How to treat hepatitis C at home - effective drugs and folk remedies. Antiviral drugs and tablets for the treatment of hepatitis C, application and list How to treat viral hepatitis C

The presence of antibodies does not mean the presence of a virus in the blood, and with a positive Anti-HCV result, a PCR analysis of HCV-RNA is done, according to the results of which we determine whether the hepatitis C virus is present in the blood. The cost of analysis is 750 rubles.

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What is special about the hepatitis C virus?

After the virus enters the human body, it enters the liver with the bloodstream, infects the liver cells and multiplies there.

The hepatitis C virus is characterized by genetic variability and the ability to mutate. There are 6 main genotypes of the virus and more than 40 subtypes. That is why the virus often manages to “trick” the immune system, which leads to the development of chronic viral hepatitis C.

Hepatitis C is one of the main reasons leading to a liver transplant, which is why it is better not to delay its treatment.

How does hepatitis C progress?

There are two forms of viral hepatitis C: acute and chronic. The acute form is most often asymptomatic and is diagnosed only by chance when markers of acute hepatitis C, anti-HCV-IgM, are detected in the blood, which persists in the blood for no more than 6 months after infection with the virus.

After suffering acute viral hepatitis C, three scenarios are possible:

• Approximately 20% of patients have a complete recovery;
• In 20% of patients, inactive chronic viral hepatitis C develops with the absence of laboratory markers of the inflammatory process in the liver;
• The remaining 60% have chronic hepatitis with clinical and laboratory manifestations of liver damage.

The transition of the disease to a chronic form occurs imperceptibly. Liver damage increases over the years and the patient develops liver fibrosis with subsequent liver dysfunction. The disease progresses slowly over years. In patients with active hepatitis, the risk of developing cirrhosis within 20 years reaches 20%, of which 5% develop liver cancer.

When do signs and symptoms of hepatitis C appear?

Symptoms may not appear at all until the disease progresses to cirrhosis. However, some patients experience non-specific, that is, typical for other diseases, symptoms: chronic fatigue, weakness, fatigue.

Extrahepatic manifestations of viral hepatitis C are also possible, for example, diseases of the skin, kidneys, and joints.

How long after infection should it take for laboratory markers of viral hepatitis C to show up in the tests?

Antibodies to the hepatitis C virus appear after three months, and the RNA of the virus in the blood (PCR analysis) - after 1-2 weeks from the moment of infection.

Can viral hepatitis C be cured?

Can. This is a curable disease. The probability of recovery depends on the correctness of the treatment plan and can reach 99%.

The result, however, depends not only on the qualifications and experience of the doctor, but also on the patient himself and his willingness to comply with the prescription.

Where to start treatment?

From survey.

A standard examination provides complete information about the virus, its genotype and viral load, as well as a detailed picture of the state of the liver. To do this, biochemical blood tests are carried out with the establishment of the structural and functional state of the liver cells, ultrasound, assessment of the degree of fibrosis (methods Fibroscan, FibroMax, Fibrotest).

An important and necessary part of the examination is the exclusion of contraindications for prescribing therapy, since the instructions for antiviral drugs prohibit their prescribing in a number of comorbidities.

Which Doctors Treat Hepatitis C?

For the treatment of viral hepatitis, you should contact hepatologists. It is extremely important that the doctor had experience in the treatment of viral hepatitis C, since, despite the existence of international standards for therapy, treatment is often accompanied by side effects from drugs and does not always give a 100% result. That is why the process of therapy requires competent decisions of the doctor, and therefore, his experience and qualifications are extremely important.

When to start treatment?

The earlier therapy is started, the better its prognosis. However, the patient's personal circumstances, such as the rate at which the disease progresses and his general condition, must also be taken into account. One of the main factors is the degree of damage to the liver tissue (fibrosis), which is assessed by specialists on a scale from 0 to 4. Grade 4 corresponds to cirrhosis.

Is it possible to not treat viral hepatitis C?

Most often, the disease proceeds without symptoms, however, the risk of activation of the process and the transition to cirrhosis is high, especially with an increase in liver tests (ALT, AST) in the blood. That is why a person with the hepatitis C virus needs to see a doctor.

Modern methods of treatment of viral hepatitis C

The international standard for the treatment of viral hepatitis C is a combination therapy with interferon and ribavirin. Doses of drugs and duration of treatment are selected by the doctor individually, depending on many factors (see. Treatment of viral hepatitis C).

Recently, new direct antiviral drugs have appeared that significantly increase the possibility of a complete recovery. assigned on an individual basis.

Hepatitis C is an inflammation of the liver of a viral origin, clinical manifestations of which in most cases are significantly delayed in time or so little expressed that the patient himself may not notice that a “gentle” killer virus has settled in his body, as the hepatitis C virus (HCV) is commonly called.

Once upon a time, and this continued until the end of the 80s of the last century, doctors knew about the existence of a special form of hepatitis that did not fit into the concept of "Botkin's disease" or jaundice, but it was obvious that it was hepatitis that affects the liver in no way less than their own " brethren" (A and B). An unfamiliar species was called hepatitis neither A nor B, since its own markers were still unknown, and the proximity of pathogenesis factors was obvious. It was similar to hepatitis A in that it was transmitted not only parenterally, but suggested other routes of transmission. The similarity with hepatitis B, called serum hepatitis, was that it could also be infected by receiving someone else's blood.

At present, everyone knows that, called neither A nor B hepatitis, is open and well studied. This is hepatitis C, which in its prevalence is not only not inferior to the infamous, but also far exceeds it.

Similarities and differences

Botkin's disease was previously called any inflammatory liver disease associated with a certain pathogen. The understanding that Botkin's disease can represent an independent group of polyetiological pathological conditions, each of which has its own pathogen and the main route of transmission, came later.

Now these diseases are called hepatitis, but a capital letter of the Latin alphabet is added to the name according to the sequence of discovery of the pathogen (A, B, C, D, E, G). Patients often translate everything into Russian and indicate hepatitis C or hepatitis D. However, the diseases assigned to this group are very similar in the sense that the viruses they cause have hepatotropic properties and, when ingested, affect the hepatobiliary system , each in its own way violating its functional abilities.

Different types of hepatitis are unequally prone to chronization of the process, which indicates the different behavior of viruses in the body.

Hepatitis C is considered the most interesting in this regard., which for a long time remained a mystery, but even now, being widely known, it leaves secrets and intrigues, since it does not make it possible to give an accurate forecast (it can only be assumed).

Inflammatory processes of the liver caused by various pathogens do not differ in relation to sex, therefore men are equally affected, and women. There was no difference in the course of the disease, however, it should be noted that in women during pregnancy, hepatitis can be more severe. In addition, the penetration of the virus in recent months or the active course of the process can adversely affect the health of the newborn.

If liver diseases of viral origin still have a clear similarity, then considering hepatitis C, it is advisable to touch on other types of hepatitis, otherwise the reader will think that only the “hero” of our article should be afraid. But through sexual contact, you can become infected with almost every species, although this ability is attributed more to hepatitis B and C, and therefore they are often referred to as sexually transmitted diseases. In this regard, other pathological conditions of the liver of viral origin are usually kept silent, since their consequences are not as significant as the consequences of hepatitis B and C, which are recognized as the most dangerous.

In addition, there are hepatitis of non-viral origin (autoimmune, alcoholic, toxic), which should also be mentioned, because one way or another, they are all interconnected and significantly aggravate each other.

How is the virus transmitted?

Depending on which way the virus could "run across" to a person and what things it will start to "do" in the body of a new "host", different types of hepatitis are distinguished. Some are transmitted in everyday life (through dirty hands, food, toys, etc.), appear quickly and pass, basically, without any consequences. Others, called parenteral, having the potential of chronicity, often remain in the body for life, destroying the liver to cirrhosis, and in some cases to primary liver cancer (hepatocarcinoma).

Thus, hepatitis according to the mechanism and routes of infection are divided into two groups:

• Having an oral-fecal transmission mechanism (A and E);
• Hepatitis, for which the blood-contact (hemopercutaneous), or, more simply, the path through the blood, is the main one (B, C, D, G - a group of parenteral hepatitis).

In addition to the transfusion of infected blood or flagrant non-compliance with the rules for medical manipulations associated with damage to the skin (the use of insufficiently processed instruments, for example, for acupuncture), often there is the spread of hepatitis C, B, D, G and in other cases:

1. Various fashionable procedures (tattoos, piercings, ear piercings) performed by a non-professional at home or in any other conditions that do not meet the requirements of the sanitary and epidemiological regime;
2. By using one needle for several people, this method is practiced by syringe addicts;
3. Transmission of the virus through sexual intercourse, which is most likely for hepatitis B, hepatitis C in such situations is transmitted much less frequently;
4. Cases of infection by the "vertical" route (from mother to fetus) are known. Active disease, acute infection in the last trimester, or HIV carriers greatly increase the risk of hepatitis.
5. Unfortunately, up to 40% of patients cannot remember the source that “gifted” the hepatitis B, C, D, G virus.

The hepatitis virus is not transmitted through breast milk, so women with hepatitis B and C can safely feed their baby without fear of infecting him.

We can agree that the fecal-oral mechanism, water, contact-household, being so interconnected, cannot exclude the possibility of transmitting the virus and sexually just as well as other types of hepatitis transmitted through the blood, have the ability to penetrate into another organism during sex.

Signs of an unhealthy liver

After infection, the first clinical signs of different forms of the disease appear at different times. For example, the hepatitis A virus declares itself in two (up to 4) weeks, the causative agent of hepatitis B (HBV) is somewhat delayed and manifests itself in the interval from two months to six months. As for hepatitis C, it the pathogen (HCV) can detect itself after 2 weeks, after 6 months, or it can “hide” for years, turning a healthy person into a carrier and source of infection for a rather serious disease.

The fact that something is wrong with the liver can be guessed from the clinical manifestations of hepatitis:

• Temperature. With it and the phenomena of influenza infection, hepatitis A usually begins (headache, pain in the bones and muscles). The onset of HBV activation in the body is accompanied by subfebrile temperature, and with C-hepatitis it may not rise at all;
• Jaundice varying degrees of expression. This symptom appears a few days after the onset of the disease, and if its intensity does not increase, then the patient's condition usually improves. A similar phenomenon is most characteristic of hepatitis A, which cannot be said about hepatitis C, as well as toxic and alcoholic hepatitis. Here, a more saturated color is not attributed to signs of an impending recovery, rather, on the contrary: with a mild form of inflammation of the liver, jaundice may be absent altogether;
• Rashes and itching more characteristic of cholestatic forms of inflammatory processes in the liver, they are caused by the accumulation of bile acids in tissues due to obstructive lesions of the hepatic parenchyma and injury to the bile ducts;
• Decreased appetite;
• Heaviness in the right hypochondrium, possible enlargement of the liver and spleen;
• Nausea and vomiting. These symptoms are more characteristic of severe forms;
• Weakness, malaise;
• Joint pain;
• dark urine, dark beer-like , discolored feces - typical signs of any viral hepatitis;
• Laboratory indicators: liver function tests (AlT, AST, bilirubin), depending on the severity of the course, can increase several times, the number of platelets decreases.

During viral hepatitis, 4 forms are distinguished:

1. Easy, more characteristic of hepatitis C: jaundice is often absent, subfebrile or normal temperature, heaviness in the right hypochondrium, loss of appetite;
2. Medium: the above symptoms are more pronounced, there is pain in the joints, nausea and vomiting, there is practically no appetite;
3. heavy. All symptoms are present in a pronounced form;
4. Lightning (fulminant), which is not found in hepatitis C, but is very characteristic of hepatitis B, especially in the case of coinfection (HDV / HBV), that is, a combination of two viruses B and D that cause superinfection. The fulminant form is the most dangerous, because as a result of the rapid development of massive necrosis of the hepatic parenchyma, the death of the patient occurs.

Hepatitis, dangerous in everyday life (A, E)

In everyday life, first of all, liver diseases that have a predominantly fecal-oral route of transmission can lie in wait, and these are, as you know, hepatitis A and E, so you should dwell a little on their characteristic features:

Hepatitis A

Hepatitis A is a highly contagious infection. Previously, it was simply called infectious hepatitis (when B was serum, and others were not yet known). The causative agent of the disease is a small but incredibly resistant virus containing RNA. Although epidemiologists note susceptibility to the pathogen as universal, it is predominantly children who have stepped over the age of one who are ill. Infectious hepatitis, triggering inflammatory and necrobiotic processes in the hepatic parenchyma, giving symptoms of intoxication (weakness, fever, jaundice, etc.), as a rule, ends with recovery with the development of active immunity. The transition of infectious hepatitis to a chronic form practically does not occur.

Video: hepatitis A in the program “Live healthy!”

Hepatitis E

Its virus also belongs to RNA-containing ones, it “feels good” in the aquatic environment. It is transmitted from a sick person or carrier (in the latent period), there is a high probability of infection through food that has not undergone heat treatment. Mostly young people (15-30 years old) living in the countries of Central Asia and the Middle East get sick. In Russia, the disease is extremely rare. The contact-household route of transmission is not excluded. Cases of chronicity or chronic carriage have not yet been established or described.

Hepatitis B and dependent hepatitis D virus

hepatitis virusB(HBV), or serum hepatitis, is a DNA-containing pathogen with a complex structure, which prefers liver tissue for its replication. A tiny dose of infected biological material is enough to transmit the virus, why this form passes so easily not only during medical manipulations, but also during sexual intercourse or in a vertical way.

The course of this viral infection is multivariate. It may be limited to:

• Carrying;
• Give acute liver failure with the development of a fulminant (fulminant) form, often taking the life of the patient;
• When the process is chronic, it can lead to the development of cirrhosis or hepatocarcinoma.

The incubation period of this form of the disease lasts from 2 months to six months, and the acute period in most cases has symptoms characteristic of hepatitis:

1. Fever, headache;
2. Decreased efficiency, general weakness, malaise;
3. Pain in the joints;
4. Disorder of the function of the digestive system (nausea, vomiting);
5. Sometimes rashes and itching;
6. Heaviness in the right hypochondrium;
7. Enlargement of the liver, sometimes - the spleen;
8. Jaundice;
9. A typical sign of liver inflammation is dark urine and discolored feces.

Very dangerous and unpredictable combinations of HBV with the causative agent of hepatitis D (HDD), which was previously called delta infection - a unique virus that is invariably dependent on HBV.

The transmission of two viruses can be simultaneous, which leads to the development co-infections. If the D-causative agent later joined the HBV-infected liver cells (hepatocytes), then we will talk about superinfection. A serious condition, which was the result of such a combination of viruses and the clinical manifestation of the most dangerous type of hepatitis (fulminant form), often threatens to be fatal in a short time.

Video: hepatitis B

The most significant parenteral hepatitis (C)

viruses of various hepatitis

The “famous” C-hepatitis virus (HCV, HCV) is a microorganism with unprecedented heterogeneity. The causative agent contains a single-stranded positively charged RNA encoding 8 proteins (3 structural + 5 non-structural), to each of which corresponding antibodies are produced during the course of the disease.

The hepatitis C virus is quite stable in the external environment, it tolerates freezing and drying well, but it is not transmitted in negligible doses, which explains the low risk of infection by the vertical route and during sexual intercourse. A low concentration of an infectious agent in the secrets released during sex does not provide the conditions for the transmission of the disease, unless other factors are present that "help" the virus "move". These factors include concomitant bacterial or viral infections (HIV in the first place), which reduce immunity, and a violation of the integrity of the skin.

The behavior of HCV in the body is difficult to predict. Having penetrated into the blood, it can circulate for a long time at a minimum concentration, forming in 80% of cases a chronic process that can eventually lead to severe liver damage: cirrhosis and primary hepatocellular carcinoma (cancer).

The absence of symptoms or a slight manifestation of signs of hepatitis is the main feature of this form of inflammatory liver disease, which remains unrecognized for a long time.

However, if the pathogen nevertheless “decided” to immediately start damaging the liver tissue, then the first symptoms may already appear after 2-24 weeks and last 14-20 days.

The acute period often proceeds in a mild anicteric form, accompanied by:

• weakness;
• Joint pains;
• indigestion;
• Slight fluctuations in laboratory parameters (liver enzymes, bilirubin).

The patient feels some heaviness on the side of the liver, sees a change in the color of urine and feces, however, pronounced signs of hepatitis, even in the acute phase, are generally not typical for this species and are rare. It becomes possible to diagnose C-hepatitis when the corresponding antibodies are detected by the method (ELISA) and the RNA of the pathogen by conducting (polymerase chain reaction).

Video: film about hepatitis C

What is Hepatitis G

Hepatitis G is considered the most mysterious today. It is caused by a virus containing single-stranded RNA. The microorganism (HGV) has 5 varieties of genotypes and is structurally very similar to the causative agent of C-hepatitis. One (first) of the genotypes chose the west of the African continent for its habitat and is not found anywhere else, the second has spread throughout the globe, the third and fourth “liked” Southeast Asia, and the fifth settled in southern Africa. Therefore, the inhabitants of the Russian Federation and the entire post-Soviet space have "chance" to meet with a representative of type 2.

For comparison: a map of the spread of hepatitis C

In epidemiological terms (sources of infection and transmission routes), G-hepatitis resembles other parenteral hepatitis. As for the role of HGV in the development of inflammatory diseases of the liver of infectious genesis, it is not defined, the opinions of scientists differ, and the data of the medical literature remain contradictory. Many researchers associate the presence of the pathogen with the fulminant form of the disease, and also tend to think that the virus plays a role in the development of autoimmune hepatitis. In addition, a frequent combination of HGV with hepatitis C (HCV) and B (HBV) viruses was noted, that is, the presence of coinfection, which, however, does not aggravate the course of monoinfection and does not affect the immune response during treatment with interferon.

HGV monoinfection usually proceeds in subclinical, anicteric forms, however, as the researchers note, in some cases it does not pass without a trace, that is, even in a latent state it can lead to morphological and functional changes in the hepatic parenchyma. There is an opinion that a virus, like HCV, can hide, and then strike no less, that is, transform into cancer or hepatocellular carcinoma.

When does hepatitis become chronic?

Chronic hepatitis is understood as a diffuse-dystrophic process of an inflammatory nature, localized in the hepatobiliary system and caused by various etiological factors (viral or other origin).

The classification of inflammatory processes is complicated, however, like other diseases, besides, there is still no universal methodology, therefore, in order not to load the reader with incomprehensible words, we will try to say the main thing.

Given that in the liver, for certain reasons, a mechanism is triggered that causes degeneration of hepatocytes (liver cells), fibrosis, necrosis of the hepatic parenchyma and other morphological changes that lead to a violation of the functional abilities of the organ, they began to distinguish:

1. Autoimmune hepatitis, characterized by extensive damage to the liver, and, therefore, an abundance of symptoms;
2. Cholestatic hepatitis, caused by a violation of the outflow of bile and its stagnation as a result of an inflammatory process affecting the bile ducts;
3. Chronic hepatitis B, C, D;
4. Hepatitis caused by the toxic effects of drugs;
5. Chronic hepatitis of unknown origin.

It is obvious that the classified etiological factors, associations of infections (coinfection, superinfection), phases of the chronic course, do not fully provide a complete picture of inflammatory diseases of the main organ of detoxification. There is no information about the reaction of the liver to the damaging effects of adverse factors, toxic substances and new viruses, that is, nothing is said about very significant forms:

• Chronic alcoholic hepatitis, which is the source of alcoholic cirrhosis;
• Nonspecific reactive form of chronic hepatitis;
• Toxic hepatitis;
• Chronic hepatitis G, discovered later than others.

For this reason, it was determined 3 forms of chronic hepatitis based on morphological features:

1. Chronic persistent hepatitis (CPH), which is usually inactive, manifests itself clinically for a long time, infiltration is observed only in the portal tracts, and only the penetration of inflammation into the lobule will indicate its transition to the active phase;
2. Chronic active hepatitis (CAH) is characterized by the transition of the inflammatory infiltrate from the portal tracts into the lobule, which is clinically manifested by varying degrees of activity: slight, moderate, pronounced, pronounced;
3. Chronic lobular hepatitis, due to the predominance of the inflammatory process in the lobules. The defeat of several lobules with multibular necrosis indicates a high degree of activity of the pathological process (necrotizing form).

Given the etiological factor

Inflammatory process in the liver refers to polyetiological diseases, as it is caused by a number of reasons:

The classification of hepatitis has been revised many times, but experts have not come to a consensus. Currently, only 5 types of liver damage associated with alcohol have been identified, so it hardly makes sense to list all the options, because not all viruses have been discovered and studied yet, and not all forms of hepatitis have been described. Nevertheless, it may be worthwhile to acquaint the reader with the most understandable and accessible division of chronic inflammatory liver diseases according to etiological grounds:

1. Viral hepatitis, caused by certain microorganisms (B, C, D, G) and uncertain - poorly studied, unconfirmed by clinical data, new forms - F, TiTi;
2. autoimmune hepatitis(types 1, 2, 3);
3. Inflammation of the liver (drug-induced), often detected in "chronics", associated with the long-term use of a large number of drugs or the use of drugs that show severe aggression to hepatocytes for a short time;
4. Toxic hepatitis due to the influence of hepatotropic toxic substances, ionizing radiation, alcohol surrogates and other factors;
5. Alcoholic hepatitis, which, together with the drug-induced one, is classified as a toxic form, but in other cases is considered separately as a social problem;
6. Metabolic that occurs in congenital pathology - disease Konovalov-Wilson. The reason for it lies in the hereditary (autosomal recessive type) violation of copper metabolism. The disease is extremely aggressive, quickly ends with cirrhosis and death of the patient in childhood or young age;
7. Cryptogenic hepatitis, the cause of which, even after a thorough examination, remains unknown. The disease is characterized by progression, requires monitoring and control, as it often leads to severe liver damage (cirrhosis, cancer);
8. Nonspecific reactive hepatitis (secondary). It is often a companion of various pathological conditions: tuberculosis, renal pathology, pancreatitis, Crohn's disease, ulcerative processes in the gastrointestinal tract and other diseases.

Considering that some types of hepatitis are very related, widespread and quite aggressive, it makes sense to give a few examples that are likely to be of interest to readers.

Chronic form of hepatitis C

An important question regarding hepatitis C is how to live with it and how many years they live with this disease. After learning about their diagnosis, people often panic, especially if they receive information from unverified sources. However, this is not necessary. With C-hepatitis they live a normal life, but they have it in mind in terms of some diet (you should not load the liver with alcohol, fatty foods and substances toxic to the organ), increasing the body's defenses, that is, immunity, being careful at home and when sexual contacts. You just need to remember that human blood is contagious.

As for life expectancy, there are many cases when hepatitis, even among lovers of good food and drink, has not shown itself in anything for 20 years, so you should not bury yourself prematurely. The literature describes both cases of recovery and the reactivation phase, which occurs after 25 years, and, of course, a sad outcome - cirrhosis and cancer. Which of the three groups you get into sometimes depends on the patient, given that there is currently a drug - synthetic interferon.

Hepatitis associated with genetics and immune response

Autoimmune hepatitis, which occurs in women 8 times more often than in men, is characterized by rapid progression with a transition to portal hypertension, renal failure, cirrhosis, and ends with the death of the patient. In accordance with the international classification, autoimmune hepatitis can occur in the absence of blood transfusions, liver damage from alcohol, toxic poisons, and medicinal substances.

The cause of autoimmune liver damage is believed to be a genetic factor. Positive associations of the disease with antigens of the major histocompatibility complex (HLA leukocyte system), in particular, HLA-B 8 , which is recognized as an antigen of hyperimmunoreactivity, were revealed. However, many may have a predisposition, but not all get sick. Some drugs (for example, interferon), as well as viruses can provoke an autoimmune lesion of the hepatic parenchyma:

• Epstein-Barra;
• Corey;
• Herpes 1 and 6 types;
• Hepatitis A, B, C.

It should be noted that about 35% of patients who were overtaken by AIH already had other autoimmune diseases.

The vast majority of cases of autoimmune hepatitis begin as an acute inflammatory process (weakness, loss of appetite, severe jaundice, dark urine). After a few months, signs of an autoimmune nature begin to form.

Sometimes AIT develops gradually with a predominance of symptoms of asthenovegetative disorders, malaise, heaviness in the liver, slight jaundice, rarely the onset is manifested by a significant increase in temperature and signs of another (extrahepatic) pathology.

The following manifestations may indicate a detailed clinical picture of AIH:

1. Severe malaise, loss of working capacity;
2. Heaviness and pain on the side of the liver;
3. Nausea;
4. Skin reactions (capillaritis, telangiectasia, purpura, etc.)
5. Itching of the skin;
6. Lymphadenopathy;
7. Jaundice (intermittent);
8. Hepatomegaly (enlargement of the liver);
9. Splenomegaly (enlargement of the spleen);
10. In women, the absence of menstruation (amenorrhea);
11. In men - an increase in the mammary glands (gynecomastia);
12. Systemic manifestations (polyarthritis),

Often AIH is a companion of other diseases: diabetes mellitus, diseases of the blood, heart and kidneys, pathological processes localized in the organs of the digestive system. In a word, autoimmune - it is autoimmune and can manifest itself in any, far from hepatic pathology.

Any liver "does not like" alcohol ...

Alcoholic hepatitis (AH) can be considered as one of the forms of toxic hepatitis, because they have one reason - a negative effect on the liver of irritating substances that have a detrimental effect on hepatocytes. Hepatitis of alcoholic origin is characterized by all the typical signs of inflammation of the liver, which, however, can take place in a sharply progressive acute form or have a persistent chronic course.

Most often, the onset of an acute process is accompanied by signs:

• Intoxication: nausea, vomiting, diarrhea, aversion to food;
• weight loss;
• Jaundice without itching or with itching due to the accumulation of bile acids in the cholestatic form;
• A significant increase in the liver with its compaction and soreness in the right hypochondrium;
• Tremor;
• Hemorrhagic syndrome, renal failure, hepatic encephalopathy with fulminant form. Hepatorenal syndrome and hepatic coma can cause the death of the patient.

Sometimes, in the acute course of alcoholic hepatitis, a significant increase in body temperature is observed, bleeding and the addition of bacterial infections are possible, causing inflammation of the respiratory and urinary tract, gastrointestinal tract, etc.

Chronic persistence of hypertension is asymptomatic and often reversible if a person manages to stop in time. Otherwise the chronic form becomes progressive with transformation into cirrhosis.

… And other toxic substances

For the development of acute toxic hepatitis a single dose of a small dose of a toxic substrate is sufficient, which has hepatotropic properties, or a large amount of substances that are less aggressive towards the liver, for example, alcohol. Acute toxic inflammation of the liver declares itself by its significant increase and soreness in the right hypochondrium. Many people mistakenly believe that the organ itself hurts, but this is not so. Pain is caused by stretching of the liver capsule due to an increase in its size.

With toxic liver damage, the symptoms of alcoholic hepatitis are characteristic, however, depending on the type of toxic substance, they can be more pronounced, for example:

1. Feverish state;
2. progressive jaundice;
3. Vomiting with an admixture of blood;
4. Nose and gingival bleeding, hemorrhages on the skin due to damage to the vascular walls by toxins;
5. Mental disorders (excitation, lethargy, disorientation in space and time).

Chronic toxic hepatitis develops over a long period of time when small but constant doses of toxic substances are ingested. If the cause of the toxic effect is not eliminated, then after years (or only months) complications can be obtained in the form cirrhosis of the liver and liver failure.

Markers for early diagnosis. How to deal with them?

Viral hepatitis markers

Many have heard that the first step in the diagnosis of inflammatory liver diseases is a study on markers. Having received a piece of paper with the answer to the analysis for hepatitis, the patient is unable to understand the abbreviation if he does not have a special education.

Viral hepatitis markers determined with the help of and, inflammatory processes of non-viral origin are diagnosed by other methods, not excluding ELISA. In addition to these methods, biochemical tests, histological analysis (based on liver biopsy material) and instrumental studies are carried out.

However, we should return to the markers:

• Infectious hepatitis A antigen can be determined only in the incubation period and only in the feces. In the phase of clinical manifestations, class M immunoglobulins (IgM) begin to be produced and appear in the blood. HAV-IgG synthesized somewhat later indicate recovery and the formation of lifelong immunity, which these immunoglobulins will provide;
• The presence or absence of the causative agent of viral hepatitis B are determined by the “Australian antigen” - HBsAg (surface antigen) detected from time immemorial (though not by modern methods) and the inner shell antigens - HBcAg and HBeAg, which became possible to identify only with the advent of laboratory diagnostics by ELISA and PCR. HBcAg is not detected in the blood serum, it is determined using antibodies (anti-HBc). To confirm the diagnosis of HBV and monitor the course of the chronic process and the effectiveness of treatment, it is advisable to use PCR diagnostics (detection of HBV DNA). The patient's recovery is evidenced by the circulation of specific antibodies (anti-HBs, total anti-HBC, anti-HBe) in the serum of his blood in the absence of the antigen itselfHBsAg;
• Diagnosis of C-hepatitis without detection of virus RNA (PCR) is difficult. IgG antibodies, having appeared at the initial stage, continue to circulate throughout life. The acute period and the reactivation phase are indicated by class M immunoglobulins (IgM), the titer of which increases. The most reliable criterion for diagnosing, monitoring and controlling the treatment of hepatitis C is the determination of virus RNA by PCR.
• The main marker for the diagnosis of hepatitis D(delta infection) class G immunoglobulins (anti-HDD-IgG) are considered to persist throughout life. In addition, to clarify monoinfection, super (association with HBV) or coinfection, an analysis is carried out that detects class M immunoglobulins, which remain forever with superinfection, and disappear with coinfection in about six months;
• The main laboratory study of hepatitis G is the determination of viral RNA using PCR. In Russia, antibodies to HGV are detected using specially designed ELISA kits that can detect immunoglobulins to the E2 envelope protein, which is a component of the pathogen (anti-HGV E2).

Hepatitis markers of non-viral etiology

Diagnosis of AIH is based on the detection of serological markers (antibodies):

In addition, the diagnosis uses the determination of biochemical parameters: protein fractions (hypergammaglobulinemia), liver enzymes (significant activity of transaminases), as well as the study of the histological material of the liver (biopsy).

Depending on the type and ratio of markers, types of AIH are distinguished:

• The first is more often manifested in adolescents or in adolescence, or “waits” up to 50;
• The second most often affects childhood, has a high activity and resistance to immunosuppressors, quickly transforms into cirrhosis;
• The third type used to stand out as a separate form, but now it is no longer considered in this perspective;
• Atypical AIH representing cross-hepatic syndromes (primary biliary cirrhosis, primary sclerosing cholangitis, chronic viral hepatitis).

Direct evidence of the alcoholic origin of liver damage does not exist, therefore there is no specific analysis for hepatitis associated with the use of ethanol, however, some factors that are very characteristic of this pathology have been noticed. For example, ethyl alcohol, which acts on the hepatic parenchyma, promotes the release of alcoholic hyaline called Mallory bodies, which leads to the appearance of ultrastructural changes in hepatocytes and stellate reticuloepithelial cells, indicating the degree of negative impact of alcohol on the "long-suffering" organ.

In addition, some biochemical indicators (bilirubin, liver enzymes, gamma fraction) indicate alcoholic hepatitis, but their significant increase is characteristic of many pathological conditions of the liver when exposed to other toxic poisons.

Clarification of anamnesis, identification of a toxic substance that affected the liver, biochemical tests and instrumental examination are the main criteria for the diagnosis of toxic hepatitis.

Can hepatitis be cured?

Treatment of hepatitis depends on the etiological factor that caused the inflammatory process in the liver. Of course , hepatitis of alcoholic or autoimmune origin usually requires only symptomatic, detoxification and hepatoprotective treatment .

Viral hepatitis A and E, although of infectious origin, are acute and, as a rule, do not give chronicity. The human body in most cases is able to resist them, therefore it is not customary to treat them, except that sometimes symptomatic therapy is used to eliminate headaches, nausea, vomiting, and diarrhea.

The situation is more complicated with inflammation of the liver caused by viruses B, C, D. However, given that delta infection practically does not occur on its own, but obligately follows HBV, B-hepatitis has to be treated first of all, but with increased doses and lengthened course.

It is not always possible to cure hepatitis C, although the chances of a cure nevertheless appeared with the use of interferons-alpha (a component of the immune defense against viruses). In addition, at present, to enhance the effect of the main drug, combined regimens are used that involve combinations of prolonged interferons with antiviral drugs, for example, ribavirin or lamivudine.

It should be noted that not every immune system adequately responds to interference with its work by immunomodulators introduced from the outside, so interferon, for all its advantages, can produce undesirable effects. In this regard, interferon therapy is carried out under the close supervision of a doctor with regular laboratory monitoring of the behavior of the virus in the body. If it is possible to completely eliminate the virus, then this can be considered a victory over it. Incomplete elimination, but the cessation of replication of the pathogen is also a good result, allowing you to "lull the enemy's vigilance" and delay the likelihood of hepatitis turning into cirrhosis or hepatocellular carcinoma for many years.

How to prevent hepatitis?

The expression “It is easier to prevent a disease than to cure” has long been hackneyed, but not forgotten, since many troubles can really be avoided if preventive measures are not neglected. As for viral hepatitis, special care will not be superfluous here either. Compliance with the rules of personal hygiene, the use of specific protective equipment when in contact with blood (gloves, fingertips, condoms) in other cases may well become an obstacle to the transmission of infection.

Medical workers in the fight against hepatitis specifically develop action plans and follow them every point. Thus, in order to prevent the incidence of hepatitis and the transmission of HIV infection, as well as reduce the risk of occupational infection, the Sanitary and Epidemiological Service recommends adhering to certain prevention rules:

1. Prevent "syringe hepatitis" common among people who use drugs. To this end, organize points for the free distribution of syringes;
2. Prevent any possibility of transmission of viruses during blood transfusions (organization of PCR laboratories at stations for transfusion and quarantine storage of drugs and components obtained from donor blood at ultra-low temperatures);
3. Minimize the likelihood of occupational infection to the maximum, using all available personal protective equipment and complying with the requirements of the sanitary and epidemiological supervision authorities;
4. Pay special attention to departments with an increased risk of infection (hemodialysis, for example).

We should not forget about the precautions for sexual intercourse with an infected person. The chance of sexually transmitting hepatitis C virus is negligible, but for HBV it increases significantly, especially in cases associated with the presence of blood, such as menstruation in women or genital trauma in one of the partners. If you can’t do without sex, then at least you shouldn’t forget about a condom.

There is a higher chance of getting infected in the acute phase of the disease, when the concentration of the virus is especially high, so for such a period it would be better to abstain from sexual relations altogether. Otherwise, carrier people live a normal life, give birth to children, remembering their peculiarities, and be sure to warn doctors (ambulance, dentist, when registering at a antenatal clinic and in other situations that require increased attention) about what is included in risk group for hepatitis.

Increasing resistance to hepatitis

Hepatitis prevention also includes vaccination against a viral infection. Unfortunately, a vaccine against hepatitis C has not yet been developed, but available vaccines against hepatitis A and B have significantly reduced the incidence of these types.

The hepatitis A vaccine is given to children 6-7 years of age (usually before school entry). A single use provides immunity for a year and a half, revaccination (re-vaccination) extends the protection period to 20 years or more.

The HBV vaccine is administered to newborn babies still in the maternity hospital without fail, for children who for some reason have not been vaccinated, or for adults there are no age restrictions. To ensure a full-fledged immune response, the vaccine is administered three times over several months. The vaccine was developed on the basis of the surface ("Australian") HBs antigen.

The liver is a delicate organ

Treating hepatitis on your own means taking full responsibility for the outcome of the inflammatory process in such an important organ, therefore, in the acute period or in the chronic course, it is better to coordinate any of your actions with the doctor. After all, anyone understands: if the residual effects of alcoholic or toxic hepatitis can neutralize folk remedies, then they are unlikely to cope with the rampant virus in the acute phase (meaning HBV and HCV). The liver is a delicate organ, albeit a patient one, so home treatment should be thoughtful and reasonable.

Hepatitis A, for example, does not require anything other than diet, which is necessary, in general, in the acute phase of any inflammatory process. Nutrition should be as sparing as possible, since the liver passes everything through itself. In the hospital, the diet is called the fifth table (No. 5), which is also observed at home for up to six months after the acute period.

In chronic hepatitis, of course, it is not advisable to offer strict adherence to a diet for years, but it would be right to remind the patient that one should not irritate the organ once again. It is advisable to try to eat boiled foods, exclude fried, fatty, pickled, limit salty and sweet. Strong broths, strong and weak alcoholic and carbonated drinks, the liver also does not accept.

Can folk remedies save?

Folk remedies in other cases help the liver cope with the load that has fallen on it, raise natural immunity, and strengthen the body. However they cannot cure hepatitis, therefore, to engage in amateur activities, to treat liver inflammation without a doctor is unlikely to be correct, because each of the types has its own characteristics that must be taken into account in the fight against it.

"Blind" sounding

Often the attending physician himself, when discharging a convalescent from the hospital, recommends simple home procedures for him. For example - "blind" probing, which is done on an empty stomach in the morning. The patient drinks 2 chicken yolks, throwing away the proteins or using them for other purposes, after 5 minutes he drinks it all with a glass of still mineral water (or clean from the tap) and puts it on the right barrel, putting a warm heating pad under it. The procedure takes an hour. You should not be surprised if after it a person runs to the toilet to give away everything unnecessary. Some use magnesium sulphate instead of yolks, however, this is a saline laxative, which does not always provide such comfort to the intestines as, say, eggs.

Horseradish?

Yes, some people use finely grated horseradish (4 tablespoons) as a treatment, diluting it with a glass of milk. Drinking the mixture immediately is not recommended, so it is first heated (almost to a boil, but not boiled), left for 15 minutes so that a reaction occurs in the solution. Use the medicine several times a day. It is clear that such a remedy will have to be prepared every day if a person tolerates a product such as horseradish well.

Soda with lemon

They say that in the same way some people lose weight . But still we have another goal - to treat the disease. Squeeze the juice of one lemon and pour a teaspoon of baking soda into it. After five minutes, the soda will be extinguished and the medicine is ready. Drink for 3 days three times a day, then rest for 3 days and repeat the treatment again. We do not undertake to judge the mechanism of action of the drug, but people do it.

Herbs: sage, mint, milk thistle

Some say that milk thistle, known in such cases, which helps not only with hepatitis, but also with cirrhosis, is absolutely ineffective against hepatitis C, but in return, people offer other recipes:

• 1 tablespoon peppermint;
• Half a liter of boiling water;
• Infused for a day;
• Strained;
• Used throughout the day.

Or another recipe:

• Sage - a tablespoon;
• 200 - 250 grams of boiling water;
• A tablespoon of natural honey;
• Honey is dissolved in sage with water and infused for an hour;
• Drink the mixture on an empty stomach.

However, not everyone adheres to a similar point of view regarding milk thistle and offers a recipe that helps with all inflammatory liver diseases, including C-hepatitis:

1. A fresh plant (root, stem, leaves, flowers) is crushed;
2. Put in the oven for a quarter of an hour to dry;
3. Remove from the oven, lay out on paper and place in a dark place to complete the drying process;
4. Select 2 tablespoons of dry product;
5. Add half a liter of boiling water;
6. Insist 8-12 hours (preferably at night);
7. Drink 3 times a day, 50 ml for 40 days;
8. Arrange a break for two weeks and repeat the treatment.

Video: viral hepatitis in the “School of Dr. Komarovsky”

• Hepatitis C is a liver disease caused by the hepatitis C virus (HCV): the virus can lead to both acute and chronic hepatitis, ranging in severity from a mild illness lasting a few weeks to a serious, lifelong illness.
• Hepatitis C is the main cause of liver cancer.
• The hepatitis C virus is a blood-borne virus that is most commonly contracted through contact with small amounts of blood. Transmission of the virus can occur through injecting drug use, unsafe injection practices, unsafe medical practices, transfusion of untested blood and blood products, and sexual intercourse that results in contact with blood.
• Worldwide, chronic hepatitis C infection affects 71 million people.
• A significant number of patients with chronic infection develop cirrhosis or liver cancer.
• WHO estimates that approximately 399,000 people died from hepatitis C in 2016, mainly from cirrhosis of the liver and hepatocellular carcinoma (primary liver cancer).
• The use of antiviral drugs cures hepatitis C infection in more than 95% of cases, reducing the risk of death from cirrhosis or liver cancer, but access to diagnosis and treatment remains low.
• There is currently no effective vaccine for hepatitis C, but research is ongoing in this area.

The hepatitis C virus can cause both acute and chronic illness. New cases of HCV infection are usually asymptomatic. Some patients develop acute hepatitis that does not lead to life-threatening illness. In about 30% (15-45%) of those infected, the virus disappears spontaneously without any treatment within six months of infection.

The remaining 70% (55-85%) of those infected develop chronic HCV infection. Among patients with chronic HCV infection, the risk of developing liver cirrhosis over the next 20 years is between 15% and 30%.

Epidemiological situation

Hepatitis C is common throughout the world. It occurs most frequently in the WHO Eastern Mediterranean Region and the WHO European Region, where HCV prevalence in 2015 was estimated to be 2.3% and 1.5%, respectively. In other WHO regions, prevalence rates for HCV infection range from 0.5% to 1%. In some countries, hepatitis C virus infection may be concentrated in certain populations. For example, 23% of new HCV infections and 33% of HCV deaths are associated with injecting drug use. However, national responses rarely include injecting drug users and prisoners in prisons.

In countries where current or past infection control practices have been inadequate, HCV infection is often widespread in the general population. There are many strains (or genotypes) of the hepatitis C virus, and their distribution varies by region. However, in many countries the distribution of genotypes remains unknown.

Virus transmission

The hepatitis C virus is transmitted through the blood. Most often, the transfer occurs when:

• sharing injection equipment for injecting drug use;
• reuse or insufficient sterilization in healthcare facilities of medical equipment, in particular syringes and needles;
• transfusion of untested blood and blood products;
• sexual intercourse that results in contact with blood (for example, male-to-male sex, especially those who are HIV-positive or who are using HIV pre-exposure prophylaxis).

HCV can also be transmitted sexually and from an infected mother to her child; however, these modes of transmission are less common.

Hepatitis C is not transmitted through breast milk, food, water, or casual contact such as hugging, kissing, or sharing food or drink with an infected person.

WHO estimates that in 2015 there were 1.75 million new HCV infections worldwide (23.7 new cases per 100,000 people).

Symptoms

The incubation period for hepatitis C ranges from two weeks to six months. Approximately 80% of cases show no symptoms after a primary infection. Patients with acute symptoms may experience high fever, fatigue, loss of appetite, nausea, vomiting, abdominal pain, dark urine, light-colored feces, joint pain, and icterus (of the skin and whites of the eyes).

Testing and diagnostics

Since new cases of HCV infection are often asymptomatic, only a small number of patients are diagnosed with recent infection. Patients with chronic HCV infection are also often not diagnosed, as the disease is asymptomatic for decades until secondary symptoms develop as a result of severe liver damage.

Diagnosis of hepatitis C infection is carried out in two stages.

1. The presence of infection is determined by testing for antibodies and HCV antigens using serological screening.
2. If HCV antibodies and antigens are positive, a nucleic acid test is performed to detect HCV ribonucleic acid (RNA) to confirm chronic infection; this is because approximately 30% of those infected with HCV will terminate the infection due to a strong immune system response without the need for treatment. But even in the absence of infection in these patients, the result of the test for antibodies and HCV antigens will be positive.

In the case of diagnosing chronic hepatitis C infection, the patient is examined to determine the degree of liver damage (fibrosis and cirrhosis of the liver). This is done with a liver biopsy or various non-invasive tests.

Information about the extent of liver damage is used to make decisions about treatment and disease management.

Passing the test

Early diagnosis helps prevent health problems that can result from infection and transmission of the virus. WHO recommends testing people who are at increased risk of infection.

Populations at increased risk of HCV infection include:

• injecting drug users;
• persons in prisons and other closed institutions;
• people who use drugs in other ways (non-injection);
• people who use intranasal drugs;
• recipients of infected blood products or invasive procedures in healthcare settings with poor infection control practices;
• children born to mothers infected with HCV;
• persons who have sexual partners infected with HCV;
• persons with HIV infection;
• prisoners or persons previously imprisoned; and
• persons with tattoos or piercings.

In settings with high HCV antibody seroprevalence in the population (threshold >2% or >5%), WHO recommends that all adults be offered HCV serological testing as part of general prevention, care and treatment services.

Approximately 2.3 million people (6.2%) of the 37 million people living with HIV worldwide are estimated to have serological evidence of current or previous hepatitis C infection. Globally, chronic liver disease is one of the leading causes of morbidity and mortality in people living with HIV.

Treatment

HCV infection does not always require treatment, because in some patients the immune system can fight the infection on its own. However, if hepatitis C infection becomes chronic, treatment is indicated. The goal of hepatitis C therapy is cure.

The updated 2018 WHO guidelines recommend treatment with pangenotypic direct-acting antivirals (DAAs). DAAs cure most HCV-infected people; while the course of treatment is short (usually from 12 to 24 weeks), depending on the absence or presence of cirrhosis of the liver.

WHO recommends treatment of all persons with chronic HCV infection aged 12 years and over. Pangenotypic DAAs remain costly in many high and upper middle income countries. However, due to the availability of generic versions of these drugs in many countries (mainly in low-income and lower-middle-income countries), prices have fallen sharply.

Access to HCV treatment is improving but remains too limited. In 2017, of the 71 million carriers of HCV worldwide, about 19% (13.1 million people) knew their diagnosis, and by the end of 2017, among diagnosed carriers of chronic HCV infection, about 5 million were treated with DAAs. However, there is still a lot of work to be done around the world to achieve the goal of treating 80% of those infected with HCV by 2030.

Prevention

Primary prevention

There is currently no effective vaccine for hepatitis C, so infection prevention depends on measures to reduce the risk of infection in health care settings, as well as high-risk groups such as injecting drug users and men who have sex with men, especially those with HIV or using pre-exposure prophylaxis for HIV infection.

The following is a list of some of the primary prevention measures recommended by WHO: adherence to good injection safety practices in health care settings;

• safe handling and disposal of sharps and waste;
• providing comprehensive services to reduce the harmful effects of injecting drugs, including the provision of sterile injecting equipment and drug dependence treatment;
• testing of donated blood for HBV and HCV (as well as for HIV and syphilis);
• training of medical personnel;
• prevention of contact with blood during sexual intercourse;
• hand hygiene practices, including surgical hand preparation, handwashing and use of gloves; and
• promoting the proper and systematic use of condoms.

Secondary prevention

For persons infected with the hepatitis C virus, WHO makes the following recommendations:

• conducting awareness-raising activities on care and treatment;
• immunization against hepatitis A and B to prevent co-infection with these viruses and protect the liver;
• proper management of patients from the moment of diagnosis of the disease, including the appointment of antiviral therapy; and
• regular monitoring for early diagnosis of chronic liver diseases.

Screening, care and treatment of people with HCV infection

In July 2018, WHO released an updated "Guidelines for the care and treatment of chronic hepatitis C virus infection". The guide is intended to be used by government officials as a basis for the development of national strategies, plans and clinical guidelines for the treatment of hepatitis. The target audience also includes country program managers and health professionals responsible for planning and delivering hepatitis care services, especially in low- and middle-income countries.

Guidelines for the care and treatment of chronic hepatitis C virus infection: summary of key recommendations

1. Alcohol screening and counseling to reduce moderate and heavy alcohol consumption

It is recommended that all persons with HCV infection have their alcohol use assessed and, if moderate or high levels are found, offer behavior modification interventions to reduce alcohol consumption.

2. Examination of patients to determine the stage of fibrosis or cirrhosis of the liver

In resource-limited settings, the aminotransferase-to-platelet ratio (APRI) or FIB-4 test is used to determine the stage of hepatic fibrosis, as opposed to other costly non-invasive tests such as elastography or FibroTest.

3. Examination to determine the method of treatment

All adults and children with chronic HCV infection should be screened for antiviral treatment.

4. Treatment

For the treatment of adolescents aged 12-17 years or weighing at least 35 kg with chronic HCV infection,

• sofosbuvir/ledipasvir for 12 weeks for genotypes 1, 4, 5 and 6;
• sofosbuvir/ribavirin for 12 weeks for genotype 2;
• sofosbuvir/ribavirin for 24 weeks for genotype 3.

For children under 12 with chronic HCV infection, WHO recommends:

• do not start treatment before reaching the age of 12 years;
• do not prescribe drugs based on interferon.

It is expected that new high-potency oral short-course pangenotypic DAA combinations will become available to children under 12 years of age in late 2019 or 2020. This will create opportunities to improve access to therapy and cure patients in a vulnerable group who are indicated for early use. therapy.

WHO activities

In May 2016, the World Health Assembly adopted the first Global Health Sector Strategy on Viral Hepatitis 2016-2020. It highlights the critical role of universal health coverage and sets out targets that align with the Sustainable Development Goals. The strategy aims to eliminate viral hepatitis as a public health problem. It is reflected in the global targets to reduce new infections by 90% and deaths from viral hepatitis by 65% ​​by 2030. The strategy sets out the steps to be taken by countries and the WHO Secretariat to achieve these goals.

To support countries in meeting the global targets for eliminating hepatitis as part of the 2030 Agenda for Sustainable Development, WHO is working in the following areas:

• raise awareness, promote partnerships and mobilize resources;
• formulating evidence-based policy and generating evidence for action;
• prevention of transmission of infection; and
• expanding coverage of screening, care and treatment services.

WHO has published the 2019 Progress Report on HIV, Viral Hepatitis and Sexually Transmitted Infections, which describes the progress made towards their elimination. The report provides global statistics on viral hepatitis B and C, rates of new infections, prevalence of chronic infections and deaths caused by these two widespread viruses, as well as information on the main actions taken at the end of 2016 and 2017.

Since 2011, WHO, together with national governments, civil society and partners, has been organizing an annual World Hepatitis Day event (one of the nine major annual public health campaigns) to raise awareness and better understand the problem of viral hepatitis. The date July 28 was chosen to commemorate the birthday of Nobel Prize-winning scientist Dr. Baruch Blumberg, who discovered the hepatitis B virus and developed a diagnostic test and vaccine against the virus.

For World Hepatitis Day 2019, WHO is focusing on Investing in Ending Hepatitis to highlight the need for increased national and international funding to scale up hepatitis prevention, screening and treatment services to achieve by 2030 .tasks for its liquidation.

Among all liver diseases, perhaps the most dangerous is such an ailment as hepatitis C. In Russia, more than 4 million people are infected with the hepatitis C virus, which makes the problem of effective treatment of the disease one of the most urgent in domestic medicine. No one is immune from this disease, so it is important for everyone to know how hepatitis is treated.

What is dangerous disease

Hepatitis has the apt nickname "gentle killer" because the symptoms of the disease are often completely invisible to the patient. However, at the same time, pathological changes in the liver increase, making it impossible for the normal functioning of this organ. Severe complications are possible, such as cirrhosis and liver cancer, hepatic encephalopathy. Fortunately, if the disease is detected in time, then it is quite treatable. Therapy of the disease can be carried out at home, but always under the supervision of a hepatologist. Self-medication here will not bring any result and may even harm. The following will detail how to treat hepatitis C at home.

Hepatitis C - features of the pathological process

The disease is caused by a microscopic virus that is transmitted hematogenously, that is, through the blood. How can you get infected with a virus? It's actually very simple. This can happen through sexual intercourse, blood transfusions, when visiting hairdressers, tattoo parlors, beauty salons, dental offices. Often the cause of infection is undisinfected syringes, scissors, razors, etc. It is far from always possible to establish the route of infection in each specific case.

Once in the body, the virus initially causes acute hepatitis. Symptoms of acute hepatitis C include yellowness of the skin, fever, nausea and vomiting, heaviness in the right hypochondrium, bitter taste in the mouth, enlarged liver, pale feces, and dark urine.

Then the hepatitis C virus, after a short acute phase, gives the disease a chronic course. Treatment of chronic hepatitis is extremely difficult. This is due, among other things, to the fact that there are more than 10 genotypes of the virus and about a hundred of its subtypes. Therefore, drugs designed for one type of virus may not be suitable for another. In addition, the presence of a huge number of types of virus hinders the development of a reliable vaccine.

What is the treatment for hepatitis C?

Hepatitis C is a serious disease, and not everyone knows how to treat it. There are many treatments for chronic hepatitis. There are quite expensive drugs that allow you to get rid of the virus with a high degree of probability. You can also use cheaper hepatitis treatment regimens, which, however, do not give a full guarantee.

There are also supportive treatments. Chronic hepatitis C is also treated with a diet and folk remedies - decoctions of medicinal herbs.

Thus, effective treatment of chronic hepatitis is quite possible to carry out at home. You should not be afraid that the patient will infect other family members, since the virus is transmitted only by the hematogenous route, and not by airborne droplets or fecal-oral. Therefore, if certain precautions are observed, the transmission of infection from the patient to other people will be excluded.

Protective measures include providing the patient with separate dishes and cutlery, towels, etc. This is necessary not only to prevent other members of the patient's family from becoming infected with hepatitis, but also to protect the patient himself from other infections that he can get from his household. After all, any additional infectious disease can complicate the course of hepatitis C.

The principles of hepatitis C treatment imply the exclusion of heavy loads for the patient. With the aggravation of the symptoms of the disease, bed rest is indicated.

What treatment is prescribed for hepatitis C by doctors?

Only a qualified doctor has information on how to treat hepatitis C and cure it. Doctors may prescribe various treatment regimens for chronic hepatitis C, depending on the degree of development of the disease, and the patient's financial capabilities. Treatment of the disease is always carried out on an outpatient basis. The exception is a severe form of acute hepatitis C. The basis of therapy is antiviral drugs.

Diet

Treatment of the disease with medicines will be meaningless without measures to change the patient's lifestyle. In addition to medications, diet is an important component of hepatitis C treatment. The objectives of the diet are to exclude from the diet products that cause the liver to work with overloads, as well as get rid of the negative symptoms that accompany gastrointestinal disorders. The diet for chronic hepatitis involves the rejection of spicy, spicy, fatty, fried, pickled, salty foods, canned food.

Alcohol, coffee, cocoa, sweet carbonated drinks are contraindicated. Nutrition should be fractional, the number of meals per day - 5-6 times. Preference is given to boiled or steamed dishes.

It is necessary to consume water in significant quantities - at least 2-3 liters per day. Water, on the one hand, helps to remove toxins from the body, and on the other hand, it allows you to restore the volume of fluid that the patient loses due to vomiting and diarrhea.

• lean meats,
• low fat soups
• boiled vegetables,
• porridge with milk
• vegetable and fruit juices (primarily those containing large amounts of beta-carotene, such as carrot, pumpkin).

It will also be useful to use reasonable amounts of butter and vegetable oils, eggs.

Healing procedures

Therapeutic exercises can also be one of the ways to treat hepatitis. Physical exercise prevents blood stasis and promotes the removal of toxins from the body, which facilitates the work of the liver, improves the overall tone of the body. Water treatments have similar effects - baths, contrast showers.

How long is hepatitis C treated in adults?

This question cannot be answered unequivocally in all cases. The duration of treatment of the disease depends on many factors:

• how far the process of liver degradation has gone;
• what drugs are used for therapy;
• whether the patient has comorbidities that aggravate the course of hepatitis.

Of course, hepatitis is a serious disease, and it will not be possible to cure it the next day, like a runny nose. It takes a long time before the patient can feel the results of treatment. In most cases, you need to be prepared for the fact that the treatment will take many months, or even years.

What medications should be taken for hepatitis C?

There are several main classes of drugs used to treat hepatitis C. The choice of drugs for hepatitis today is quite wide. They can be treated at home, but it is necessary to follow the dosages indicated by the doctor.

Next generation direct acting drugs

These drugs act directly on the viral RNA, interfering with the process of virus reproduction. Practice has shown that these drugs, with the right dosage, can get rid of the virus in 95% of cases. These drugs include ledipasvir, sofosbuvir, veltapasvir, daclatasvir. They allow for the most effective hepatitis therapy.

A serious disadvantage of these drugs is that they are still very expensive. And the course of treatment can cost the patient $ 10,000-30,000. However, this statement is true only if you use drugs officially sold in pharmacies. There are also analogues of antiviral drugs produced in the countries of South Asia, primarily in India, which are oriented to the local market. Generics of antiviral agents can also be purchased in Russia by ordering their delivery from India. Treatment with these medications can cost several times cheaper than using original drugs.

The combination of velpatasvir 100 mg and sofosbuvir 400 mg provides an effective antiviral treatment in case of disease caused by viruses of genotypes 1-6 and not aggravated by liver cirrhosis.

The combination of sofosbuvir 400 mg and daclatasvir 60 mg can be used to treat disease associated with compensated stages of liver disease, including cirrhosis. The drug is active against the most common type of virus in Europe 1b.

The combination of ledipasvir 90 mg and sofosbuvir 400 mg is used in the treatment of hepatitis C caused by viruses of genotypes 1-4, less often caused by viruses of genotypes 5 and 6. It is effective in hepatitis C aggravated by HIV, in decompensated cirrhosis and hepatitis C caused by 1 virus genotype.

Directions for the use of antiviral drugs

The course of treatment can be from 4 to 12 weeks, depending on the recommendations of the doctor. In rare cases, if a 12-week course is not effective, the doctor may extend the course up to 24 weeks.

It is necessary to take one tablet per day, so a package of 28 tablets is enough for 4 weeks. Take antiviral tablets with food, drinking water. It is best to take the medicine every day at the same time. If the moment of taking the pill is missed, but no more than 18 hours have passed, you should take the missed pill, otherwise it is better to skip the dose.

Tablets usually do not cause significant effects associated with the gastrointestinal tract, but a patient suffering from hepatitis may experience various stomach disorders, including those accompanied by vomiting. If the patient took a pill, and then vomited, then another pill should be taken. If the patient vomited more than 2 hours after taking the pill, then a new pill should not be taken.

Antiviral drugs can cause a worsening of the reaction rate. Therefore, during therapy, driving is not recommended.

Contraindications to taking antiviral drugs - pregnancy, age under 18, recent surgery.

Regular intake of antiviral drugs is a reliable tool in order to defeat hepatitis at home.

Ribavirin

An antiviral drug of the previous generation, which has not lost its relevance so far. It is usually used in conjunction with interferon preparations. However, this treatment regimen has certain disadvantages - a large number of side effects and relatively low efficiency, since a complete cure for hepatitis is achieved only in about half of the cases.

Side effects when taking ribavirin:

• stomach ache,
• headaches,
• changes in the composition of the blood.

Injections of interferons can cause side effects similar to flu symptoms - fever, severe malaise, muscle pain. These symptoms may last for several days.

Hepatoprotectors

These drugs do not affect the virus itself, but slow down the destruction of liver tissue, support the liver and help it perform its functions better. contribute to the restoration of the walls of hepatocytes, prevent the formation of connective tissue, normalize metabolism in the liver, stimulate the excretion of bile. Hepatoprotectors can be used in combination with antiviral agents.

The main classes of hepatoprotectors:

• preparations of artichoke, milk thistle, sillimarin;
• preparations with ursodeoxycholic acid;
• essential phospholipids (essentiale forte).

Vitamin complexes, immunomodulators are also used.

How to treat hepatitis C with home remedies

Means for strengthening the liver of natural origin (mummy, honey) have gained great popularity. Also, decoctions of the following herbs are widely used for liver diseases:

• sage,
• horsetail,
• tansy,
• chamomile,
• yarrow,
• agrimony,
• mountaineer bird,
• burdock,
• elecampane,
• hypericum,
• lovage,
• calamus roots,
• hellebore caucasian,
• oats.

Folk remedies will strengthen the immune system, have a choleretic effect, and neutralize pain.

However, it must be understood that, although herbal remedies have anti-inflammatory, choleretic, analgesic and strengthening effects, not a single folk recipe will help kill the virus. The cause of hepatitis is a viral infection, and not at all the slagging of the liver or the body as a whole, as many are mistaken.

Hepatitis C - this term refers to an infectious disease, the causative agent of which is a special hepatotropic RNA-containing HCV virus. Currently, there are 7 genotypes, 88 subtypes (subtypes) and 9 intergenotypic recombinant strains of hepatitis C virus (for example, recombinant strain 2k/1b). The infection spreads through the blood. Infection most often occurs through the use of injecting drugs due to the use of syringes, on the walls of which there are remnants of blood with the virus. Transfusion of donated blood that contains the virus and the inadvertent use of non-sterile instruments in health care are also extremely high risk factors for hepatitis C infection.

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What is hepatitis C?

Hepatitis C is a specific liver disease, which is based on a progressive diffuse necroinflammatory process in the liver due to the effect of the HCV virus on the liver cells. There is no effective vaccine for this disease. For this reason Everyone needs to take safety precautions to avoid infection.

There are 2 forms of hepatitis C - acute and chronic. No more than 10-20% of patients with an acute form of the disease have a chance of a full recovery. In the vast majority of cases, the body's immune system is not able to cope with the virus on its own, as a result of which hepatitis C becomes chronic, and then progresses to cirrhosis of the liver and often transforms into liver cancer with a fatal outcome.

Disease statistics - hepatitis C in numbers

WHO (World Health Organization) annually releases reports on global hepatitis C statistics. Despite significant efforts made in most countries of the world to prevent the spread of this dangerous infection, the number of new cases of the disease is at a high level:

• the probability of "catching" the HCV virus is 0.002%;
• the causative agent of the disease, the HCV virus, is present in the body of at least 70 million people on the planet;
• only 25% of patients (one in four) of these 70 million are aware of their diagnosis, of which only one in seven (13%) receives at least some antiviral therapy;
• At least 400,000 people die from the effects of hepatitis C every year around the world;
• Egypt has the highest prevalence of hepatitis C (at least 15% of the population), followed by countries in northern Africa, the Eastern Mediterranean and Southeast Asia.

Why does a person need a liver?

The liver is the largest gland of internal and external secretion of the human body. The knowledge of an ordinary person about the liver lies only in the fact that this organ ensures the coordinated work of all departments of the digestive system. In addition to this, the liver is also responsible for the metabolism and elimination of various toxins and harmful substances from the body. The main functions of the liver are listed below:

• metabolism (metabolism and bile synthesis) - the liver breaks down animal and vegetable proteins and produces glycogen, which ensures the correct biochemical metabolism of glucose and a complete fat metabolism; the liver forces the body to produce enough hormones and vitamins; liver cells produce bile, ensuring the absorption of vitamins, digestion of fats and stimulation of the intestines;
• detoxification - the liver controls the complex biochemical processes of neutralizing various exogenous (external) and endogenous (internal) toxins and harmful substances that are excreted from the body with bile;
• protein synthesis - the liver synthesizes special proteins, albumins and globulins, which determine the normal functioning of the human body.

Effect of hepatitis C virus on the liver

The liver is one of the organs with the unique ability to fully recover from a single severe acute injury from alcohol, drugs or hypoxia (lack of oxygen). At the same time, with chronic long-term damage to liver cells by the HCV virus against the background of an active necroinflammatory process, the dead liver cells are gradually replaced by fibrous connective tissue and coarse connective tissue scars (fibrosis) are formed inside the liver.

Over the years, the amount of scar connective tissue is constantly increasing, fibrosis progresses to the stage of liver cirrhosis. The liver tissue loses its elasticity and becomes dense, the anatomical structure of the organ is significantly disturbed, because of this, the blood flow through the liver is disturbed and a state of portal hypertension occurs - the pressure in the portal vein system increases. With portal hypertension, the risk of massive life-threatening esophageal-gastric bleeding from varicose veins of the esophagus and stomach increases significantly. Due to significant structural changes, the liver gradually loses its ability to perform its functions.

How can you get hepatitis C?

Hepatitis C virus (HCV) can be transmitted through human blood and body fluids such as saliva, vaginal secretions, urine, semen, and sweat. The virus is quite stable in the external environment and for some time retains its viability in dried blood. Even when a tiny amount of biological material containing the hepatitis C virus enters a susceptible organism, infection occurs.

There are natural and artificial transmission routes, as well as various transmission mechanisms, the most common of which are:

• surgical interventions and operations in which surgical instruments “contaminated” with the HCV virus are used (artificial route of infection transmission, blood contact mechanism);
• transfusion of donor blood containing even a small amount of hepatitis C virus (artificial way of transmission of infection - blood contact mechanism);
• the use of tools “contaminated” with the HCV virus in tattoo parlors and during traumatic manicure (artificial transmission of infection, blood contact mechanism);
• perinatally from mother to child through amniotic fluid or blood (natural vertical transmission of infection);
• traumatic sexual intercourse (natural sexual transmission of infection);
• household infection when using a toothbrush or razor blade “contaminated” with the HCV virus from an infected person (artificial transmission of infection).

Hepatitis C is one of the most insidious infectious diseases. The hepatitis C virus in the patient's body constantly mutates and changes its antigenic structure. Because of this, the immune system of an infected person simply does not have time to respond to the constant changes in the structure of the HCV virus and cannot “cleanse” the body.

You can suspect and recognize the acute form of hepatitis C by the following clinical symptoms:

• weakness, malaise, headache;
• nausea, vomiting, loss of appetite, diarrhea syndrome;
• flu-like syndrome with a moderate increase in body temperature, the appearance of aches and pains in the bones, muscles and joints;
• darkening of the color of urine, lightening of feces, skin itching, yellowness of the sclera, skin and mucous membranes.

In most patients, the acute form of hepatitis C becomes chronic. In the early stages of the disease, chronic hepatitis C may not manifest itself at all, the state of health of patients for a very long time remains quite satisfactory, patients do not pay attention to their condition.

For a long time (many years and decades), the virus is present in the body of a patient with chronic hepatitis C in an overt or latent (occult, latent) form. From time to time, the virus becomes more active, the inflammatory process in the liver intensifies and an exacerbation develops. The following clinical signs allow to recognize an exacerbation of chronic hepatitis C:

• unmotivated decrease in physical activity, excessive fatigue;
• constant weakness and increased drowsiness;
• the appearance of disorders in the gastrointestinal tract;
• the appearance of jaundice of the sclera, skin and mucous membranes;
• darkening of the color of urine and discoloration of feces;
• spider veins appear on the skin of the body;
• the appearance of a feeling of heaviness and discomfort in the liver and right hypochondrium.

In women, chronic hepatitis is diagnosed more often and at earlier stages compared to men. Often there is a failure of the menstrual cycle, which causes a visit to a gynecologist. For women, such complaints as increased fragility of nails, spider veins on the skin of the body, hair loss, hormonal disorders and a decrease in sexual desire are more typical. Due to metabolic disorders in both men and women, complications in the work of the gastrointestinal tract are possible.

Should a healthy person be tested for hepatitis?

Every person should be screened and tested annually for hepatitis C infection, which, along with hepatitis B (HBV), HIV infection and syphilis, is among the most urgent human infections.

Patients of hematological and phthisiatric (tuberculosis) departments, hemodialysis departments, recipients of blood and donor organs, as well as blood donors and patients of psychiatric hospitals are at an increased risk of contracting hepatitis C. The same high-risk group includes medical personnel of surgical and intensive care units and individuals in places of detention. They need to be screened for hepatitis C at least once every six months.

In the multidisciplinary medical clinic EXCLUSIVE in St. Petersburg, you can undergo an in-depth laboratory and instrumental examination of the liver. A program for a complete liver examination is presented.

Prevention of infection and disease

Hepatitis C is an infectious disease with a blood-borne transmission mechanism. This means that the virus is transmitted through contact with blood containing the virus. For reliable protection, it is enough not to come into contact with the blood and other biological fluids of an infected person. Do not forget about the basic rules of personal hygiene - use only your own toothbrush, razor and manicure accessories.

The risk of infection exists through unprotected sexual intercourse. Seminal fluid and vaginal secretions can contain some virus under certain conditions, so try to use a condom for any sexual intercourse.

There is currently no effective vaccine against hepatitis C. Scientists from the University of Oxford are developing a vaccine that would provide strong immunity to this disease. Now the vaccine is at the stage of testing and testing among several dozen volunteers.

Tests for hepatitis

To date, 7 genotypes of hepatitis C virus (HCV) are known. Examination for this disease should be comprehensive. If a doctor suspects an HCV infection, the patient is prescribed the following types of tests:

• serological blood test (ELISA) - for the presence of total antibodies to various proteins of the hepatitis C virus (anti-HCV); this is a qualitative test (yes/no), a positive result of which indicates that the immune system has already "meet" the virus and has developed antibodies to the virus; the results of such an analysis do not allow determining the stage of the disease or the form of hepatitis C;
• molecular biological blood test (PCR) - for the presence of HCV RNA in blood plasma (HCV RNA); analysis can be qualitative (yes/no) and quantitative (how many); the results of a qualitative analysis allow us to assess the activity of the virus, the results of a quantitative analysis allow us to estimate the viral load, that is, the concentration of specific components of HCV RNA in a unit volume of blood;
• molecular biological blood test (PCR) - genotyping of the HCV virus; makes it possible to determine the genotype and subtype of the hepatitis C virus with an accuracy of 99.99%, which to some extent determines the clinical picture and prognosis of the disease and, in many respects, the choice of the most optimal treatment regimen;
• molecular biological analysis of "target cells" (PCR) - for the presence of HCV RNA in immunocompetent cells of peripheral blood and bone marrow or liver cells; this is a qualitative test (yes/no) for the diagnosis of occult (hidden) hepatitis C.

Antibodies to the hepatitis C virus (ELISA test) and / or HCV RNA (PCR test) were found in the blood test - what does this mean and what to do next?

After receiving positive test results for hepatitis C, their correct decoding and interpretation is necessary. This can only be done by a competent infectious disease specialist. Negative results of both ELISA and PCR tests at the same time with a 97% probability indicate the absence of the HCV virus in the body. Unfortunately, the negative results of a single study do not guarantee a 100% absence of a virus in the body, which can “hide” deep in the immune cells of peripheral blood, bone marrow or liver cells. In such cases, traditional blood tests, ELISA and PCR, simply will not “see” the virus, and a special analysis must be done - testing HCV RNA in immunocompetent cells of peripheral blood, bone marrow, or hepatocytes in the liver.

concentration of HCV RNA per unit volume of blood plasma (IU/ml)	commentary on possible PCR analysis results
HCV RNA is not detected in plasma...	... this means that there is no virus in the blood plasma, most likely the person is healthy or there is an occult (hidden) HCV infection
HCV RNA concentration in blood plasma is below 800.000 IU/ml...	… this means that the virus is present in the blood, but the viral load is low
HCV RNA concentration in blood plasma ranges from 800.000 IU/ml to 6.000.000 IU/ml...	... this means that the virus is present in the blood in large quantities, the viral load is high
the concentration of HCV RNA in blood plasma exceeds 6.000.000 IU / ml ...	... this means that the virus is present in the blood in a very large amount, the viral load is extremely high ...

If even the smallest amount of HCV RNA can be detected in the blood plasma, then the virus is multiplying and the infection is active. It is possible not to re-examine, since the result of the analysis is never false positive. It is very important to see a doctor right away in order to start treatment as soon as possible and minimize the risk to your own health.

Hepatitis C virus genotypes

The division of the large HCV virus family into different genotypes suggests the classification of the pathogen by a set of genes. At the moment, WHO experts and virologists identify 7 HCV genotypes, which are unevenly distributed around the world. Approximately 5-10% of patients in the body can simultaneously have 2 or even 3 genotypes of the virus at once - this situation is designated by the special medical term "simultaneous", or mixed HCV infection.

Most HCV genotypes have subtypes (subtypes) that differ in composition and amino acid sequence in the RNA chain. Genotypes of the HCV virus are designated by Arabic numerals from 1 to 7, and subtypes by Latin letters a, b, c, d, e, f, g, and so on. The maximum number of subtypes of one virus genotype can be more than 10 (for example, from a to m).

The table below shows a general description and characteristics of the 1st, 2nd and 3rd genotypes found in Russia.

genotype 1 (1a, 1b, 1a/b)	genotype 2	genotype 3 (3a, 3b, 3a/b)	other genotypes
detected in approximately 60% of patients with HCV infection in Russia; moderately "aggressive" (medium risk of liver cirrhosis and liver cancer);	responds well to modern DAA-therapy without interferon (up to 95-98%) responds well to antiviral therapy; the risk of complications is low; the least "aggressive" in comparison with the 1st and 3rd genotypes; best of all "responds" to modern DAA-therapy without interferon (98-99%)	detected in approximately 30% of patients with HCV infection in Russia; characterized by the highest rate of fibrosis; the most “aggressive” (highest risk of liver cirrhosis, liver cancer, liver steatosis) compared to genotypes 1 and 2; worse than all others "responds" to modern DAA-therapy without interferon (90-92%)	4th, 5th, 6th and 7th genotypes are very rare in Russia; insufficiently studied; distributed in certain geographical regions of the world (countries in Africa, the Middle East, Southeast Asia, India, China)

Can hepatitis C be cured?

Without exception, all patients who have become infected with the HCV virus are interested in the question of whether hepatitis C is treated or not. Previously, it was believed that it was impossible to completely get rid of such an insidious virus, and until the start of the use of simple interferon and the first antiviral drugs in 1991, the main type of treatment for patients with hepatitis C was maintenance therapy with hepatoprotectors. But such treatment could only improve the well-being and quality of life of a sick person for a short time.

To date, with the help of the most modern tableted antiviral drugs with direct antiviral action, at least 90% of patients manage to completely and permanently get rid of the hepatitis C virus and prevent the development of dangerous complications of this disease.

At the very beginning of 2019, WHO experts officially announced that today hepatitis C can be completely cured in at least 90% of patients. The ultimate effectiveness of treatment depends on several factors. With a very high probability of 99.99% eradication of the hepatitis C virus can be achieved in the following cases:

• if the patient does not have the 3rd HCV genotype;
• if the patient has no experience of any antiviral therapy in the past;
• if the patient does not have hepatic fibrosis (F0 st.) or only minimal (F1, F2 st.) fibrotic changes in the liver;
• if the patient has a plasma viral load level of less than 800,000 IU/ml;
• if the patient is Caucasian;
• if the patient does not have cryoglobulinemia.

Should hepatitis be treated?

Hepatitis C treatment is mandatory for all patients who have HCV RNA detected in their blood. Only in the case of complete eradication (eradication) of the HCV virus as a result of treatment, it is possible to guarantee the absence of any serious complications and death associated with hepatitis C in the future. insidious disease. If the disease is left without attention and proper treatment, the life expectancy of a particular patient can be reduced by 10-15 years.

What happens if hepatitis C is not treated?

The lack of timely and effective treatment of chronic hepatitis C can lead to the development of serious complications, which ultimately lead to disability and death. The quality of life of a sick person without treatment progressively worsens. Among the most common and clinically important complications of untreated chronic hepatitis C are the following:

• liver failure with hepatic coma is one of the most severe outcomes of chronic hepatitis C, in which the liver suddenly ceases to perform all its functions (synthetic, metabolic and detoxification), a huge amount of dangerous toxins and waste products accumulate in the body, jaundice, bleeding rapidly increase and multiple organ failure develops. failure; most patients with liver failure die;
• cirrhosis of the liver is the terminal stage of chronic hepatitis C, in which normal liver tissue is replaced by coarse fibrous connective tissue, the structure of the liver changes dramatically, the liver loses its natural elasticity and becomes very dense; cirrhosis of the liver is accompanied by accumulation of fluid in the abdominal cavity (ascites), jaundice, a critical deterioration in blood clotting (bleeding) and severe bleeding from varicose veins of the esophagus and stomach;
• liver cancer (hepatoma, hepatocellular carcinoma, HCC) is a malignant tumor of the liver as a result of untreated long-term chronic hepatitis C; even the most modern surgical, chemotherapeutic, radiation and combined methods of treating liver cancer do not provide a positive result, all patients die;
• hepatic encephalopathy is a specific clinical syndrome of chronic hepatitis C, which is associated with a severe violation of the detoxification function of the liver and is manifested by a decrease in mental activity, intelligence and deep depression of the central nervous system due to the entry of biological poisons and intestinal toxins with the blood into the brain;
• hepatosis (steatosis, fatty degeneration of the liver) is a specific syndrome of untreated chronic hepatitis C, in which lipids (fats) accumulate in hepatocytes damaged by the HCV virus, which leads to impaired liver function; fatty degeneration of the liver is manifested by constant weakness, decreased appetite, bleeding, jaundice of the skin and sclera.

How long do people live with hepatitis C?

The average life expectancy of patients with untreated hepatitis C is about 15-20 years shorter than that of people without hepatitis C. After 20-25 years from the moment of infection, 70-80% of patients with hepatitis C develop cirrhosis of the liver and liver failure. The life expectancy of patients with HCV is affected by the nature of damage to the liver and immune blood cells of B-lymphocytes, concomitant hepatitis B, delta and G (ji), the amount of alcohol consumed.

The completeness and correctness of timely initiated antiviral treatment are of paramount importance and increase the survival rate of patients. Therapy is selected individually. Patients who follow all the instructions of the attending physician successfully get rid of the virus and begin to live a healthy and fulfilling life. To increase life expectancy, it is necessary to be treated, follow all the doctor's prescriptions and eliminate the factors that significantly aggravate the course of hepatitis C (alcoholic beverages and drugs).

Cirrhosis of the liver and its stages

Liver cirrhosis is the terminal (final) stage of chronic hepatitis C and any other chronic inflammatory liver disease. The structure of the liver in cirrhosis changes dramatically, the liver tissue loses its natural elasticity and becomes very dense (fibroscan, elastometry).

Cirrhosis of the liver develops within 18-23 years in 80% of patients with hepatitis C who do not receive antiviral treatment. The number of fibrous nodes gradually increases in the liver, but the liver mobilizes its internal reserves and continues to work, so it can be quite difficult to recognize the early stage of cirrhosis. In some cases, patients report severe weakness and fatigue.

Depending on the functional state of the liver, 3 stages of progressive cirrhosis can be distinguished:

• Stage 1 is compensated cirrhosis of the Child-A functional class (5-6 points), in which dying liver cells are replaced by fibrous connective tissue, and remaining cells are still able to provide full liver function; some patients occasionally develop subtle jaundice, itching of the skin, pain in the right hypochondrium, and disruption of the gastrointestinal tract (gastrointestinal tract);
• Stage 2 is subcompensated cirrhosis of the Child-B functional class (7-9 points), in which the remaining liver cells are no longer able to fully provide liver functions, so the patient’s well-being deteriorates significantly, there are clear signs of internal poisoning, ascites, swelling of the legs, increased bleeding, impaired activity of the nervous system (hepatic encephalopathy);
• Stage 3 is decompensated cirrhosis of the Child-C functional class (10-15 points), or the final (terminal) stage of cirrhosis, in which almost the entire liver is affected by fibrous nodes, the single remaining liver cells are no longer able to support normal life and the patient imminent death awaits within the next year; such patients urgently require a liver transplant.

Liver transplant for hepatitis C

Liver transplantation for hepatitis C is the only way to save the life of a sick person with an advanced form of decompensated liver cirrhosis. Independent attempts by patients to improve the condition of the liver with a variety of drugs in combination with folk remedies do not bring any results.

Liver transplantation for hepatitis C is carried out according to strict medical indications. This is a very complex surgical operation, which was performed for the first time in the history of medicine on November 3, 1964 in the USA.

There are two options for orthotopic liver transplantation for hepatitis C:

• cadaveric donor liver transplantation;
• transplantation of a part of the liver from a living and healthy donor (most often a close relative); after a while, the size of the organ is almost completely restored.

Recently, the method of liver transplantation from a living healthy donor is becoming increasingly common. This technique was developed and first performed by American transplantologists in the late 80s.

Hepatitis C treatment

The success of hepatitis C treatment largely depends on the timeliness of the start of therapy and an integrated approach to assessing the general condition of the patient. It is very important that the scheme and the correct regimen of antiviral therapy be developed by a qualified specialist doctor. During treatment, the patient must take all prescribed medicines, undergo regular examinations and take the necessary tests.

The ultimate goal of hepatitis C treatment is the complete eradication (eradication) of the HCV virus from the body of a sick person. As a result of the eradication of the virus, the inflammatory process in the liver completely stops and the liver begins to slowly recover, the levels of ALT and AST enzymes normalize, the processes of reverse development of coarse connective fibrous tissue begin, pathological cryoglobulins partially or completely disappear from the blood, and the risk of developing a liver cancer tumor becomes equal zero.

The most modern treatment in the EXCLUSIVE clinic in St. Petersburg

EXCLUSIVE Medical Clinic provides patients with the most advanced methods for diagnosing and treating hepatitis C and its complications. Patients are treated by highly qualified doctors the only specialized department of innovative hepatology in Russia under the direction of Doctor of Medical Sciences, Professor of the First St. acad. I.P. Pavlov Dmitry Leonidovich Sulima , who is both a freelance clinical consultant and lecturer for global biopharmaceutical companies AbbVie Inc., Gilead Sciences Inc., MSD Pharmaceuticals and "Bristol-Myers Squibb".

The clinic presents the widest range of the most effective treatment and diagnostic measures for patients with hepatitis C, including:

• without exception, all types of the most complex tests for hepatitis C, including PCR analysis of HCV RNA in immune blood cells, liver cells, kidney cells and bone marrow stem cells, typing of cryoglobulinemia and determination of drug resistance mutations (resistance) of the HCV virus;
• the most accurate determination of the HCV genotype (HCV genotyping), which affects the final result of treatment and complete eradication (eradication) of the virus;
• antiviral therapy for HCV infection based on pegylated interferon in combination with ribavirin (course of treatment 24, 48 or 72 weeks);
• combined antiviral therapy in the mode of pegylated interferon + ribavirin + sofosbuvir (treatment course 12 weeks);
• any regimen of the most modern interferon-free DAA / 1 therapy (treatment course of 8, 12, 16 or 24 weeks), including:
  1. combined regimen "Vikeyra Pak" (Paritaprevir / ritonavir / Ombitasvir + Dasabuvir);
  2. combined drug "Maviret" (Glecaprevir / Pibrentasvir);
  3. combined regimen "Sovaldi" + "Daklinza" (Sofosbuvir + Daclatasvir);
  4. combined drug "Zepatir" (Grazoprevir / Elbasvir);
  5. combined regimen "Daklinza" + "Sunvepra" (Daclatasvir + Asunaprevir);
  6. combined drug "Epclusa" (Velpatasvir / Sofosbuvir);
  7. combined drug "Harvoni" (Ledipasvir / sofosbuvir);
• effective treatment of cirrhosis of the liver and its complications, including hepatic encephalopathy and refractory ascites resistant to diuretics;
• effective treatment of mixed cryoglobulinemia and immunocomplex cryoglobulinemic vasculitis;
• effective treatment of all extrahepatic manifestations of chronic HCV infection, including hematological, nephrological, rheumatological, dermatological, neurological, endocrinological, dental diseases and disorders;
• interferon-free DAA therapy and follow-up of patients-recipients of a donor liver before and after liver transplantation;
• different retreatment (retreatment) regimens for patients with a failed experience of previous antiviral therapy, including:
  1. repeated DAA/2 therapy for secondary occult hepatitis C (secondary occult HCV infection);
  2. repeated DAA/2 therapy for relapse of HCV RNA viremia after any primary DAA/1 regimens containing one or another NS5A replicase inhibitor or a combination of NS3/4A + NS5A inhibitors.

The EXCLUSIVE clinic rightfully occupies a leading position in Russia among non-state clinics for the diagnosis and treatment of patients with hepatitis C. Patients come to us for treatment from different cities of Russia, countries of the former USSR and from abroad (see map).

Since 2015, more than 150 patients have been treated at the clinic with the most modern original direct-acting antiviral drugs, which is more than 3.5% of the total number of all patients in Russia treated with expensive original DAA drugs. The success rate of interferon-free therapy in our clinic today is 95.8%.

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Interferon therapy

Interferons (IFN) are specific proteins synthesized by cells of the human immune system in response to the introduction of a particular pathogenic virus. For the first time in medical practice, interferons α (alpha), β (beta) and γ (gamma) for the treatment of hepatitis C began to be used since 1992. To date, interferons are not considered as an effective drug to combat the hepatitis C virus, although they continue to be used to treat patients.

Simple short-acting interferons and long-acting pegylated interferons are available in the form of powders for the preparation of solutions or in the form of solutions for injection, as well as in the form of rectal suppositories (suppositories). Simple and pegylated interferons are prescribed as part of combination antiviral therapy in combination with ribavirin alone or in combination with ribavirin and sofosbuvir. Ribavirin and sofosbuvir enhance the effect of interferon.

It is very important to use IFN correctly, otherwise patients experience undesirable side effects from the hematopoietic system, endocrine system, cardiovascular and nervous systems.

The effectiveness of the use of outdated treatment regimens based on pegylated interferon in combination with ribavirin in hepatitis C does not exceed 50%. The duration of the course of treatment depends on the genotype of the HCV virus and can be 24 or 48 weeks, but in special cases it increases to 72 weeks. Typically, the following types of interferons are used for treatment:

• pegylated highly purified interferons (Pegasys, Pegintron, Algeron), which are quite effective at a relatively high cost; have a prolonged action, so injections are done 1 time per week;
• simple interferons are much less effective, cost less and require more frequent administration (injections should be done at least 3 times a week).

Interferon-free therapy

In most patients with hepatitis C, traditional therapy based on pegylated interferon in combination with ribavirin does not provide eradication of the HCV virus, causes many serious side effects and worsens the quality of life. Therefore, modern treatment of hepatitis C involves the use of completely oral interferon-free therapy with direct antiviral drugs, which are produced in the form of tablets.

Interferon-free therapy has practically no contraindications, is effective in 90-95% of patients, is very well tolerated, has no serious side effects and is much shorter in duration (only 8 or 12 weeks). The only disadvantage of interferon-free therapy is the very high cost of original drugs.

Interferon-free therapy, unlike interferon-based therapy, can be used in very severe and difficult patients with hepatitis C, including:

• with decompensated cirrhosis of the liver;
• with severe renal failure;
• with severe concomitant hematological, rheumatological, neurological, endocrine and other systemic diseases.

The results of real clinical practice over the past five years have convincingly shown that interferon-free therapy was a real breakthrough in the treatment of patients with hepatitis C. Most experts note that such treatment is effective and safe even in especially severe patients with a complicated course of the disease. Among the most popular original drugs of direct antiviral action for interferon-free therapy, the following should be listed:

• "Sovaldi" / "Sovaldi" (Sofosbuvir) is an antiviral drug inhibitor of NS5B RNA polymerase of the 1st generation, which is highly active against all known genotypes of the hepatitis C virus and has virtually no side effects; the effectiveness of sofosbuvir-based regimens largely depends on the competent choice of the second inhibitor for co-administration as part of combination therapy;




• Viekira Pak / Viekira Pak (Paritaprevir / ritonavir / Ombitasvir + Dasabuvir) is an innovative combination antiviral drug that contains three powerful inhibitors (NS3 / 4A, NS5A, NS5B) and is designed to completely suppress replication (reproduction ) HCV 1a and 1b genotypes; the use of this drug is effective in 95-98% of patients; the drug is safe and can be used in patients with severe renal failure treated with hemodialysis (artificial kidney); the duration of the course of treatment can be 8, 12 or 24 weeks;




• "Harvoni" / "Harvoni" (Ledipasvir / Sofosbuvir) - a highly effective antiviral drug, which includes two powerful inhibitors (NS5A replicase and NS5B RNA polymerase) in one tablet, disrupting the replication process of the hepatitis C virus 1st, 4th , 5th and 6th genotypes; effective in at least 95% of patients; practically no side effects; the duration of the course of treatment can be 8 or 12 weeks;




• "Maviret" / "Maviret" (Glecaprevir / Pibrentasvir) - a modern combined pangenotypic antiviral drug, consisting of two 2nd generation inhibitors (NS3 / 4A protease and NS5A replicase) in one tablet; application efficiency reaches 98-99%; safe and can be used in patients with end-stage renal disease; the duration of the course of treatment can be 8, 12, 16 or 24 weeks;




• "Zepatir" / "Zepatir" (Grazoprevir / Elbasvir) - a modern combination drug, which includes two 2nd generation inhibitors (NS3 / 4A protease and NS5A replicase) in one tablet; highly active and effective in at least 92-95% of patients with HCV genotype 1; safe for patients with severe renal insufficiency; the duration of the course of treatment can be 8 or 12 weeks;
• "Daklinza" / "Daklinza" (Daclatasvir) - a powerful pangenotypic inhibitor of NS5A replicase of the 1st generation, which is used only in combination with the NS5B inhibitor sofosbuvir or the NS3 / 4A inhibitor asunaprevir;




• "Epclusa" / "Epclusa" (Velpatasvir / Sofosbuvir) - a modern highly active pangenotypic combined drug, consisting of two powerful inhibitors of NS5A replicase and NS5B RNA polymerase in one tablet; shows significant efficacy at a level of at least 96-98% when used in patients with any HCV genotype; the duration of the course of treatment is 12 weeks.

Proper diet in patients with hepatitis C is an important component of a complete and balanced treatment. Nutrition must comply with the following principles:

• the energy value of the food consumed must fully correspond to the metabolic needs and costs of the body;
• you need to limit the use of table salt to 4-6 grams per day;
• you need to eat food in small portions, fractionally, 5-6 times during the day;
• The main ways of cooking should be boiling, stewing, baking.

It is very important that overly fatty, fried, spicy, smoked and salty foods are completely excluded from the diet. It is useful to limit the amount of bread, muffins, creams, ice cream, spirits and sugary soft drinks consumed. During antiviral therapy, it is advisable to eat low-fat varieties of fish, meat, chicken eggs, vegetables, not very sweet fruits and berries. In general, nutrition for hepatitis C should be consistent with the principles of proper and healthy nutrition.

What to do after the virus has left the body?

With timely started and properly conducted treatment, the hepatitis C virus quickly loses its activity, stops multiplying, the amount of the pathogen in the body decreases, and eventually the virus disappears completely. After treatment, it is very important to adhere to the principles of liver protection and proper nutrition as long as possible, as well as periodically visit the attending physician for a comprehensive examination and assessment of the general condition.

For at least 3 years after the end of the course of treatment, it is advisable to take an annual blood test for PCR HCV RNA. Precautions should also be taken to prevent re-infection. Patients are advised not to take large amounts of strong alcoholic beverages and drugs that can cause liver damage.

Virus "returned" after treatment (relapse of HCV RNA viremia)

Each patient is sure that after the end of the therapeutic course, the disease will recede forever. However, there are cases when after some time a relapse of hepatitis C occurs and the question arises of how to treat a relapse of HCV RNA viremia if the virus has “returned”. Most often, the causes of such an unpleasant situation are the following factors:

• the presence in the patient's body of concomitant viral infections HBV, HDV, HGV, CMV, TTV, which "distract" the immune system from the fight against HCV;
• the patient has concomitant chronic diseases that weaken the immune system;
• wrong choice of drugs for treatment, regimen and regimen of therapy;
• taking drugs of dubious quality or expired;
• premature termination of therapy or a short duration of treatment;
• advanced stage of hepatic fibrosis (or cirrhosis);
• the patient has cryoglobulinemia, hematological or lymphoproliferative diseases;
• violation by the patient during treatment of the rules for taking medications;
• the presence of drug resistance mutations in the HCV virus;
• lack of drug compatibility control during the course of treatment.

Latent, occult (hidden) hepatitis C

According to WHO, "carriers" of the hepatitis C virus are currently at least 70 million people worldwide. 95% of them have a chronic viremic form of hepatitis C. In the remaining 5% of patients, chronic HCV infection is presented as a latent form of hepatitis C, in which the virus in the blood cannot be detected by PCR due to the low concentration of HCV RNA. The hepatitis C virus in the body of patients with occult hepatitis C is present, but "hidden" deep in the cells of the liver, immune cells of the blood and bone marrow, which requires a sternal puncture of the bone marrow. A sick person with latent hepatitis C is unaware of the presence of an insidious infection, which over time becomes the cause of many dangerous complications.

The latent form of hepatitis C poses an increased danger to an infected person, since even minimal signs of the disease are absent and all tests remain normal for a long time. Because of this, the patient is not prescribed any treatment. The latent period of latent hepatitis C can last for many years. All this time, people consider themselves completely healthy, but the liver imperceptibly collapses and cirrhosis progresses.

Patients with a latent form of hepatitis C are a source of infection and pose a danger to others.

Sex with hepatitis C

Most often, infection with the hepatitis C virus occurs through direct contact with blood that contains HCV virus particles (the so-called blood-borne transmission mechanism). A small drop of blood is enough to transmit the virus. The hepatitis C virus may also be present in the vaginal secretions of women and the semen of men, but sexual transmission is considered unlikely. To avoid infection and the negative consequences of the disease, you must adhere to the following elementary rules:

• use a condom during sexual contact with unfamiliar partners;
• refuse unprotected sexual contacts in the presence of damage to the skin and mucous membranes in the genital area;
• refuse unprotected sexual intercourse if the partner (partner) has sexually transmitted infections;
• avoid frequent changes of sexual partners.

Pregnancy and Hepatitis C

Active HCV virus infection and hepatitis C in pregnant women are often detected for the first time in their lives quite by accident during the primary screening examination in the antenatal clinic. No emergency actions are taken in such cases, pregnancy is not terminated, antiviral therapy is prescribed only after childbirth. Carrying a child during pregnancy does not adversely affect the nature of the course of chronic hepatitis C and the state of the liver in a pregnant woman. During the first two to three months after the birth of a child, the levels of ALT and AST enzymes return to normal and are fully restored. This is due to the peculiarities of immunity and blood supply to the liver in pregnant women.

The presence of an active hepatitis C virus infection in a pregnant woman does not affect reproductive function in any way, does not increase the likelihood of congenital anomalies of the fetus or stillbirth. At the same time, decompensated cirrhosis of the liver in a pregnant woman can provoke severe intrauterine malnutrition and / or fetal hypoxia, miscarriage, spontaneous abortion, premature birth, and even death of the puerperal (see the presentation "Liver and pregnancy - the norm and pathology" on the corresponding page of the site ). Due to the increased likelihood of esophageal-gastric bleeding from varicose veins, the risk of stillbirth or death of the puerperal significantly increases.

Sports with hepatitis C

Sport is an integral and important part of the full life of patients with hepatitis C. This is due to the following reasons:

• sports and physical education ensure the normalization of body weight; it has been proven that extra pounds have a bad effect on the metabolism of a patient with hepatitis C and can provoke fatty liver and the occurrence of stones (stones) in the gallbladder; regular physical education and sports will normalize the metabolism of fat and bile acids and prevent the development of liver steatosis and cholelithiasis;
• physical education and sports increase immunity and strengthen the body's defenses; lack of physical activity causes stagnation in the liver, disturbances in the functioning of the cardiovascular system, physical inactivity and other problems; due to reduced immunity, the hepatitis C virus begins to multiply more actively in liver cells and immune cells of the blood and bone marrow and spread more rapidly throughout the body;
• sports and physical education contribute to the improvement of blood circulation and greater filling of blood with oxygen; due to this, the work of the diseased liver and other organs of the gastrointestinal tract improves;
• physical education and sports in patients with hepatitis C improve oxygen saturation of tissues and prevent additional hypoxic damage to the liver itself and other organs and tissues of a sick person;
• sports and physical education have a positive effect on the overall emotional background; due to constant physical activity, a patient with hepatitis C has a lot of positive emotions and the nervous system becomes more stable;
• physical education and sports are important factors in social communication, since playing sports together with friends significantly improves the mood of patients with hepatitis C, many of whom, having learned about their diagnosis, withdraw into themselves.

In the family of a patient with hepatitis, what to do?

The hepatitis C virus is quite stable and can persist in the external environment for up to several days. For this reason, if suddenly the blood of a person with hepatitis C gets on any surfaces in the room, it is necessary to carry out a wet cleaning of the entire room with antiviral disinfectants. Clothes contaminated with the blood of a patient with hepatitis C must be washed in a washing machine using washing powder for one hour at a temperature not lower than 90 degrees. We must not forget the simple rules of personal hygiene:

• in case of any injuries or injuries with open wounds, they should be immediately treated and sealed with adhesive tape; when providing medical care to a family member with hepatitis C, it is necessary to wear rubber gloves in each case when contact with blood is possible;
• each member of the family where there is a patient with hepatitis C should have his own personal razor, manicure set and toothbrush;
• at each sexual contact with unfamiliar partners, it is imperative to use protective equipment, since infection with the HCV virus often occurs during intense sexual intercourse; the use of condoms almost 100% eliminates the risk of infection.

findings

Hepatitis C is a dangerous infectious disease caused by the RNA-containing hepatitis C virus (HCV), which damages and gradually dies off liver cells and immune cells in the blood and bone marrow. More than 70 million people in the world suffer from chronic hepatitis C.

• blood is the main "culprit" of the spread of the virus; the ingress of blood particles of a patient with hepatitis C into the wound of a healthy person is almost guaranteed to lead to infection;
• the highly pathogenic HCV virus can be present in almost all human biological fluids; for this reason, the sexual route of transmission of hepatitis C virus infection remains relevant;
• hepatitis C virus remains viable in environmental conditions for up to several days; therefore, one must be careful when in contact with cutting objects and medical instruments, on the surface of which the dried blood of a patient with hepatitis C may remain;
• lack of effective and timely treatment of hepatitis C reduces the life expectancy of a sick person by an average of 15-20 years and often causes premature death from liver cirrhosis, liver cancer and other severe complications of hepatitis C.