How to treat chronic hepatitis, what you need to know? Symptoms and treatment of hepatitis B. Chronic hepatitis: treatment. Causes of chronic hepatitis

Modern methods of treatment of chronic hepatitis
Modern methods of treatment of chronic hepatitis

TREATMENT OF CHRONIC HEPATITIS

Diet. It is necessary to bring the daily amount of protein administered to 2 g/kg of body weight.
In portosystemic encephalopathy, the amount of protein administered is minimized.
It is rational to introduce 50% of animals and 50% vegetable proteins. Carbohydrates - up to 4-6 g / kg of body weight.
The use of rice, oatmeal, semolina, bread, sugar and less fiber foods is recommended.
Fats are administered in amounts up to 1.5 g/kg of body weight.
You need a complete vitamin diet.

Drug therapy.
In the treatment of inactive hepatitis, you can get by with the appointment of vitamins and hepatoprotectors.
The same drugs can be used as background therapy for active hepatitis.
It is better to give vitamins enterally, but it is also possible to conduct courses of parenteral administration.
Daily doses: vitamin B2 - 5-15 mg, vitamin B6 - 50-120 mg, folic acid - 15-20 mg, vitamin B12 - 200 mcg.
This mixture, of course, is recommended to be administered in more than one syringe, every other day.

Hepatoprotectors- compound preparations plant origin, designed to increase the resistance of the liver to toxic effects, contributing to the restoration of its functions, normalizing or enhancing the activity of liver cell enzymes.
The main function of hepatoprotectors is to protect liver cells from damaging effects. various factors.

One of the most popular hepatoprotectors is Essentiale, which is administered parenterally or taken per os.
This is a membrane protector, the active principle of which is essential PL, represented by cholinergic phosphatides, unsaturated fatty acids.
The drug improves the functional state of hepatocytes, thickens pathologically porous cell membranes and their organelles.
Available in ampoules of 5 ml (250 mg active substance) and 10 ml (1000 mg), in capsules for oral administration of 175 and 300 mg.
Essentiale can be prescribed for persistent hepatitis, and even for liver failure.
Duration of admission - at least 2 months.

Currently widely used heptral(ademetionine).

It belongs to the group of hepatoprotectors with antidepressant activity. It has a detoxifying, regenerating, antioxidant, antifibrosing and neuroprotective effect.
Ademetionine (b-adenosyl-1-methionine) is a biological substance found in all tissues and body fluids.
Its molecule is included in most biochemical reactions both as a donor of the methyl group - methylation of phospholipids in the composition of the lipid layer of the cell membrane (transmethylation), and as a precursor of physiological thiol compounds - cysteine, taurine, glutathione, one of the most important intracellular antitoxic agents, CoA, etc. (transsulfurization), and as a precursor of polyamines - putrescine, which stimulates cell regeneration, proliferation of hepatocytes, spermidine, spermine, which are part of the structure of ribosomes (aminopropylation).
Indications - intrahepatic cholestasis: toxic (including alcoholic), viral, medicinal (antibiotics, antitumor, antituberculosis and antiviral drugs, tricyclic antidepressants, oral contraceptives), cirrhotic and precirrhotic conditions; encephalopathy of secondary origin; depressive and withdrawal syndrome.
The average dose of heptral per day is 1600 mg; since the effect is dose-dependent, in some cases it is possible to prescribe heptral at a dose of 3200 mg, which is normally tolerated.

Ursodeoxycholic acid(UDCA) has cholelitholytic, choleretic, hepatoprotective, hypocholesterolemic, immunomodulatory effects. UDCA, stabilizing the membranes of hepatocytes and cholangiocytes, has a direct cytoprotective effect, reduces the concentration of hydrophobic bile acids in the enterohepatic circulation (thus preventing their toxic effects on the membranes of hepatocytes and on the epithelium of the bile ducts), and also reduces the autoimmunity of the process (drugs Ursofalk, Ursosan, etc. .).

Possessing high polar properties, UDCA forms non-toxic mixed micelles with apolar (toxic) bile acids, which reduces the ability of gastric reflux to damage cell membranes in biliary reflux gastritis and reflux esophagitis. The immunomodulatory effect is due to the inhibition of the expression of HLA antigens on the membranes of hepatocytes and cholangiocytes, the normalization of the natural killer activity of lymphocytes, etc.

Significantly delays the progression of fibrosis in patients with primary biliary cirrhosis, cystic fibrosis and alcoholic steatohepatitis, reduces the risk of developing esophageal varicose veins.
The drugs are used at a dose of 10-15 mg / kg until the resolution of cholestasis, then long-term treatment at maintenance doses is indicated.
When taken systematically, UDCA becomes the main bile acid in the blood serum and is about 48% total bile acids in the blood. Included in the gastrointestinal circulatory system.

Of the other liver protectors, it should be noted hofitol- extract fresh leaves field artichoke.
Hofitol except hepatoprotective and choleretic action has a diuretic effect and reduces the content of urea in the blood.
Hofitol has a metabolic, membrane-stabilizing and energy effect.
Hofitol is most effective in the treatment of patients with toxic forms lesions, cholestasis, with concomitant cardiac pathology and congestive heart failure, as well as with kidney damage.

Silymarin (legalon, carsil) interacts with free radicals in the liver and converts them into less toxic compounds, interrupting the process of lipid peroxidation; prevents further destruction of cellular structures. In damaged hepatocytes, it stimulates the synthesis of structural and functional proteins and phospholipids (due to specific stimulation of RNA-lopolymerase A), stabilizes cell membranes, prevents the loss of cell components (transaminases), accelerates the regeneration of liver cells.
It inhibits the penetration into the cell of some hepatotoxic substances (poisons of the fungus pale toadstool).
Clinically, the effect is manifested by an improvement in the general condition of patients with liver diseases, a decrease in subjective complaints, an improvement in laboratory parameters (a decrease in the activity of "liver" transaminases and alkaline phosphatase, bilirubin content).
It is used in the form of tablets (pellets) of 35 or 70 mg.
You can also take in solution 1/2 teaspoon 3 times a day.

Very close to them in terms of mechanism of action domestic drug silibor, vegetable origin.
Tablets of 40 mg are taken three times a day for 3-6 months.

katergen(Cathergen). Tetraoxy-5,7,3",4"-flavonol-3.
Synonyms: Cyanidanol, Ansoliver, Clanidanol, Cianidol, Hepanorm, Transepar, etc.
Belongs to the group of natural flavonoids and chemical structure very close to quercetin and rutin, as well as to silibinin.
It is used as a hepatoprotective agent to improve liver function in patients with viral hepatitis, with compensated cirrhosis of the liver of viral etiology, chronic lesions liver of alcoholic etiology (moderate) and with other toxic lesions liver. It is believed that the mechanism of hepatoprotective action is due to the binding of toxic free radicals and stabilization of cell membranes and lysosomes (which is also characteristic of other flavonoids).
Assign inside before or during meals J tablet (0.5 g) 3 times a day.
Apply for a long time (duration of the course is about 3 months).
Possible side effects: heaviness in the stomach, heartburn, retching.
Release form: tablets Pink colour 0.5 g in a package of 40 pieces. In cholestasis, it is advisable to prescribe lipoic acid, cholestyramine, etc.
At alcoholic hepatitis alcohol is strictly prohibited for patients, rest is recommended (better - bed rest), persons of physical labor - a sharp decrease in loads, balanced diet, rich in vitamins.
Treatment of active hepatitis of viral origin.

Today, the main direction of therapy is the direct impact on the virus.
At the same time, an antifibrotic and immunomodulating effect is realized.
All these three qualities are possessed by interferons (IFN).
IFN is a family of non-specific regulatory proteins that delay the replication of certain viruses. In the body, IFN is synthesized by lymphocytes, fibroblasts and other cells. It has been established that their concentration (in particular, IFNcc) in the blood of patients with CAH is reduced.

Currently, there are three main commercial preparations of IFN.
Purified native IFN (IFN-lns, Velferon) is obtained from human lymphoblastoid cells exposed to the Sendai virus.
It is a mixture of different subtypes of IFN.
Two other drugs - IFNa-2b (Intron-A) and IFNa-2a (Roferon-A) - are produced by the recombinant method.
All three drugs are used only parenterally.
On the long time IFN is usually administered subcutaneously. The combination of zinc salts with interferon significantly potentiates the effect of the latter.

Lamivudine- the second drug that is recommended for the treatment of chronic hepatitis.
Lamivudine is a cytosine analog that is phosphorylated to triphosphate (3TC-TR).
The latter has the ability to integrate into the growing DNA chain of the virus, causing its interruption. This occurs both during reverse transcription of the first and synthesis of the second DNA strand.
Lamivudine has been proven effective in treating various groups CHB patients.
The most important predictor of a positive response to maiming with lamivudine is considered to be a baseline ALT level of 5 times normal. The standard dose is 100 mg / day, the duration of treatment is at least 2 months.
Lamivudine is effective in the treatment of both HBeAg-positive and HBeAg-negative patients with chronic hepatitis B, it suppresses viral replication, normalizes serum transaminases and improves the histological picture of liver tissue even without achieving HBV eradication.
In general, a complete response was observed in 76-96% of patients treated for 6-12 months.
Partial virological and biochemical response occurred in 65-90% and 60-96% of cases, respectively.
The efficacy of lamivudine in HBeAg-positive patients is 47% with ALT levels greater than 5 times normal.

Chronic viral hepatitis B(virus in the replication phase).
The main goals of treatment are to achieve sustained suppression of HBV replication and remission of liver disease.
The following indicators are used as criteria for the effectiveness of treatment: normalization of the ALT level; disappearance of HBV DNA and HBeAg (with or without HBeAb formation); improvement of the histological picture of the liver.
Recommended use of interferon-a and lamivudine.
a-Interferon (intron-A, velferon, roferon, etc.) is administered intramuscularly 5 million IU 3 times a week for 6 months or 10 million IU 3 times a week for 3 months.

In recent years, therapeutic tactics have been differentiated depending on infection with "wild" or mutant viruses in the progenome region of the genome.
In the first case, a course of a-interferon is most effective, while in the second case, a long-term (for at least 1 year) administration of lamivudine is the most effective.
The standard dose is 100 mg / day, the duration of treatment is at least 12 months. Such therapy causes a decrease in the histological activity of hepatitis and fibrosis index, stopping or significantly slowing down the progression of the disease.

A new antiviral drug has been developed - adefovir used both as monotherapy and in combination with lamivudine.
The latter combination is of most interest, although the safety of a long-term course of adefovir has yet to be clarified.

Serious hopes are also placed on entecavir, demonstrating antiviral activity in vitro, tens of times higher than that of lamivudine.

Another specific antiviral drug is vidarabine(8-adeninarabinoside), has the ability to long-term inhibit the replication of the virus, which is clearly manifested by a decrease in the content of HBV DNA in the blood serum.
Vidarabine at a dose of 7.5-15 mg / (kg / day) during the first 3-week course only transiently inhibits the replication of virus B, but a second course gives a lasting effect with a decrease in the activity of DNA polymerase in 73% and the disappearance of the HBeAg antigen in 40 % of patients.
Basic therapy: intravenous drip gemodez 200-300 ml for 3 days, orally lactulose 30-40 ml / day for a month.
Doses and treatment regimens depend on the activity of the process, the level of serum HBV DNA, the drug and many other factors.
If there is no effect after a break, treatment with a-interferon in the above doses can be continued after pre-treatment with prednisolone for 4 weeks (30-40 mg / day).

Another new effective antiviral drug is Baraclude.
Indications for the use of the drug Baraclude:
Chronic hepatitis B in adults with:
- compensated liver damage and the presence of viral replication, increased levels of serum transaminase activity (ALT or ACT) and histological signs of an inflammatory process in the liver and / or fibrosis;
- decompensated liver damage.

Contraindications to treatment with Baraclude:
- hypersensitivity to entecavir or any other component of the drug;
- rare hereditary lactose intolerance, lactase deficiency or glucose-galactose malabsorption;
- children's age up to 18 years.
Disadvantages - the relatively high cost of the drug.

A fundamentally new approach to the treatment of chronic hepatitis B was the development of therapeutic vaccines.
There are three types of vaccines:
1) recombinant - contain pre-S, pre-S, pre-S2 HBV proteins (similar to prophylactic vaccines);
2) T-cell - lipopeptide containing the HBcorAg epitope (target of cytotoxic T-lymphocytes);
3) DNA vaccines - plasmid DNA encoding HBV antigens. The effectiveness of the first two types of vaccines has already been shown in clinical trials.
The effect is associated with a decrease in the initial viral load (combination with antiviral drugs) and with additional immunostimulation due to the combination with interferon gamma and interleukin-12.

Chronic viral hepatitis C.
Widely used in the first half of the 90s, monotherapy of CHC with interferon-a (IFNa) in the standard regimen (3 million IU 3 times a week) made it possible to obtain a stable virological response in 16-25% of cases.
Today there is an effective drug for oral therapy of CHC - ribavirin (rebetol) - a cyclic nucleoside, an analogue of guanosine, with a wide range activity against RNA and DNA viruses.
Taking it per os daily at a dose of 1000-1200 mg (5-6 capsules) in two doses for 6 months showed nice results.

Combination therapy with IFN in the standard regimen in combination with ribavirin (up to 10-12 months, as recommended by the International Conference on Hepatitis C, Paris, February 26-28, 1999) increased the effectiveness of CHC treatment by 3 times.

Today we can say that all patients with CHC and compensated liver cirrhosis in the outcome of CHC (in cases of anti-HCV and K-HCV pH in the blood serum) should receive this therapy.

The beginning of the new century was marked by the introduction of clinical practice combined antiviral therapy with pegylated IFN and ribavirin, which allowed for individual selection of doses of drugs calculated by the patient's body weight (in particular, PegIntron (IFNa-2b) - 1.5 μg / kg / week and ribavirin (rebetol) > 10.6 mg /kg/day) to achieve a sustainable virological response in more than 60% of CHC patients.

The success of modern approaches to the treatment of CHC allows us to talk about the actual curability of patients infected with the 2nd or 3rd HCV genotype, and the potential curability of patients with the 1st HCV genotype.
The success of HCV treatment is determined by the mandatory use combination therapy, selection of optimal doses of drugs and duration of treatment depending on the HCV genotype, correction of factors of adverse response to treatment ( overweight weight, steatosis, cholestasis, iron overload syndrome) and side effects of antiviral therapy (depression, hemolytic anemia, leuko- and thrombocytopenia, dysfunction thyroid gland flu-like syndrome).

Once again, therapy is effective with PegIntron at a fixed dose of 180 mcg/week and ribavirin at a dose of 1000-1200 mg/day.
Schemes of triple therapy for chronic hepatitis C are proposed, in which, along with a-interferon and ribavirin, drugs of the amantadine group - amantadine, rimantadine, etc. are used.

Basic therapy: intravenous drip gemodez 200-300 ml for 3 days, orally lactulose 30-40 ml per day for a month.

And the latest information on this issue.
In the company Boehringer Ingelheim a new drug (enzyme) has been developed that prevents the C virus from reproducing freely.
Tests carried out on eight volunteers showed that within 48 hours after taking the new drug, called BILN 2061, the concentration of the virus in the blood of the subjects dropped by 100-1000 times without any noticeable side effects.
Ahead of the cure are still numerous clinical trials, but the potential of the new drug is obvious.

Chronic viral hepatitis D(in the presence of HbsAg and/or HbsAT and HDV RNA in the blood serum).
Recommended:
1) intramuscularly a-interferon (intron-A, velferon, ro-feron, etc.) 5 million IU 3 times a week, if there is no effect, the dose is increased to 10 million IU 3 times a week for up to 12 months;
2) basic therapy: intravenous drip gemodez 200-300 ml for 3 days; inside lactulose 30-40 ml / day for a month.

Recent studies have revealed new possible points applications of antiviral drugs.
Thus, virus replication requires the presence of Small-DAg, which is a nuclear phosphoprotein.
There is evidence that the process of phosphorylation itself is very important for replication.
The next step of replication requires "self-splitting" and "self-linking".
Interestingly, one of the groups of antibiotics, aminoglycosides, has a strong inhibitory effect on HDV ribozyme activity.
At the next stage of the assembly of the virus, 2 post-translational modifications occur, namely isoprenylation (isoprenylation) of Large-D-Ag and glycosylation of HbsAg.
Substances capable of blocking these 2 modifications can reduce the production of the virus.

And yet, judging by the data in the literature of the most recent years, remains relevant self therapy prednisolone.
Prednisolone is recommended for a preliminary 4-8-week course at a dose of 40 mg / day (metipred - 60 mg / day) followed by a rapid dose reduction to maintenance.
Then, a course of treatment with IFN is carried out (according to the described scheme) or vidarabine in a daily dose of 10 to 15 mg/kg parenterally for 25-28 days.

Vaccines are used.
The 2nd generation vaccine Engerix-B is also successful against HDV. Vaccines of the 3rd and 4th generation are being created.

autoimmune hepatitis. The main goal of treating an exacerbation of autoimmune hepatitis is to try to break the vicious circle: the formation of a self-antigen from the affected hepatocytes and auto-AT.
This process is accompanied by further strengthening negative impact on the liver, an increase in the formation of autoantigen, etc.
The treatment of choice is corticosteroids and immunosuppressants.
Prednisolone 30 mg/day is recommended for a month, then monthly the daily dose is reduced by 5 mg to the level of a maintenance dose (10 mg/day), which remains for several years.
Azathioprine treatment - initially 50 mg / day, maintenance dose (for several years) 25 mg / day.
The scheme includes polyenzymatic preparations of the pancreas - Creon or pancitrate lo 1 capsule before meals 3 times a day for 2 weeks quarterly.
Other types of therapy are prescribed taking into account the variants of the course of the disease.

Tacrolimus. IL-2 receptor expression inhibitor.
It is considered the "gold" standard for maintenance therapy in liver transplant recipients.
Violates the cycle of cell proliferation, especially cytotoxic T-lymphocytes. Tacrolimus at a dose of 4 mg 2 times a day significantly reduces the levels of bilirubin and aminotransferases.
Duration of therapy up to 25 months.
Tacrolimus significantly reduces the levels of aminotransferases and improves the histological picture of the liver.
It is positioned as a drug for the treatment of patients with relapse of AIH after glucocorticoid withdrawal and patients initially resistant to glucocorticoids.

Mycophenolate mofetil (cellcept)- a derivative of mycophenolic acid. Inhibits inosine monophosphate dehydrogenase, as a result of which the conversion of inosine monophosphate to xanthosine monophosphate is blocked, which significantly inhibits DNA synthesis and lymphocyte proliferation.
The drug at a dose of 1 g 2 times a day in patients with AIH resistant to corticosteroids, and in patients with recurrent AIH after discontinuation of corticosteroids, in most cases led to the normalization of clinical and laboratory parameters and improvement of the histological picture.

Budesonide (budenofalk).
GCS II generation, characterized by fast metabolism in the liver; metabolites also have glucocorticoid activity.
The drug was administered to patients with low clinical and laboratory activity of AIH, resistant to traditional immunosuppressive therapy, at a dose of 3 mg 3 times a day.
Budesonide can be used as a replacement for traditional corticosteroids (methylprednisolone, prednisolone).
Requirements for the results of treatment - to ensure remission of the disease. Primary remission - normalization of AST and ALT during treatment, confirmed by repeated studies with an interval of 1 month.
Stable remission - normal level AST and ALT are retained for 6 months after treatment.
Long-term remission - the normal level of AST and ALT is maintained for 2 years after treatment.

No remission - cases in which there is no positive dynamics in relation to AST and ALT during 3-month treatment.

Relapse - a repeated increase in the level of AST and ALT after the onset of remission.

Treatment of alcoholic hepatitis.
Abstinence from alcohol intake.
Intensive therapy:
a) intravenous injection of 300 ml of a 10% glucose solution with the addition of 10-20 ml of Essentiale (avoid with signs of cholestasis), or 10 ml of heptral (especially with cholestasis), or 10 ml of hofitol (with hyperazotemia); 4 ml of a 5% solution of pyridoxine or pyridoxal phosphate; 4 ml of 5% thiamine solution (or 100-200 mg of cocarboxylase); 5 ml of 20% solution of piracetam (nootropil) - 5 days;
b) IV gemodez 200 ml (or gemodez-N, or gluconodez).
Three infusions per course - 10 days;
c) vitamin B12 (cyanocobalamin, oxycobalamin) 1000 mcg IM daily for 6 days;
d) pancitrate or creon inside (capsules) or other enzyme preparation with food (10 days);
e) folic acid 5 mg per day and ascorbic acid 500 mg per day orally (10 days).
2-month course (carried out after the end of the course of intensive therapy) includes: Essentiale 2 capsules 3 times a day after meals or hofitol 1 tab. 3 times a day or heptral 400 mg 2 times a day; pancitrate or creon 1 capsule 3 times a day with meals; picamilon (2 tablets 3 times a day).

In modern society, the following question is often asked: "Hepatitis B - what is it?" Everything is explained by the ubiquitous spread of this disease and heightened danger infections.

Hepatitis B is a serious disease that attacks liver cells and can be fatal. It is caused by the HBV virus. greatest danger hepatitis B is in perspective, since in most cases it occurs without obvious signs. Symptoms and treatment of hepatitis B should be known to everyone modern man. The disease is difficult to treat, but if a person with hepatitis B manages to recover, he develops the necessary antibodies that provide strong immunity.

In this article, we will consider the following issues related to the disease called "hepatitis B":

How is it transmitted?

Disease prevention.

Hepatitis B treatment.

How infection occurs

Extremely viable. For him, such factors as boiling, freezing, treatment with highly toxic chemicals are not destructive. At room temperature The virus can survive for a very long time. It poses a danger, even when in a dried old stain of blood or saliva. It is hundreds of times more infectious than the AIDS virus.

The most frequently asked question is: “How is hepatitis B transmitted?”. To get sick, a small amount of the virus enters the human bloodstream. The routes of infection are also mucous membranes and damaged skin. Through the blood, this virus reaches the liver cells, where it settles and multiplies. This results in tissue changes this body. The diseased person's own lymphocytes begin to attack and damage the altered cells, detrimentally affecting the condition of the liver.

The main danger is the blood of a sick person. Hepatitis B is most commonly transmitted in the following ways:

1. In beauty salons (manicure, pedicure, piercing).

2. In tattoo parlors (including when permanent makeup is performed).

3. In the process of transfusion of blood or serum.

4. During the procedure of hemodialysis through devices.

5. When using other people's razors, toothbrushes, towels and other personal hygiene items.

6. Through instruments in medical institutions ( dental offices, operating rooms, dressing rooms, donor stations, etc.).

7. Through non-sterile syringes (risk group - drug addicts).

8. Sexual contact with a sick person (any unprotected relationship).

9. From mother to child (infection occurs when passing through the birth canal).

Infection is almost impossible (but acceptable) from kissing, sneezing, breastfeeding a child, sharing utensils and shaking hands. Next, consider the symptoms and treatment of hepatitis B.

What are the signs of infection

Main danger this disease is that at first the symptoms are not expressed. Minor signs begin to appear only when the virus has already multiplied and is actively operating in the body. The asymptomatic incubation period takes an average of 2-6 months. Warning signs that may indicate an advanced disease:

It should also be noted that in adults, these symptoms are more pronounced than in children. If these signs are found, it is necessary to take a blood test for hepatitis B antigen, which will confirm or refute the presence of the disease.

Hepatitis carrier

One of the forms of viral hepatitis B disease is carriage. In this case, it manifests itself depending on personal immunity and is asymptomatic. The course of this disease often does not become chronic due to the viability of the body, its strength and endurance. Most often, the carriage flows into the chronic form of hepatitis B in 15-20 years.

Even 10 years ago, carriage was not perceived as a disease of hepatitis B. Currently, many infectious disease doctors insist that this form of the disease is the beginning of chronic hepatitis B. There is no specific treatment for carriers of the virus, therefore, for prevention, it is necessary to conduct immunostimulating and restorative courses. However, you need to know that the carrier is a danger to others due to its contagiousness.

Forms of the disease

The most severe form of viral hepatitis B is a fulminant onset of the disease, when symptoms develop very quickly. Within a few hours, cerebral edema occurs, then coma and death occur. Cases of survival of patients after such a disease are very rare.

Acute hepatitis B is also isolated. In this case, the following variants of the disease are possible:

• subclinical (symptoms are moderate, there is no jaundice, minor changes in the biochemical blood test);
• icteric (jaundice, intoxication, bright pronounced changes in biochemical analysis);
• protracted (significant duration of the disease, occurring from 3 to 12 months, most often manifested in the elderly);
• cholestatic (features of inflammation are moderately expressed, signs of biliary tract damage dominate).

The most frequently asked question is: “What are the causes, symptoms, and treatment of hepatitis B?” Signs of an acute form of the disease on initial stage can be compared with the manifestations of a cold: general weakness, fatigue, nausea, sweating, sore throat, headaches, runny nose, fever, cough. Later arise external signs viral disease (jaundice, darkening of urine, lightening of feces, etc.).

One of the most common forms of the disease is a chronic form of hepatitis B. In this case incubation period lasts from one month to six months. This disease is insidious in that it is asymptomatic at the initial stage. Only after major changes signs of hepatitis begin in the liver. There have been cases when the virus was found in human blood quite by accident, and the patient was unaware of his disease and did not experience any discomfort.

Hepatitis B: diagnosis

Most often, people are interested in information about which tests for hepatitis and HIV infection should be taken. Hepatitis B is diagnosed using the following tests:

1. Biochemical analysis blood (shows the state of the liver, you can only indirectly diagnose).

2. Blood test for the "Australian" HBSAg antigen. It should be noted that a negative result this survey cannot exclude carriers of the virus or inactive hepatitis B.

3. Blood test for IgM antibodies (their presence confirms sharp shape diseases).

4. A blood test for IgG antibodies (their presence will allow us to talk about the chronic form of hepatitis B and the carriage of the virus).

If you suspect that you have HIV infection, you must pass special analysis can detect the virus only after 1.5-3 months after infection. PCR analysis confirms infection 2-3 weeks after infection.

Chronic hepatitis: treatment

In the chronic form of hepatitis B, an infectious disease hepatologist prescribes a course of antiviral drugs:

• nucleazide analogs help to reduce the activity of reproduction of this virus in the blood;
• interferons reduce pathological changes in the liver.

In addition, regular maintenance therapy is recommended. For this, hepatoprotectors are prescribed, which contribute to the resistance of liver cells to the penetration of viruses; immunomodulatory drugs that increase the overall resistance of the body to infection.

It is also possible to carry out detoxification, when, thanks to special preparations, the blood is cleansed of various toxins. For general maintenance of the body, it is recommended to take vitamins in courses, as well as strictly follow a diet.

When serious violations liver function, surgery is possible. In this case, liver transplantation is performed from a donor.

Treatment of an acute form of the disease

If hepatitis B is mild, antiviral treatment not assigned. Patients are shown:

• detoxification (drinking plenty of water to reduce symptoms and restore fluid levels in the body);
• a strict diet (with the rejection of alcohol and the intake of toxic drugs).

cure

Full recovery is possible. At proper treatment, lifestyle and observation by a doctor, it occurs within a few years. In the event that you are sick with an acute form of hepatitis B, there is a chance that it will become chronic. An asymptomatic carrier may persist throughout life without manifesting itself in serious complications or liver disease.

If the necessary treatment is not given, hepatitis B can lead to serious diseases such as cirrhosis or liver cancer.

Prevention

If the question of hepatitis B - what it is, everything is more or less clear, then we will clarify how to avoid this disease. To reduce the risk of contracting the hepatitis B virus, the following guidelines should be followed:

• Timely vaccination against hepatitis B.
• Protected sex.
• Compliance with hygiene rules.
• Passing preventive medical examinations.

Graft

Vaccination against hepatitis B is carried out during the first days of a baby's life. Often women ask this question: “Why vaccinate a child so early?” The fact is that when infected with hepatitis B in the first 12 months after birth, the baby becomes a carrier of the virus for the rest of his life. Given the asymptomatic course of the disease, one can seriously fear for the future health of the child. Untreated hepatitis B often causes complications such as cirrhosis or liver cancer.

This vaccination is carried out for all children, since it is sometimes impossible during the mother's pregnancy to identify the carriage of hepatitis B in her. The fact is that the analysis that is prescribed during gestation confirms only the chronic or acute form of the disease.

In the Russian Federation, vaccinations against hepatitis B are carried out according to the 0-1-6 scheme. This means that vaccination occurs in three doses: at birth, at 1 month and at six months. In the event that the woman in labor is a carrier of the virus, vaccination is carried out according to the scheme: 0-1-2-12. The vaccine is injected into the front of the thigh intramuscularly.

An adult also needs to be vaccinated against hepatitis B. This is due to the wide spread of this disease in Russia and around the world. Vaccination is carried out in three doses according to the scheme 0-1-6. It must be carried out at a certain time without delay, otherwise the body will not develop effective immunity against this disease.

Contraindications for hepatitis B vaccination are as follows:

• Allergy to baker's yeast.
• Acute respiratory diseases.
• Meningitis.
• Diabetes mellitus type 1.

A little about hepatitis C

The probability of infection with hepatitis C and B virus occurs under the same circumstances. Symptoms appear only in the acute course of the disease and manifest themselves in the form of general fatigue, weakness, joint pain, and digestive disorders. Jaundice in hepatitis C develops very rarely. After the transfer of acute hepatitis C, a complete recovery of the patient is possible, as well as the transition of the disease to a chronic form or carriage.

The symptoms and treatment of hepatitis B and C are very similar. The probability of cure is possible in 60-80% of cases, provided timely treatment to a medical facility.

Vaccination against viral hepatitis C currently does not exist, therefore, to prevent infection, it is necessary to follow the recommendations of doctors.

Types of illness

Viral hepatitis is very insidious disease. Its danger lies in an asymptomatic course, while one of the vital important organs- liver. Hepatitis directly affects his condition.

The types of this disease are as follows: viral hepatitis A, B, C, D, E, F (G). They have different course, infection also occurs different reasons. The only thing they have in common is the similarity of symptoms and pernicious influence on the human liver. For diagnosis and treatment, you must contact a medical institution and take tests.

Conclusion

With timely diagnosis, you can achieve a complete recovery from a disease such as hepatitis. The types of this virus are different. Some require expensive and long-term treatment, while others can be eliminated without special therapy.

Many people with hepatitis B do not receive the necessary treatment because antiviral drugs are quite expensive. The minimum price of a course for one month is 10,000 rubles, and it is necessary to take medicines for a year or more. If a cure does not occur, then after a break, the necessary medicines will be prescribed again.

Is it possible to defeat chronic hepatitis? Treatment depends on timely access to a medical facility. If this disease is detected in time, the symptoms will not complicate your life, and the therapy will be faster, more efficient and cheaper.

Chronic hepatitis is a diffuse polyetiological inflammatory process in the liver that develops over more than six months. In chronic hepatitis, in contrast to cirrhosis of the liver, there is no violation of the architectonics of the liver.

The reasons

Chronic hepatitis occurs as a result of the development of previous diseases:

• viral hepatitis B and C;
• medicinal hepatitis;
• non-alcoholic steatohepatitis;
• autoimmune hepatitis;
• Wilson's disease;
• deficiency of a 1 -antitrypsin.

HCV infection transforms into the chronic stage in 75% of cases, and HBV infection in 5-10%. Hepatitis A and E do not become chronic. The mechanism of the chronic process is not fully understood, it is known that liver damage is caused by the immune system's response to infection.

With the idiopathic origin of hepatitis, the following are observed:

• pronounced symptoms of hepatocellular immune damage, including serological immune markers;
• association with haplotypes of histocompatibility antigens that are inherent in autoimmune diseases (HLA-DR4, HLA-B8, HLA-B1, HLA-DR3);
• the dominance of plasma cells and T-lymphocytes in histological preparations of pathological areas of the liver;
• immunoregulatory disorders and cellular immunity during in vitro studies;
• relationship with others autoimmune diseases(rheumatoid arthritis, hemolytic anemia, proliferative glomerulonephritis, etc.) and positive reaction on treatment with immunosuppressants and corticosteroids.

Sometimes hr. hepatitis occurs with signs of other liver diseases (autoimmune hepatitis, primary biliary cirrhosis, etc.). Such conditions are referred to as crossover syndromes.

Chronic hepatitis can be caused by drugs (Paracetamol, Isoniazid, Nitrofurans, Methyldop, etc.). Origin mechanism drug-induced hepatitis depends on the drug and may contain:

• change in the immune response;
• the occurrence of intermediate cytotoxic metabolites;
• genetically determined pathologies of metabolism.

In the past hr. hepatitis was classified according to histological features:

• chronic active hepatitis;
• chronic persistent hepatitis;
• chronic lobular hepatitis.

The modern classification takes into account the etiology, the severity of the inflammatory process and necrosis, the degree of fibrosis, studied during histological examination. Infiltration and inflammation are potentially reversible, necrosis is usually irreversible.

Symptoms

Chronic hepatitis often occurs after acute hepatitis (about one in three cases), but usually there is a gradual development of the disease. In many cases, the disease is asymptomatic, especially in HCV. There are symptoms such as:

• anorexia;
• malaise;
• fatigue;
• discomfort in the upper abdomen;

Occasionally, the disease is accompanied by subfebrile fever. Jaundice is most often absent.

Initial clinical manifestations, especially in HCV, are symptoms of chronic liver disease:

• splenomegaly;
• palmar erythema;
• spider veins or spiders;
• pain in the hypochondrium on the right.

In some cases, signs of cholestasis appear. With the autoimmune nature of the disease, especially in women, the disease can involve almost any organ in the painful process and be expressed in amenorrhea, ulcerative colitis, thyroiditis, hemolytic anemia, pulmonary fibrosis, nephritis, arthralgia. chronic infection HCV may be accompanied by Wilson's lichen, glomerulonephritis, mucocutaneous vasculitis, and cutaneous porphyria.

Chronic active hepatitis is vivid symptoms: jaundice, splenomegaly, thrombocytopenia, hypergammaglobulinemia, enzyme activity, high titers of immunoglobulins.

The lupoid variant is characterized by arthralgia, allergic symptoms, lymphadenopathy, and cardiovascular changes.

Diagnostics

Chronic hepatitis is suspected in patients with characteristic symptoms, in case of incidental detection of elevated aminotransferase levels, and in the presence of a history of information about acute hepatitis. Functional tests for the liver are analyzed, including the determination of the level of AST and ALT, serum bilirubin, alkaline phosphatase.

Elevated levels of aminotransferases are distinctive laboratory markers of the disease. Enzyme levels can fluctuate but average 100–500 IU/L. Aminotransferase levels may not go beyond the normal range if the disease is stable, especially with HCV infection. AST is usually lower than ALT.

Alkaline phosphatase is most often either normal or slightly elevated, and in rare cases markedly high. Bilirubin in mild cases is usually within the normal range. When clinical signs of hepatitis are not confirmed laboratory tests, are held serological studies for exclusion of HCV and HBV. If serology does not reveal viral etiology, further analyzes are needed.

Research consists in determining the parameters of immunoglobulins, autoantibodies and a1-antitrypsin. Children undergo a screening test for Wilson's disease with the determination of the ceruloplasmin index. Detection elevated levels Serum immunoglobulin is one of the markers of autoimmune chronic hepatitis. Autoimmune hepatitis is diagnosed in terms of antinuclear bodies: over 1:80 in adults, over 1:20 in children. Also, to confirm the autoimmune nature of hepatitis, tests are carried out for microsomes of the kidneys and liver (anti-LKMI) and anti-smooth muscle antibodies.

To confirm chronic hepatitis liver biopsy. Occasionally, chronic hepatitis presents with only mild hepatocellular necrosis and inflammatory cell infiltration in the portal venules, with normal acinar architecture, and little or no fibrosis.

In severe cases, biopsy reveals periportal necrosis with cellular mononuclear infiltration against the background of bile duct proliferation and periportal fibrosis. Deformations by foci of damage and fibrosis of acinar architectonics are possible. A biopsy is also necessary to analyze the severity and determine the stage of the disease.

The specific cause of chronic hepatitis usually cannot be determined by biopsy. However, cases of disease provoked by HBV infection are differentiated by the presence of opaque vitreous hepatocytes and the specific coloration of the HBV constituents.

In autoimmune hepatitis, a pronounced plasma cell and lymphocytic infiltration is observed. In the presence of histological and absence of serological symptoms of chronic autoimmune hepatitis, its variants should be diagnosed - some of them may meet the criteria for the syndrome of crossover.

If symptoms of cryoglobulinemia appear in the chronic form of the disease, it is necessary to analyze the rheumatoid factor and cryoglobulin parameters. High performance rheumatoid factor and low complement levels indicate cryoglobulinemia.

Liver failure is characterized by low albumin numbers and prolonged prothrombin time.

To rule out hepatocellular carcinoma, an annual ultrasound scan and a serum α-fetoprotein test are required. Patients with chronic hepatitis C are screened for HCC only if cirrhosis is detected.

Forecast

Chronic drug-induced hepatitis often resolves following discontinuation of the respective drugs. If hepatitis B is not treated in the chronic stage, the disease progresses and can transform into cirrhosis of the liver. Most severe course hepatitis B in a chronic form acquires when combined with HDV infection. Untreated chronic hepatitis C in 20-30% of cases leads to cirrhosis of the liver, while the process can take decades. Chronic autoimmune hepatitis is usually treatable but can lead to progressive fibrosis and often cirrhosis.

Hepatitis B in the chronic stage increases the risk of hepatocellular carcinoma. The same risk increases with chronic hepatitis C, but only in the presence of cirrhosis of the liver.

Treatment

The goals of therapy are to prevent complications (eg, encephalopathy and ascites) and smooth out the manifestations of the disease. If hepatitis is caused by taking medications, it is necessary to stop the corresponding drugs. Prevention of contact infection is useful. HCV infection does not require preventive measures.

autoimmune hepatitis

The simultaneous use of glucocorticoids and Azathioprine is the subject of controversy among specialists. Some believe that the combination of glucocorticoids and Azathioprine increases the life expectancy of patients with autoimmune hepatitis. Azathioprine is prescribed orally at 1-1.5 mg per day in one dose. Other doctors prescribe azathioprine only when low doses of prednisolone do not provide suppression.

Prednisolone is taken orally at 30–40 mg per day in one dose. Later, the dose is reduced to a level that keeps aminotransferases within normal limits.

A liver transplant is needed only in the final stage of the disease.

HBV

Therapy is needed for HBeAg-positive patients who have a high level of aminotransferases. Treatment goals: conversion of the patient from HBeAg to anti-HBe and elimination of HBV DNA. HBsAg disappears from the serum in about 10% of cases. Interferon or Lamivudine are used as medicines.

The interferon preparation is administered subcutaneously at 5 million IU per day or 10 million IU per day three times a week for 4 months. In about 40% of cases, this treatment regimen causes the elimination of HBV DNA and promotes seroconversion to anti-HBe. Evidence of the effectiveness of treatment is a transient increase in aminotransferase levels.

The beginning of treatment with Interferon may take place against the background of the influenza-like syndrome caused by it.

Other negative impacts Interferon:

• malaise;
• depression;
• fatigue;
• bone marrow suppression;
• autoimmune diseases and bacterial infections(occasionally).

Interferon contributes to the development of liver failure in people with cirrhosis of the liver. Therefore, with cirrhosis of the liver, Interferon is contraindicated. Also, the drug is not prescribed for immunosuppression, kidney failure, cytopenia, substance abuse, after organ transplantation. Patients with co-infections of hepatitis D virus and HBV respond poorly to treatment. The effect of the use of pegylated interferon in chronic hepatitis B, in contrast to chronic hepatitis C, remains not fully understood.

An alternative drug in the treatment of HBV is lamivudine - 150 mg daily orally. Compared to Interferon, Lamivudine has fewer side effects, but its use is designed for longer periods. The drug reduces the level of HBV DNA and aminotransferase levels in most cases, however, at the end of therapy, relapse is noted before seroconversion from HBeAg to anti-HBeg. The onset of seroconversion is recorded in 15-20% of cases after a year of treatment and in approximately 40% of patients over a three-year period. With prolonged therapy, resistance to lamivudine develops.

Lamivudine can be used in people who have advanced cirrhosis of the liver because it does not contribute to liver failure. The combination of lamivudine with interferon did not reveal any advantages of such treatment tactics.

Oral adefovir may become a popular drug of choice in the treatment of chronic hepatitis B in the future. Adefovir is safe, and resistance to it is rare. Liver transplantation is relevant only in the end stage of HBV-induced liver disease. However, the infection exposes the graft to intense attacks, so the prognosis for the success of a transplant is worse than for transplants for other indications. Long-term use of lamivudine improves the prognosis of transplant success.

HCV

Treatment for chronic hepatitis C is necessary if the aminotransferases are elevated and the biopsy shows active development inflammation and fibrosis. Therapy is required to eliminate HCV RNA, resulting in a normalization of the aminotransferase index and the histological process stops.

Reliable results are obtained by simultaneous therapy with pegylated Interferon and Ribavirin. Comparable effects are obtained with injections of pegylated Interferon-alpha 2b (1.5 mcg/kg subcutaneously per week in a single dose) and pegylated Interferon-alpha 2a (180 mcg/kg subcutaneously per week in a single dose). Ribavirin is taken orally at 500–600 mg twice a day. With genotypes 2 and 3 of the virus, a sufficient dose is two doses of 400 mg per day.

The viral load and HCV genotype are established before treatment, as its regimen depends on it. Genotype 1 is observed more often and is quite resistant to treatment. Combination therapy stretches for a year and gives positive effect in 45-50% of cases. The favorable results depend on the stage of the disease at which treatment is started. 3 months after the start of therapy, the viral load is determined. If the RNA index has not decreased by at least 2 l.u., the treatment is stopped.

Genotypes 2 and 3 are less common, but are more amenable to therapy. The period of combination therapy is 6 months, and a sustained response is observed in three quarters of patients. Extending the duration of treatment does not improve results. Regulated Interferon gives almost the same side effects as standard Interferon, but they are more pronounced. The drug is used with caution or is not prescribed at all to drug-addicted patients and people with mental disorders.

Ribavirin is well tolerated but can cause hemolytic anemia. Doses of the drug should be reduced if there is a decrease in hemoglobin to less than 10 g / dl. Since Ribavirin is teratogenic, patients should use contraceptives during the entire period of treatment and for six months after its completion.

Patients who have found intolerance to Ribavirin are prescribed pegylated interferon monotherapy. However, this treatment tactic is not as effective as a combination of drugs. The use of Ribavirin as the only treatment has no effect.

In HCV, the most common indication for transplantation is the progressive nature of liver cirrhosis. Despite the fact that the infection recurs in the transplanted organ, the long-term results of transplantation are favorable.

As already mentioned, the leading cause of the disease is a virus, which belongs to DNA-containing pathogens. The infection spreads from a carrier or a sick person in several ways:

• through the blood. This method of infection is carried out with blood transfusion (transfusion), hemodialysis, the use of infected surgical and dental instruments. Thus, the risk of getting hepatitis is present in medical institutions, beauty salons, as well as injection drug addicts;

Today, thanks to disposable medical instruments and high-quality disinfectants, the likelihood of infection has significantly decreased.

• with intimacy. The risk group includes lovers of unprotected sex and frequent shift partners;
• vertical path. Infection of an infant occurs during its passage through birth canal. Due to blood contact of the injured skin of the newborn and the mucous membrane of the woman, the baby may become infected. To avoid this, a caesarean section is recommended.

To understand whether chronic hepatitis B is curable, it is first necessary to understand the mechanism of its development. The disease occurs due to the penetration of the pathogen into the liver cells, which are gradually destroyed and replaced by connective tissue.

Chronic hepatitis B is characterized by an undulating course and staging:

1. phase of immune tolerance. It is mostly characteristic of young people when infection occurs in childhood. The duration of the stage reaches 20 years, during which the pathogen does not manifest itself at all and is in a "sleeping" state;
2. active phase. Distinctive feature is the rapid multiplication of viruses, resulting in observed mass death hepatocytes (liver cells), as well as the occurrence clinical symptoms illness;
3. the stage of chronicity of the infectious-inflammatory process is observed with immunodeficiency, when the body cannot fully cope with the pathogen. This is also facilitated by improper treatment and late detection of the disease.

Exacerbation of hepatitis occurs against the background of infection with other viruses, such as herpes. The latter is able to activate the replication of pathogens, due to which the process of liver damage resumes.

According to international classification disease, hepatitis B chronic form has a microbial code - B 18.1. If a mixed infection with type D virus is diagnosed, the pathology is encrypted as B 18.0.

Clinical manifestations

For the chronic form of the disease, pronounced symptoms are not typical. Often the patient complains of non-specific signs of the disease, namely:

1. malaise;
2. poor appetite;
3. weight loss;
4. insomnia;
5. subfebrile condition;
6. aching muscles and joints;
7. headache;
8. irritability;
9. increased bleeding. It is caused by protein deficiency against the background of slowly progressive liver failure. A person notices hematomas on the body, spider veins and nasal bleeding.

An asymptomatic course is recorded in 65% of cases. In other patients, hepatitis has more pronounced signs of liver damage.

Ictericity (icteric coloration) of the skin and mucous membranes is not excluded, which is not observed in all patients with chronic

Hepatitis B. Often there are dyspeptic disorders in the form of nausea, heaviness in the epigastrium, bitterness in the mouth and vomiting.

An important sign is hepatomegaly (an increase in the volume of the liver), which is characterized by pain in the right hypochondrium. The appearance of discomfort is associated with stretching of the capsule of the gland and irritation of the nerve endings.

Complications

With proper nutrition and regular examination disease progresses without severe complications. In this case, the death of hepatocytes occurs slowly, which is practically not accompanied by clinical symptoms.

The risk of tissue malignancy does not exceed 10%, however, with frequent exacerbations, the probability can reach 20%. The form and severity of complications largely depend on the person's lifestyle. The fact is that the use of alcohol, hepatotoxic drugs in uncontrolled doses, as well as non-compliance with the diet is fraught with rapid progression of the disease and an increase in the risk of complications several times.

Extrahepatic manifestations are associated with autoimmune reactions and damage to their own tissues by antibodies. Among them it is worth highlighting:

• damage to the heart membranes (myocarditis, pericarditis);
• inflammation of the joints, muscles (arthritis, myositis);
• the formation of granulomas in the lungs;
• damage to the vascular wall (vasculitis);
• renal dysfunction on the background of glomerulonephritis.

Diagnostic methods

For the treatment of chronic hepatitis B to be successful, it is necessary to conduct a comprehensive examination. It makes it possible to correctly diagnose, determine the cause and stage of the disease, as well as assess the general state of health of the patient.

First of all, the doctor interviews complaints and the features of their occurrence, after which he conducts a physical examination. With its help, it is possible to detect hepatomegaly and spider veins. Further diagnostics is required.

Non-specific methods

Non-specific laboratory and instrumental methods include:

Specific Methods

AT recent times widely used express methods that allow you to quickly identify the virus carrier. Linked immunosorbent assay makes it possible to detect HCV markers. These include:

1. surface type of antigen, which is determined both in the acute and chronic stages. HBsAg is registered starting from 4 weeks after infection;
2. anti-HBsIgG - confirms previous hepatitis, and is also an indicator of the effectiveness of the vaccination;
3. anti-HBc - does not allow for differential diagnosis between the acute and chronic phases. IgM can be detected in asymptomatic carriers;
4. HBeAg - appears at an early stage, but by the time of occurrence clinical signs is already disappearing. The chronic stage is characterized by simultaneous registration of HBeAg and surface antigen.

The following serological variants of the chronic course of hepatitis B are distinguished:

Treatment of chronic hepatitis B

In most cases, subject to properly formulated therapy, there is complete cure chronic hepatitis B. For this, the doctor prescribes a dietary diet and medication support. Only way integrated approach manages to defeat the infection and restore the structure of the liver.

The doctor tells the patient how to live with chronic viral hepatitis B so as not to infect others. Preventive actions help protect healthy people from infection, as well as prevent the progression of the disease.

Medications

To date, there is a certain scheme for the treatment of hepatitis. It includes the mandatory appointment of interferons. They have an antiviral effect by inhibiting the replication of pathogens. By reducing the number of pathogenic agents to a minimum, medicine allows the immune system to deal with them on its own.

According to clinical studies, the drug is used in the treatment of hepatitis with both positive and negative HBe.

The second group of drugs is glucocorticosteroids. They reduce the destruction of hepatocytes, thereby reducing the severity of liver failure.

Another remedy for antiviral action- Lamivudine. It is important to remember that each medication has side effects, which must be taken into account when combining drugs and the presence of concomitant diseases in the patient.

Diet for chronic hepatitis B in adults

The purpose of the diet is to reduce the load on hepatocytes, prevent cholestasis (bile stasis), and normalize digestive function in general. Here are the basic principles of table number 5:

A mandatory requirement is the refusal of alcohol.

Impact on pregnancy and fetus

Often HCV is registered in pregnant women (in 1% of cases). Throughout the entire period of gestation, hepatitis often does not progress. If the disease is complicated by cirrhosis, the risk of developing severe toxicosis and worsening liver failure increases.

The main task during pregnancy is to prevent infection of the embryo. Infection is observed in 90% of cases during labor activity if the mother has HBsAg and HBeAg registered in the blood. The risk is reduced to 15% in the presence of an exclusively superficial type of antigen. In this case, it is mandatory to vaccinate the newborn in the first hours after birth.

How long do people live with chronic hepatitis B?

Factors that affect life expectancy include:

• profession (severity of physical labor, sedentary work);
• age and body weight;
• alcohol abuse;
• dieting;
• virus activity;
• the duration of the period of illness during which there was no treatment.

Subject to compliance with medical recommendations, the cause of death of the patient may not be a virus at all, but age-related diseases. If a person continues to take drugs, life can be over by the age of 40. Alcoholics with chronic hepatitis live slightly longer - up to 50 years.

High mortality in these groups is due to overdose, severe liver failure against the background of cirrhosis, bleeding and progression of portal hypertension.

Preventive measures include vaccination and healthy lifestyle life.