a daily tablets). Depending on the type of virus, the course is 24 or 48 weeks. It is best to respond to therapy with genotype 2 and 3 - the success of treatment is 80-90%.

At first the genotype combination therapy is successful in 50% of cases. If the patient has a contraindication to the combination therapy, is appointed by monotherapy with interferon-alpha. In this case, the course of treatment lasts 12-18 months. Prolonged interferon-alpha monotherapy lowers viral load in 30-50% of cases.

New drugs for the treatment of

On November 2016 final, III phase clinical trials tested therapeutic next generation modes consisting of two or three replication inhibitors sofosbuvir / velpatasvir / voksilaprevir from company Gilead gletsaprevir and / pibrentasvir ± sofosbuvir, test company AbbVie. Both modes pangenotipichnuyu exhibit high potency and efficacy in patients with multidrug resistance.

Phase I-II clinical trials tested pangenotipichnye first representatives of the class of non-nucleoside inhibitors of NS5B-polymerase CC-31244 and injectable form GSK2878175 prolonged action. Both inhibitors can potentially be used in combination therapies with both the PDP of other classes and with antivirals indirect action.

Can hepatitis C go on their own without treatment?

Probability recover Hepatitis C in the acute form and recover is at different data, to 10-30%. Acute hepatitis C is practically not diagnosed and in most cases becomes chronic.

Chronic hepatitis C does not pass on their own and require treatment.

How much is the treatment?

The cost of modern drugs needed for treatment can range from $ 550 to $ 2,500 per month. The duration of treatment of 12 months (respectively, $ 6600-30000 per year).

More innovative, efficient, learning, suitable for use of the drug, produced well-known companies, are more expensive - 40-100 thousand dollars for a course of therapy.

The main costs fall to interferon preparations. Pegylated interferons foreign origin are more expensive than conventional interferon from any manufacturer.

As the therapy can last long?

Selection schemes and duration of treatment depends on the current stage and hepatitis C, which establishes a physician. Treated with a combination of interferon and ribavirin may last 12 months.

In this case, in contrast to many other infectious diseases in chronic hepatitis C there is no uniform treatment standards recommended by individual planning in special cases. There are complicated treatment protocols that take into account the genotype, liver condition (performance of its functions and the changes in its tissue biopsies), viral load.

Doses and their assignment scheme may be changed, and are also dependent on the species of drugs (e.g., various forms of interferon).

Is there a vaccine against hepatitis C?

The vaccine yet. However, the search for her progress.

Scientists have for a long time can not find a stable viral protein that is specific for all genotypes and subtypes of hepatitis C virus, which would have produced neutralizing antibodies. The possibilities of genetic engineering technologies to create such a vaccine.

Currently, several teams of researchers is seeking vaccines creating technologies against hepatitis C virus According to WHO, Clinical trials in Europe passes vaccine for hepatitis C. There are a number of international projects for the development of a prophylactic vaccine against hepatitis C.

How to protect your liver if hepatitis C have discovered

If the tests show the presence of infection (anti-HCV), you should:

1. Immediately renounce the use of alcohol;
2. Find your doctor periodically to show him;
3. Do not take any treatment (including OTC, "non-traditional", "approved as a harmless") without the advice of your doctor;
4. Be vaccinated against hepatitis B (in any case) and Hepatitis A (if there are any changes in liver function).

Nutrition and diet

Dining with hepatitis C should be different from the standard diet. Compliance with the specific diet is urgently needed, so you should take to change very seriously. The complete exclusion of alcoholic beverages - the first and mandatory item. In addition, there is an acceptable list of foods authorized for use:

• beef, rabbit, veal, steamed or boiled. Meatballs, burgers and other variations of meat dishes should be cooked in a double boiler;
• yogurt, yogurt and low-fat cheese;
• pasta all kinds of cereals;
• vegetable butter and easy;
• transparent, vegetarian soups (vegetables, cereals, noodles);
• low-fat chicken and fish boiled;
• fresh and boiled vegetables, except beans, garlic and radish;
• raisins, dried apricots, prunes and ripe, juicy, sweet fruit.

Sweet, spicy, salty, smoked, fried foods and raw eggs should be deleted irrevocably. Choosing the right power tactics, remember that for the full satisfaction of the body and building new cells, as part of the food should be not only carbohydrates, proteins and fats, but also vitamins, minerals, water. Strict but balanced diet is very important the first six months of treatment, and it is better to stick to such a diet for several years. The longer eat through the list, the easier it is definitively abandon banned products

prevention

Specialized vaccine against hepatitis C to date does not exist. Therefore, as the prevention of the disease is recommended to follow some simple rules:

1. When injections can not use the same needle on a few people.
2. Tools for piercing and tattooing must be sterilized after each use, and the master should use disposable gloves.
3. Tools for manicure, razors, toothbrushes should be personal and not shared with other people.
4. Safe sex. It must be remembered that although the probability of infection during unprotected sex is relatively small, it increases sharply in casual sexual relations. In such cases, the use of a condom is a must.

To avoid infection of the child with a woman planning a pregnancy should be tested for hepatitis C.

Forecast for life as living?

In patients with active hepatitis over, ie with constantly elevated transaminase activity, the risk of transformation into cirrhosis within 20 years is 20%. At 5% of patients with cirrhosis can develop primary liver cancer.

The probability of developing liver cancer is higher, while for two infections - hepatitis B and hepatitis C. Prolonged use of alcohol is also associated with a higher risk of developing liver cancer.

How many live with this diagnosis? General Statistics outcomes of hepatitis C is as follows. Out of every 100 people are infected with hepatitis C virus,

• from 55-85 people have chronic infection (chronic hepatitis or carrier without symptoms);
• 70 people is a chronic liver disease;
• 5-20 people for 20-30 years will develop cirrhosis of the liver;
• 1-5 people die from the consequences of chronic hepatitis C (cirrhosis or liver cancer);

To avoid these consequences of chronic hepatitis C, it is necessary to undergo treatment.