The hepatitis virus is dangerous. What is the danger of hepatitis C. What happens to the body infected with HCV

It's no secret that in 2014 Hepatitis C received the status completely curable infectious disease. This sensational verdict was delivered by hepatologists-infectionists from around the world, who gathered at the annual European Congress of Liver Diseases (EASL).

New treatment protocols show a 99% success rate, which is equivalent to a complete victory over the virus, and is also a consequence of medical progress. The editors of our site have prepared an article about modern methods of treatment, which will talk about the benefits of taking new drugs and how to get them.

Causes

The etiology of hepatitis C is based on the presence of a virus and a susceptible organism, subject to the conditions of the infection mechanism. It must be said that this is one of the most persistent infections, it persists for up to 4 days on instruments and surfaces that the infected blood has come into contact with.

At what temperature does the hepatitis C virus die? Boiling destroys it within 2 minutes, while at 60 degrees Celsius it takes about half an hour.

Despite the fact that the virus was discovered more than thirty years ago, the controversy around it has not subsided so far. There are adherents of the theory that says that hepatitis C does not exist. However, the evidence base is the isolation of the RNA of the virus and antibodies to it in the course of specific studies.

According to the International Classification of Diseases (ICD-10), the hepatitis C code is B18.2.

Classification of hepatitis C divides the disease into two forms: acute and chronic. In the acute form, there may be no symptoms or they may be similar to any other infectious hepatitis. The chronic course has such phases as latent (hidden) and bright clinical manifestations.

What is hepatitis C? In fact, this is an infection that purposefully selects the liver as a kind of “target”. The pathogen, which has six genotypes, feels great inside hepatocytes (liver cells), and the immune system is powerless to destroy it without destroying the parenchyma (tissue) of the liver at the same time.

Type 1 hepatitis C is prevalent throughout the world. This is due to the fact that subsequent variants are most likely the result of a mutation - a means of adapting the virus to ways to fight against it. Type 3 hepatitis C predominates among drug addicts.

Why is hepatitis C dangerous? First of all, the development of cirrhosis of the liver - a chronic irreversible process of replacing the functioning parenchyma with dense fibrous nodes.

The hepatitis C virus has several routes of entry into the body. Among them:

1. parenteral. Means infection by contact with blood. Its quantity in this case does not matter: just a tiny drop, not visible to the eye, can cause illness.
   Hepatitis C is transmitted during blood transfusions - this is a blood transfusion procedure, and hemodialysis - cleansing the body of metabolic products in kidney diseases. Remains of blood can be found on instruments for medical and non-medical manipulations - surgical and endoscopic examinations, manicure, tattooing, ear piercing and other types of piercing.
   There is a risk even when using someone else's toothbrush or shaving accessories, kissing, if the infected person and his partner have wounds in the oral cavity. Of course, organ transplantation offers the same opportunities for transmission of hepatitis C, while transplantation implies immunodeficiency, which makes the infection process more difficult and faster.
   One of the most common mechanisms is the entry of the hepatitis C pathogen into the body with the same syringe needle in people who inject drugs.
2. Sexual. The danger is the discharge (secret) of the glands of the genital organs, abrasions and microtrauma due to damage to the mucous membrane during unprotected intercourse. The hepatitis C virus, as a rule, is secreted in significant quantities only when the process is active in the body; during the latent period, hepatitis C is rarely transmitted sexually.
3. Vertical. This infection of a child in the womb is transplacental (through the vessels of the uteroplacental blood flow) or during childbirth, when the baby is forced to come into contact with the maternal mucosa and can receive minor damage that opens the "entrance gate" of the infection.
   Perhaps this mechanism provides an exhaustive answer to the question: is it possible to have children with hepatitis C? Reproductive function, i.e. the possibility of conception, is not affected by the disease. The degree of viral load is important as a fundamental factor in the likelihood of transmission of the pathogen.

The source of infection can be not only a patient, but also a carrier of hepatitis C.

What it is? Carrier means a state when the virus is in the blood, but does not cause harm; there are no symptoms
liver damage. At the same time, it can be transferred to another person, in whose body the disease is activated in full force.

Can hepatitis C be dangerous for family members who use the same household items as the patient? The contact-household route of transmission of this infection is not typical, however, in case of injuries of the oral mucosa, blood can remain on dishes, towels, a toothbrush, therefore it is undesirable to transfer them to anyone.

What to do if you find hepatitis C? It is necessary to follow the instructions of the attending physician, who, if necessary, will prescribe additional diagnostic tests and select the optimal antiviral therapy regimen.

Symptoms

The incubation period for hepatitis C lasts from two weeks to six months; The viral RNA binds to cell surface receptors and enters the hepatocyte. Once under the reliable protection of a membrane impermeable to immunity, the pathogen starts the process of replication (copying) and multiplies.

During this time, the course may be asymptomatic; inactive hepatitis C, or latent period can last for months and years.

In the presence of immunodeficiency or concomitant liver diseases, it is reduced.

The hepatitis C clinic is characterized by the following symptoms:

• constant weakness, fatigue, apathy, depressed mood;
• decrease or lack of appetite, nausea, vomiting;
• abdominal pain mainly in the right hypochondrium;
• enlargement of the liver (hepatomegaly), less often - the spleen (splenomegaly);
• dark urine, gray feces;
• yellowing of the skin, mucous membranes and sclera of the eyes;
• pain in the joints.

These signs are observed in the acute period. Depressive disorders are quite common in hepatitis C, but they are not a specific obligatory symptom.

Does your liver hurt all the time? The chronic form is accompanied by the formation of cirrhosis and portal hypertension - a syndrome that develops as a result of an increase in pressure in the portal vein.

Then, when examining a patient, you can notice dilated saphenous veins on the anterior abdominal wall, while the liver is often enlarged and the person experiences discomfort, pain in the right hypochondrium during exercise or nutritional errors. Serous fluid accumulates in the abdomen - this phenomenon is called ascites.

With fibrogastroduodenoscopy (examination of the gastrointestinal tract with an optical tube), dilated venous vessels of the esophagus and stomach are detected. In the later stages, disturbances in the coagulation system are characteristic, since one of the functions of the liver is the synthesis of vitamin K and blood clotting factors.

They manifest as nasal, gastrointestinal bleeding of varying severity.

Such complications of hepatitis C indicate irreversible damage to the hepatic parenchyma.

Do they give disability with hepatitis C and which group? In fact, viral hepatitis with impaired liver function is the basis for this. Clinical and laboratory indicators and the ability to self-service and labor activity are taken into account.

Is it possible to work with hepatitis C? Since the virus is not transmitted through household contacts, there is no need to limit the patient's activity in society, which includes professional aspects.

Diagnostics

To date, medicine has ample opportunity to confirm hepatitis C.

The carrier is detected only by laboratory data.

Diagnostic methods are divided into non-specific (reflect the general picture of damage to the liver and the body as a whole) and specific (aimed at detecting the virus or the immune response to its presence):

Sometimes there is such a situation: there are antibodies to hepatitis C, but there is no virus. This is possible if self-healing occurs - the immune system managed to overcome the infection. Antibodies indicate that the immune system reacted to the penetration of the pathogen.

A false-positive result in the diagnosis of hepatitis C is very rare, but possible. The reasons may be a violation of the rules for the preparation and study of the material, a banal confusion with test tubes, or the patient’s intentional donation of blood that is not their own, which is possible with remote sampling (taking blood outside the walls of the laboratory).

Microbiology, or microbiological diagnostics, is not performed because hepatitis C has a viral etiology, and simply will not grow on a nutrient medium used for bacteria.

Treatment

There is an opinion that hepatitis C is incurable. Is this true and how effective are the proposed pharmaceutical preparations then? Unfortunately, after infection, the virus really cannot be completely destroyed, but modern methods of therapy can suppress its replication so much that it will not be detected in the blood.

Hepatitis C positive needs to be treated, not to completely eliminate (remove) the virus from the body, but to prevent complications.
Cirrhosis in the absence of proper medical care is a threat of liver failure, the consequences of which in hepatitis C are very severe.

How is hepatitis C treated? There are several main groups of medicines used to fight the virus:

1. Interferons (viferon, alfaferon).
2. RNA polymerase inhibitors (ribavirin, sofosbuvir).
3. Protease inhibitors (simeprevir, boceprevir, telaprevir).

The duration of medication is from 16 to 72 weeks, while these drugs are combined for a more effective effect on the virus.

To maintain the liver, hepatoprotectors are also prescribed - substances that stimulate regenerative abilities and help the body resist the destructive effects of hepatitis C.

Alcohol and its surrogates are incompatible with treatment, the diet implies the rejection of fatty and fried foods, hot spices, and synthetic flavors.

Patients complain of constant fatigue, so it is necessary to rationalize the regime of work and rest, engage in strengthening physical exercises, but avoid excessive overwork.

It is better to consult a doctor and replace or cancel completely hepatotoxic drugs - it is difficult for a weakened liver to cope with an increased load, and the risk of side effects increases tenfold.

There is also a risk for women after menopause.

The type of infection is important - genotype 1 recurs much more often than other variants of the disease, this is due to its high resistance to treatment, which can lead to
insufficient effect on hepatitis C. This should be taken into account when planning the duration of the drug regimen.

Alcohol abuse seriously aggravates and accelerates the onset of the consequences of hepatitis C, since even in uninfected people it leads to the development of cirrhosis.

It is impossible to deny that hepatitis C is a serious disease, but nevertheless it is not a sentence. The main obstacles to quality treatment are its high cost and late diagnosis, when the pathogen is detected already at the stage of liver cirrhosis. The course of hepatitis C, detected in a timely manner, can be slowed down and even interrupted.

Prevention

What can I do to avoid getting hepatitis C? Strictly individual use of medical and cosmetic instruments or careful sterilization with proper quality control are required.

When performing procedures associated with the risk of contact with the patient's blood or other biological fluid on the skin and mucous membranes, medical workers wear gloves, masks and goggles.

Protective equipment must be disposable and destroyed after use in accordance with the existing regulations.

Compulsory use of a condom during sexual intercourse is recommended. This also applies to a regular partner who is a carrier or confirmed hepatitis C infection. Pregnant women and women planning to conceive are screened for hepatitis C.

All about the risk to the child can be found by consulting with an obstetrician-gynecologist.

The term hepatitis refers to inflammatory processes occurring in the liver caused by various viruses. Therefore, there are several forms of hepatitis that have a destructive effect on the corresponding organ. Depending on the type of disease, you can answer the question of what is terrible about hepatitis in different ways.

In medicine, hepatitis is classified as follows: A, B, C, D, E, F and G. Any of the following factors can cause the disease.

The first type A is the result of infection with the A virus, which is easily picked up through contaminated food and water. In the people, this disease is called jaundice, due to the fact that the patient's skin acquires a yellowish tint.

Modification B is caused by the corresponding type B virus, which can be contracted through sexual, enteral and household routes. Hepatitis of this form is present in almost all biological fluids of the human body, so many are interested in why hepatitis B is terrible.

The most dangerous form remains hepatitis C, which cannot be diagnosed immediately, is transmitted by the enteral method.

The RNA virus provokes type B hepatitis, which is transmitted through the enteral route. Such a virus is often found in tests together with the B virus.

The causative agent of the next form of hepatitis is the E virus, which can be contracted through the fecal-oral route. New diseases include modification F, which is caused by two viruses. Infection with one of them is carried out when donor blood enters, and the second is detected in the feces of patients after a blood transfusion.

You can get the G virus anywhere, for example, during an operation, from mother to child, during a blood transfusion, and also through sexual contact.

It is not for nothing that so many are concerned about the question of what is terrible about hepatitis C, because doctors rightly consider it the most dangerous not only for health, but also for human life. This is due to the fact that effective drugs against it can not be found. While hepatitis A or B can be prevented by vaccination, there is no vaccine against the C virus.

This form of hepatitis than scary yet? The strength of this viral infection lies in the fact that it can provoke severe complications, which include cancer or cirrhosis of the liver. Most importantly, this modification in the human body is quite difficult to detect at the first stages of infection.

A person can safely continue to live, not implying the presence of such a terrible disease in his body, because it is asymptomatic, causing a devastating blow to health every day.

Therefore, we can safely answer the frequently asked question "Hepatitis C is terrible?" - yes, scary! First of all, it begins to affect one of the most important human organs - the liver, which is the main "filter" of the human body and a hematopoietic organ.

But a certain percentage of the population believes that hepatitis C is no longer terrible. This may be due to the fact that the disease can progress over 10-40 years and the person lives a relatively normal life. And liver cancer, which is a consequence of hepatitis, develops in only 1-5% of people suffering from chronic infection. But with cirrhosis, things are a little different - 15-20%.

With acute forms of hepatitis B and A, under the constant supervision of doctors and taking appropriate drugs, the body can cope on its own. Modern methods of treatment of chronic viral hepatitis B and C are combined antiviral therapy, which includes interferon and nucleoside analogues. Thanks to this form of treatment, it is possible to stop the multiplying virus and protect the liver from destruction.

The most favorable form of hepatitis for treatment is that caused by the A virus. It is also called Botkin's disease, and it is one of the most common. It does not cause serious consequences, but is provoked by E. coli, which enters the body through unwashed food, dirty hands and contaminated water. The infection is easiest to pick up in the summer, because the virus is very "heat-loving". The incubation period of the disease is about a month. At the first stages of diagnosis, it can be confused with a respiratory disease, because the temperature usually rises, a general malaise appears, accompanied by headaches.

The disease can last from one week to two months, but the body successfully fights it on its own. Sometimes it does without medical treatment. It is enough that the patient eats properly and observes bed rest.

Viral hepatitis B can proceed in different ways. It happens that a person remains just a carrier of the virus, but he himself does not get sick. If the disease manifests itself, then in a very severe form - liver cells are severely affected, and the digestive tract may also suffer. What is the insidiousness of this form of the disease? The hepatitis B virus sets up the body's immune system so that it begins to perceive the liver as a foreign object, destroying its cells.

Some statistics!

The problem of viral hepatitis C among the world population is becoming more and more urgent every year. Thus, the World Health Organization (WHO) has estimated that about 500 million people in the world are infected with hepatitis C, which is 10 times more than the number of HIV-positive people. Of the total, 150 million suffer from chronic hepatitis C, with an annual increase of more than 3 million people, and about half a million people die a year.

But, as you know, official statistics lag behind reality, there is still no specific count of cases of detection of viral hepatitis in the world, and not everyone seeks medical help. So, according to some data, the official figure for the incidence of hepatitis C can be multiplied by 5-10 times.

A bit of history!

The hepatitis C virus was discovered relatively recently, in 1989, even later than HIV infection. Before that, hepatitis A and B viruses were already known, their clinical picture was described in detail. But doctors identified patients who had symptoms of hepatitis, but hepatitis A and B viruses were not detected, and even for 2 decades this pathology was called "neither A nor B" hepatitis. Given the relatively short period of observation of this pathology, doctors have not yet fully studied the hepatitis C virus, especially with regard to effective treatment, but scientists around the world are conducting intensive research in this direction.

July 28 - World Hepatitis Day.

Interesting Facts!

• Hepatitis C is called the "gentle killer". This is due to the fact that the disease can be asymptomatic or oligosymptomatic, but at the same time, irreversible changes occur in the patient's liver, leading to the death of a person.
• Hepatitis C is the most common blood-borne disease.
• Prevention of hepatitis C is easier to prevent than to cure. So the prevention of this disease is a priority all over the world.
• More than half of cases of hepatitis C lead to the development of chronic hepatitis, which in 15-50% ends with cirrhosis of the liver.
• 75% of patients with liver cancer have chronic hepatitis C.
• Modern antiviral drugs can cure hepatitis C.
• Despite the fact that doctors combine hepatitis A, B, C, D, E and others into one group of diseases, all these viruses differ significantly in their structure and belong to different genera and families, the only thing that unites them is the ability to damage the liver.
• Hepatitis C can be infected in a hospital, in a beauty salon and a dental office, so few people are 100% insured against this disease.

The causative agent is the hepatitis C virus (HCV or HCV)

• Kingdom: RNA virus;
• Family: Flaviviruses (Flaviviridae), from Latin "yellow";
• Genus: Hepavirus (Hepacivirus);
• Species: Hepatitis C virus.

Ways of transmission of hepatitis C virus

Parenteral route - through the blood

Conventionally, there are several risk groups for hepatitis C infection:

1. People who inject drugs are the main group of people infected with hepatitis C, which is also called "hepatitis of drug addicts" because of this. This is due to the fact that the addict does not always use individual syringes. In addition, some "drug chemists", in the manufacture of the drug, add their own blood to it to purify the resulting solution from sediment. That is, a drug addict, buying a dose of a solution, can get hepatitis viruses or even HIV as a "bonus".

2. Clients of beauty salons. Unfortunately, beauty salon masters do not always conscientiously disinfect their tools, spreading blood-borne diseases, especially hepatitis B, which can live on objects for months and even years.
Procedures during which you can become infected with hepatitis C:

• manicure and pedicure for cuts;
• tattoo;
• shaving;
• haircut for damaged skin;
• some cosmetic procedures that can lead to a violation of the integrity of the skin.

• Transfusion of donor blood products that have not been properly tested, including from a donor who had hepatitis C virus at the time of blood donation, but has not yet developed antibodies to it (seronegative window). For your information, before 1992, donated blood was not tested for hepatitis C, so people who received a blood transfusion before this period are considered to be at high risk for hepatitis C (if the person is not tested).
• Treatment at the dentist, unfortunately, often causes infection with hepatitis, especially hepatitis B.
• People on hemodialysis have an average risk of hepatitis infection.
• Surgery and dental treatment cause the transmission of hepatitis C is rare, but this route of infection is possible, especially in underdeveloped countries and unscrupulous health workers.

5. Other persons at risk of hepatitis C infection through blood:

• Employees of the police, places of detention, military personnel who can become infected during the detention of criminals, first aid for injuries and in other situations.
• In everyday life: in the presence of patients with hepatitis C in the family. Household transmission is possible in rare cases, with the non-individual use of a toothbrush, blades, razors and other hygiene products.

Sexual way

Can you get hepatitis C through semen?

The hepatitis C virus lives only in the blood. In other biological fluids, the virus may be present, but in a very low concentration, which is not enough for infection. That is, semen and vaginal discharge cannot cause the transmission of the virus.

Can you get hepatitis C through sex during your period?

Menstruation is the discharge of blood from the vessels of the uterus, which can be infected with hepatitis C, so a woman during menstruation can easily infect her sexual partner with hepatitis, but only if there are injuries to the penis or skin in contact with menstrual blood.

Also, during menstruation, the risk of infection with hepatitis in women also increases.

Is it possible to get hepatitis C through oral sex?

Oral sex, like vaginal sex, can cause the transmission of hepatitis C, but subject to the simultaneous presence of microtraumas or cracks in the mucous membranes.

Transplacental route - from mother to child

How is hepatitis C not transmitted?

• Airborne;
• household way;
• when communicating;
• through saliva and kisses;
• with hugs and handshakes;
• when using shared utensils;
• through toys;
• when using shared towels;
• other contacts that do not involve contact with blood.

Disease pathogenesis

What happens with viral hepatitis C?

• The virus enters the blood and with it is delivered to the liver cells - hepatocytes.
• In the hepatocyte, the virus multiplies - RNA replication.
• The virus secretes toxin proteins (antigens) into the blood, including those that destroy the hepatocyte cell wall (cytotoxic proteins).
• Hepatitis occurs, liver cells are gradually destroyed.
• The immune system begins to react to the virus only after 1 month or even more. First, lymphocytes, macrophages, NK killers and other cells of cellular immunity come to the liver cells. Antibodies to the hepatitis C virus are not yet detected at this stage.

• Liver enzymes are released from damaged liver cells, which further destroy hepatocytes.
• In response to proteins and the reaction of cellular immunity, the body produces immunoglobulins (antibodies) that are specific to hepatitis C. As a result, the amount of virus in the blood decreases sharply.
• Autoimmune reactions are involved in the process, that is, when the immune system perceives its cells as foreign. At the same time, hepatitis C immunoglobulins destroy the hepatocyte along with the virus, aggravating the course of hepatitis.

• Spontaneous cure of hepatitis C may occur, while HCV RNA in the blood is not detected, but whether the virus persists in the human body or not has not yet been established. There is an opinion that it remains in an inactive form throughout a person's life. Recovery occurs only if the immune response is good.

• With the transition of hepatitis C to the chronic form, the virus constantly mutates, changes and multiplies unhindered, and the produced immunoglobulins do not have time to respond to new mutations. The immune response is no longer effective.
• In chronic hepatitis C, the death of liver cells occurs slowly and gradually, sometimes several decades can pass before cirrhosis of the liver.
• Against the background of hepatitis, fat metabolism in the liver is disturbed, which can lead to the development of fatty hepatosis (steatosis), that is, when normal liver tissue is replaced by fatty tissue.
• There is a depletion of immunity, further destruction of the liver. First of all, T-lymphocyte cells are affected. It is these cells that are damaged by HIV, so HIV and hepatitis C exacerbate each other's course.
• Possible remission with the risk of further relapses. The liver can partially recover (regenerate), but only if cirrhosis of the liver has not occurred.

What is hepatitis C carrier?

What happens in the patient's liver?

• Acute course of hepatitis C. The liver somewhat increases in size, fills with blood (bright crimson), the surface is smooth, even. In the liver, a small number of foci of necrosis (destroyed tissue) are determined, foci of fatty degeneration are determined. The blood flow in the liver is not disturbed.
• In chronic hepatitis C the number of foci of necrosis increases, in place of the destroyed hepatic tissue, fibrosis is formed - the growth of connective tissue, which does not perform the function of hepatocytes. The liver continues to be enlarged. First, single fibrous bands are formed, then the connective tissue gradually replaces the liver tissue, that is, cirrhosis of the liver occurs. In this case, the liver decreases in size, shrinks, becomes tuberous. A decrease in the number of normal hepatocytes leads to liver failure, the liver gradually or acutely ceases to perform its functions.
• With cirrhosis of the liver blood circulation through the hepatic vessels is disturbed, portal hypertension syndrome occurs, varicose veins of the hepatic vessels. In this case, additional vessels (anastomoses) are formed, through which part of the blood circulates, bypassing the liver. The lack of blood and oxygen in the hepatic lobule contributes to further destruction of the liver, exacerbating liver failure.
• Hepatitis C virus affects the genetic material of liver cells which can result in the formation of a cancerous tumor.

What does the liver of a patient with hepatitis C look like (photo)?

Classification

Forms and types of hepatitis C

• Acute course of HCV- is diagnosed only in one case out of five, this is due to the fact that the disease may not manifest itself clinically. In more than 70% of cases, acute hepatitis C becomes chronic.
• Chronic course of HCV- the most common form of hepatitis C, characterized by slow and gradual destruction of the liver.
• Fulminant (malignant or fulminant) hepatitis C- a variant of the acute course of hepatitis, in which there is a rapidly progressive destruction of the liver, with this form, liver failure develops 10-15 days after the onset of the first symptoms. This variant of hepatitis C, fortunately, develops quite rarely, less than 1% of all cases. Among the predisposing factors for the development of malignant hepatitis are infancy, features of the virus genotype, infection with several types of hepatitis viruses (A, B, D), alcohol, drugs and other liver damage. Mortality is about 70%.

Chronic hepatitis C activity

Hepatitis C activity levels:

• "Minimal" chronic hepatitis C;
• "mild" (mild) chronic hepatitis C;
• chronic hepatitis C with moderate activity;
• severe chronic hepatitis C.

• the degree of liver damage according to the results of a histological examination of a liver biopsy;
• the presence of fibrosis (connective tissue);
• the presence and severity of symptoms of the disease;
• laboratory parameters of liver tests (namely ALT - alanine transferase).

Stages of liver fibrosis in hepatitis C:

• liver fibrosis is absent;
• weakly expressed;
• moderately expressed;
• severe liver fibrosis;
• cirrhosis of the liver.

ICD-10 code

• Acute viral hepatitis C: B 17.1.
• Chronic viral hepatitis C: B 18.2.

Periods and phases of hepatitis C

2. Acute phase- the symptoms of the disease in most cases may be absent or there are symptoms that the patient does not particularly pay attention to, does not go to the doctor. Acute hepatitis C lasts up to 6 months.
Variants of the course of the acute phase of hepatitis C:

• Latent or latent hepatitis - no symptoms or few symptoms - is 8 out of 10 cases.
• Manifest hepatitis C - bright clinical manifestations, severity of symptoms - occurs only in 20% of cases. You can separate the preicteric period (lasts an average of 10 days) and the icteric period.

4. The period of reactivation and transition to the chronic stage of hepatitis C occurs with or without clinical manifestations. This period lasts for the majority of decades and may end in the development of cirrhosis or liver cancer.

5. The period of remission of chronic hepatitis C , which is achieved as a result of a course of therapy with antiviral drugs. Remission can be considered with normalization of liver function tests and a negative result of HCV RNA analysis. Any remission can end with a relapse.

The duration of each period may differ in each individual case.

Symptoms of acute and chronic hepatitis C

Possible symptoms and signs of viral hepatitis C

The first signs of hepatitis C

In acute hepatitis C with a manifest course, the first signs are symptoms of intoxication (fever, weakness, joint pain, headaches, and others), that is, a flu-like condition, against which jaundice appears after 7-10 days.

But in most cases, the first manifestations of hepatitis C are symptoms of liver cirrhosis and liver failure, that is, many years after the onset of the disease.

Signs of chronic hepatitis C:

• regular increase in body temperature up to 37.5-38 o C;
• drawing pains in the right hypochondrium;
• periodic nausea, bloating after eating;
• spider veins on the skin of the trunk.

Features of the course of hepatitis C depending on the genotype of the virus

Genotype 1 HCV, especially 1b - more often than other genotypes, causes a severe and malignant course of the disease. Hepatitis caused by HCV genotype 1 requires longer treatment and higher doses of drugs. Genotype 1b suggests a poor prognosis. It is this genotype that is most common in Russia.

Genotype 2 HCV- more often cause a mild or moderate course of hepatitis C, such hepatitis is easier to treat, in most cases a favorable outcome is noted (recovery and restoration of the liver).

Genotype 3 HCV- such hepatitis also in most cases is milder and has good prognosis, but most often it is this genotype that contributes to the development of fatty hepatosis.

Features and patterns of other genotypes are still being studied.

However, there are cases when hepatitis C is caused not by one, but by several virus genotypes at once, then such a disease is much more severe and dangerous with its complications.

What do people with hepatitis C look like?

Photo: jaundice.

Photo: dark urine with hepatitis C.

Photo: this is how a patient with cirrhosis of the liver may look like (an increase in the volume of the abdomen, vasodilation on the anterior abdominal wall, atrophy of the muscles of the upper shoulder girdle, yellowness of the skin).

Photo: hepatic palms.

Features of the course of hepatitis C in men and women

Just why this happens is still not known. Perhaps men lead a more irregular lifestyle, more often allow themselves to drink a glass or two with or without a reason, like to eat, work hard, listen to their body less.

What is the hepatitis C virus, how does it penetrate and multiply in liver cells - video

Diagnosis of the disease

Blood test for antibodies (markers) to hepatitis C

To diagnose viral hepatitis C, the level of such antibodies is determined:

• Total class G antibodies to HCV (Ig G anti HCV);
• Immunoglobulins M and G to HCV nuclear antigens (Ig M anti HCV core, Ig G anti HCV core);
• Antibodies to non-structural antigens (anti HCV NS).

Table. Deciphering the results of a blood test for the determination of antibodies to hepatitis C.

* Class G immunoglobulins to hepatitis C appear only 2-4 months after infection.
** During remission of chronic hepatitis C, the virus may remain in the patient's body or be eliminated (disappear).

"-" Negative result, that is, no antibodies or RNA of the virus were detected.
"+" Positive, HCV antibodies or RNA detected.

PCR diagnostics (RNA detection) and viral load of hepatitis C

There are two types of PCR for diagnosing hepatitis C:
1. Qualitative determination of HCV RNA - Hepatitis C virus is detected or not detected. This type of PCR is used for primary diagnosis.
2. Quantification of HCV RNA, or viral load - used to determine the concentration of the virus in the blood. Viral load allows you to evaluate the dynamics during treatment and indicates how contagious the patient is. The higher the viral load, the greater the likelihood of infection in a person who has been in contact with his blood.

PCR is the most accurate method for diagnosing any infectious disease (over 98-99%), but only if it is carried out correctly.

In addition to identifying the virus itself, using PCR, you can determine the genotype of the virus, which affects the course of the disease and treatment tactics.

What does doubtful, false positive and false negative for hepatitis C mean?

About false positive they say when, in the presence of class M immunoglobulins to hepatitis C, the hepatitis C virus is not detected by PCR RNA.

Such a result requires a retake of the analysis.

False negative hepatitis C test usually obtained during the incubation period of the disease, doctors call this period the immunological window. During this period, a person is already infected with HCV, but does not yet have immunity to it, and there are no symptoms of the disease.

Can a hepatitis C test be wrong?

Yes, any laboratory diagnostics has a percentage of errors. But such incidents are possible in relation to only ELISA or only PCR. Therefore, when diagnosing hepatitis C, it is necessary to conduct both types of research. By the way, PCR for HCV can give a false result if there is a violation of the cleanliness in the laboratory or the inexperience of the laboratory assistant.

How to detect hepatitis C immediately after infection (for example, after a blood transfusion or needle stick)?

It will be possible to accurately answer the question of whether infection with viral hepatitis has occurred or not, no earlier than 3 months later, then the blood is examined for markers for HCV. A preliminary result is possible after 2 months, but there is a high probability of error.

Before donating blood for hepatitis C

Preparation for this type of study is not required, this analysis, unlike liver tests, does not require the patient to be on an empty stomach. As with other types of ELISA tests, it is undesirable to eat fried, fatty, spicy and salty foods the day before, as well as drink alcohol.

How long does a hepatitis C test take?

Often markers for hepatitis C are ready the next day after donation, no later than 7 days later. It all depends on the laboratory, the need to deliver the material and results, diagnostic methods.

Where can I get tested for hepatitis C and how much does it cost?

An analysis for hepatitis can be taken at any medical institution, both public and private, where only blood is taken. The diagnosis itself is carried out in the laboratories of infectious institutions, immunological and private laboratories.

In polyclinics and hospitals, a doctor's referral is required. In laboratories, they can do an analysis without a referral and even anonymously.

The average cost of research is from 15 to 60 USD. e.*

* the price is indicated in US dollars due to the instability of exchange rates.

Rapid test for hepatitis C. Where to buy, what is the price?

Such a rapid test also exists for the diagnosis of hepatitis C. It is based on the determination of total antibodies to HCV (Ig G anti HCV) in the blood.

Such a test can be bought at pharmacies, ordered on official websites on the Internet or in special medical equipment stores. The price is on average 5-10 USD. e.

Hepatitis C Rapid Test Technique:

• wash and sanitize hands with an alcohol wipe;
• with a special needle (scarifier), which is in the package, pierce the fingertip treated with a napkin;
• take 1 drop of blood with a pipette;
• drip blood into a special test window marked S, then add 2 drops of the reagent there;
• the result is evaluated in 10-20 minutes, not later.

• negative result - the presence of one red strip opposite the mark C;
• a positive result - the presence of two red stripes opposite the C and T marks, while the second strip may be of lesser intensity;
• the test is invalid - if there are no strips or if there is one strip opposite the T mark, such a test must be redone.

General blood analysis

Liver tests for hepatitis C

The ALT indicator reflects the dynamics of the course of hepatitis C, with the help of which the severity of the course of the disease is determined.

Determination of the degree of HCV hepatitis depending on the ALT index

Changes in other biochemical blood parameters in hepatitis C:

• decrease in the level of albumin (normal 20-36 mmol / l);
• increase in the level of gamma globulins (norm 30-65 mmol / l);
• increased cholesterol levels (normal 3.4-6.5 mmol / l);
• an increase in the concentration of iron in the blood (the norm is 10-35 µmol / l).
• reduction or increase in size;
• surface roughness;
• deformation of the shape of the liver;
• the structure of the liver in the form of a mosaic;
• thickening of the walls of portal vessels, impaired blood flow through them;
• an increase in the size of the spleen;
• the presence of fluid in the abdominal cavity.

Liver biopsy

To take biopsy material, a laparoscopic operation is performed, in which a puncture is made in the liver area and a “piece” of the organ is taken with special forceps. Next, the biopsy material is examined under a microscope and the degree of destruction of the liver and the formation of connective tissue (fibrosis) in it are assessed.

Elastography of the liver

This is a new diagnostic method based on ultrasound scanning of liver tissues. A special range of ultrasonic waves allows you to assess the spread of connective tissue in the liver, that is, the degree of fibrosis. This method avoids the liver biopsy procedure for hepatitis C.

Immunogenetic studies

These are new research methods that determine the risk factors for the formation of fibrosis (cirrhosis) of the liver against the background of hepatitis C. These studies help assess the prognosis of the disease, which is necessary to determine treatment tactics.

At the same time, immunogenetic markers are detected:

• fibrogenesis factors;
• immunoregulatory proteins.
All patients with suspected or confirmed hepatitis C must be tested for hepatitis B and HIV! These diseases are also transmitted through the blood, and often there is a combination of viral hepatitis with HIV infection.

Hepatitis C: prevalence of the disease, complications, mechanism of infection, symptoms, diagnosis, risk groups - video

What is hepatitis C virus? The mechanism of hepatitis C disease, diagnosis, treatment (drugs, diet) - video

Hepatitis C: what organs does HCV affect? Complications of hepatitis C. Diagnosis (where to get tested for hepatitis C), treatment - video

Before use, you should consult with a specialist.

Good day, dear readers!

In today's article, we will continue to consider hepatitis in all its aspects and next in line - hepatitis C, its causes, symptoms, diagnosis, treatment and prevention. So…

What is hepatitis C?

Hepatitis C (hepatitis C) is an inflammatory liver disease caused by exposure to the hepatitis C virus (HCV). The main danger that lies in hepatitis C is a pathological process that provokes the development or cancer of the liver.

Due to the fact that the cause of this disease is a virus (HCV), it is also called - viral hepatitis C.

How does hepatitis C get infected?

Infection with hepatitis C usually occurs through microtrauma of the surface of the skin or mucous membranes, after contact with contaminated (infected with the virus) objects. The hepatitis virus itself is transmitted through the blood and its components. When any infected object comes into contact with human blood, the virus enters the liver through the bloodstream, where it settles in its cells and begins to actively multiply. The virus does not die for a long time, even if the blood on cosmetic and medical instruments dries up. Also, this infection is resistant to improper heat treatment. Thus, it can be revealed that hepatitis infection occurs in places where blood can be present in any way - beauty salons, tattooing, piercing, dental clinics, hospitals. You can also become infected when sharing hygiene items - a toothbrush, a razor. Most of those infected with hepatitis C are drug addicts, because they often use one syringe for several people.

During sexual contact, infection with hepatitis C is minimal (3-5% of all cases), while there remains an increased risk of infection with the hepatitis B virus. However, with a promiscuous sexual life, the risks of infection increase significantly.

In 5% of cases, HCV infection of an infant was noticed while breastfeeding by a sick mother, but this is possible if the integrity of the breast is violated. The woman herself sometimes gets infected during childbirth.

In 20% of cases, the mode of infection with the HCV virus cannot be established.

Hepatitis C is not transmitted by airborne droplets. Talking and sneezing with saliva at close range, hugging, shaking hands, sharing utensils, eating are not causes or factors for HCV infection. At home, you can become infected only with a microtrauma and its contact with an infected object, on which there are remnants of infected blood and its particles.

Most often, a person learns about their infection during a blood test, whether it is a routine medical examination, or to act as a blood donor.

A very important preventive measure is to avoid visiting unverified and little-known organizations that provide certain beauty and health services.

The development of hepatitis C

Unfortunately, hepatitis C has a name - "gentle killer". This is due to the possibility of its asymptomatic development and course. A person may not be aware of his infection, even living 30-40 years. But, despite the absence of obvious signs of the disease, he is a carrier of the infection. At the same time, the virus gradually develops in the body, provokes the development of chronic liver disease, slowly destroying it. The liver is the main target of hepatitis viruses.

Direct acting drugs for HCV

Since 2002, Gilead has been developing the latest anti-hepatitis C drug, sofosbuvir (TM Sovaldi).

Until 2011, all tests were passed, and already in 2013 the US Department of Health approved the use of sofosbuvir in all hospitals in the country. Until the end of 2013, sofosbuvir began to be used in clinics in a number of countries: Germany, Israel, Switzerland, France, Denmark, and Finland.

But unfortunately the price was inaccessible to most of the population. One tablet had a price of $ 1000, the entire course cost $ 84,000. In the US, 1/3 of the cost was covered by the insurance company and the state. subsidies.

In September 2014, Gilead announced that it would be issuing manufacturing licenses for certain developing countries. In February 2015, the first analogue was released in India by Natco Ltd under the trade name Hepcinat. The 12-week course is available in India for a suggested retail price of $880-$1200 depending on region.

The main components of the drugs are sofosbuvir and daclatasvir. These drugs are prescribed by a doctor according to the scheme, depending on the genotype of the virus and the degree of fibrosis, and also allow you to completely get rid of the hepatitis C virus in 96% of cases, compared with the traditional interferon treatment regimen, which has only 45-50% success.

When treating with these drugs, there is no need to stay in the hospital, as before. The medicine is taken orally.

The course of treatment is from 12 to 24 weeks.

One of the first companies delivering the drug from India to Russia and other countries of the world was the company owned by the large Indian retailer Hepatit Life Group.

Direct-acting antiviral drugs are prescribed by a doctor according to the scheme, depending on the genotype of the hepatitis C virus.

Direct acting antivirals for acute hepatitis C: Sofosbuvir / Ledipasvir, Sofosbuvir / Velpatasvir, Sofosbuvir / Daclatasvir.

The course of treatment is from 12 to 24 weeks. The combinations are effective in various HCV genotypes. There are no contraindications if present.

Direct acting antivirals for chronic hepatitis C: Sofosbuvir / Ledipasvir, Sofosbuvir / Velpatasvir, Sofosbuvir / Daclatasvir, Dasabuvir / Paritaprevir / Ombitasvir / Ritonavir, Sofosbuvir / Velpatasvir / Ribavirin ".

The course of treatment is from 12 to 24 weeks. The combinations are effective in various HCV genotypes. Sofosbuvir has no contraindications for HIV infection, as well as "interferon-resistant individuals for the IL28B gene.

Maintaining Liver Health

To maintain the health of the liver, as well as for enhanced tissue regeneration of this organ, together with antiviral therapy, hepatoprotectors are used: "", "Lipoic acid" (), "Silimar", "Ursonan", "Phosphogliv", "".

Immune System Support

To strengthen the immune system, as well as to enhance the body's adequate response to a viral infection, additional immunomodulators are used: "Zadaksin", "Timogen".

Diet for hepatitis C

With hepatitis C, a therapeutic nutrition system according to Pevzner is usually prescribed -. This diet is also prescribed for cirrhosis of the liver and.

The diet is based on restrictions in the diet of fats, as well as spicy, salty, fried, preservatives and other foods that can enhance the secretion of digestive juices.

Buy cheap medicines for hepatitis C

Hundreds of suppliers are bringing Sofosbuvir, Daclatasvir and Velpatasvir from India to Russia. But only a few can be trusted. Among them is an online pharmacy with an impeccable reputation Phoenix Pharma. Get rid of the hepatitis C virus forever in just 12 weeks. Quality drugs, fast delivery, the cheapest prices.

Hepatitis is called acute and chronic inflammatory diseases of the liver, which are not focal, but widespread. Different hepatitis has different methods of infection, they also differ in the rate of progression of the disease, clinical manifestations, methods and prognosis of therapy. Even the symptoms of different types of hepatitis are different. Moreover, some symptoms are more pronounced than others, which is determined by the type of hepatitis.

Main Symptoms

1. Jaundice. The symptom is common and is due to the fact that bilirubin enters the patient's blood during liver damage. Blood, circulating through the body, carries it through the organs and tissues, staining them yellow.
2. The appearance of pain in the region of the right hypochondrium. It occurs due to an increase in the size of the liver, leading to the appearance of pain, which is dull and prolonged, or is paroxysmal in nature.
3. Deterioration of well-being, accompanied by fever, headaches, dizziness, indigestion, drowsiness and lethargy. All this is a consequence of the action on the body of bilirubin.

Hepatitis acute and chronic

Hepatitis in patients have acute and chronic forms. In an acute form, they appear in the case of viral liver damage, as well as if there has been poisoning with various types of poisons. In acute forms of the course of the disease, the condition of patients deteriorates rapidly, which contributes to the accelerated development of symptoms.

With this form of the disease, favorable prognosis is quite possible. Except for its transformation into a chronic one. In the acute form, the disease is easily diagnosed and easier to treat. Untreated acute hepatitis easily develops into a chronic form. Sometimes with severe poisoning (for example, alcohol), the chronic form occurs on its own. In the chronic form of hepatitis, the process of replacement of liver cells with connective tissue occurs. It is weakly expressed, goes slowly, and therefore sometimes remains undiagnosed until the onset of cirrhosis of the liver. Chronic hepatitis is treated worse, and the prognosis for its cure is less favorable. In the acute course of the disease, the state of health worsens significantly, jaundice develops, intoxication appears, the functional work of the liver decreases, and the content of bilirubin in the blood increases. With timely detection and effective treatment of acute hepatitis, the patient most often recovers. With a duration of the disease for more than six months, hepatitis becomes chronic. The chronic form of the disease leads to serious disorders in the body - the spleen and liver increase, metabolism is disturbed, complications arise in the form of cirrhosis of the liver and oncological formations. If the patient has reduced immunity, the treatment regimen is chosen incorrectly, or there is alcohol dependence, then the transition of hepatitis to a chronic form threatens the patient's life.

Varieties of hepatitis

Hepatitis has several types: A, B, C, D, E, F, G, they are also called viral hepatitis, since the cause of their occurrence is a virus.

Hepatitis A

This type of hepatitis is also called Botkin's disease. It has an incubation period ranging from 7 days to 2 months. Its causative agent - an RNA virus - can be transmitted from a sick person to a healthy person with the help of poor-quality products and water, contact with household items used by the patient. Hepatitis A is possible in three forms, they are divided according to the strength of the manifestation of the disease:

• in the acute form with jaundice, the liver is seriously damaged;
• with subacute without jaundice, we can talk about a milder version of the disease;
• in the subclinical form, you may not even notice symptoms, although the infected person is a source of the virus and is able to infect others.

Hepatitis B

This disease is also called serum hepatitis. Accompanied by an increase in the liver and spleen, the appearance of pain in the joints, vomiting, temperature, liver damage. It proceeds either in acute or in chronic forms, which is determined by the state of the patient's immunity. Ways of infection: during injections with violation of sanitary rules, sexual contacts, during blood transfusion, use of poorly disinfected medical instruments. The duration of the incubation period is 50 ÷ 180 days. The incidence of hepatitis B is reduced by the use of vaccination.

Hepatitis C

This type of disease is one of the most serious diseases, as it is often accompanied by cirrhosis or liver cancer, which subsequently leads to death. The disease is difficult to treat, and moreover, having had hepatitis C once, a person can be re-infected with the same disease. It is not easy to cure HCV: after contracting hepatitis C in an acute form, 20% of the sick people recover, and in 70% of patients the body is not able to recover from the virus on its own, and the disease becomes chronic. It has not yet been possible to establish the reason why some heal themselves, while others do not. The chronic form of hepatitis C will not disappear on its own, and therefore needs therapy. Diagnosis and treatment of the acute form of HCV is carried out by an infectious disease specialist, the chronic form of the disease - by a hepatologist or gastroenterologist. You can become infected during a transfusion of plasma or blood from an infected donor, using poorly processed medical instruments, sexually, and a sick mother transmits the infection to her child. The hepatitis C virus (HCV) is rapidly spreading around the world, the number of patients has long ago exceeded one and a half hundred million people. Previously, HCV was difficult to treat, but now the disease can be cured using modern direct-acting antivirals. Only this therapy is quite expensive, and therefore not everyone can afford it.

Hepatitis D

This type of hepatitis D is possible only with co-infection with the hepatitis B virus (co-infection is a case of infection of one cell with viruses of different types). It is accompanied by massive liver damage and an acute course of the disease. Ways of infection - the entry of a disease virus into the blood of a healthy person from a virus carrier or a sick person. The incubation period lasts 20 ÷ 50 days. Outwardly, the course of the disease resembles hepatitis B, but its form is more severe. May become chronic, then progressing to cirrhosis. It is possible to carry out a vaccination similar to that used for hepatitis B.

Hepatitis E

Slightly resembles hepatitis A in its course and transmission mechanism, since it is also transmitted through the blood in the same way. Its feature is the occurrence of fulminant forms that cause death in a period not exceeding 10 days. In other cases, it can be effectively cured, and the prognosis for recovery is most often favorable. An exception may be pregnancy, as the risk of losing a child approaches 100%.

Hepatitis F

This type of hepatitis has not yet been studied enough. It is only known that the disease is caused by two different viruses: one was isolated from the blood of donors, the second was found in the feces of a patient who received hepatitis after a blood transfusion. Signs: the appearance of jaundice, fever, ascites (accumulation of fluid in the abdominal cavity), an increase in the size of the liver and spleen, an increase in the levels of bilirubin and liver enzymes, the occurrence of changes in the urine and feces, as well as general intoxication of the body. Effective methods of therapy for hepatitis F have not yet been developed.

Hepatitis G

This type of hepatitis is similar to hepatitis C, but is not as dangerous as it does not contribute to cirrhosis and liver cancer. Cirrhosis can occur only in case of co-infection of hepatitis G and C.

Diagnostics

Viral hepatitis in their symptoms are similar to one another, just like some other viral infections. For this reason, it is difficult to accurately diagnose the patient. Accordingly, to clarify the type of hepatitis and the correct prescription of therapy, laboratory blood tests are required to identify markers - indicators that are individual for each type of virus. By identifying the presence of such markers and their ratio, it is possible to determine the stage of the disease, its activity and possible outcome. In order to track the dynamics of the process, after a period of time, the surveys are repeated.

How is hepatitis C treated?

Modern regimens for the treatment of chronic forms of HCV are reduced to combined antiviral therapy, including direct-acting antivirals such as sofosbuvir, velpatasvir, daclatasvir, ledipasvir in various combinations. Ribavirin and interferons are sometimes added to enhance effectiveness. This combination of active ingredients stops the replication of viruses, saving the liver from their destructive effects. This therapy has a number of disadvantages:

1. The cost of medicines to fight the hepatitis virus is high, and not everyone can buy them.
2. Taking certain drugs is accompanied by unpleasant side effects, including fever, nausea, and diarrhea.

The duration of treatment for chronic forms of hepatitis takes from several months to a year, depending on the genotype of the virus, the degree of damage to the body and the drugs used. Because hepatitis C primarily affects the liver, patients are required to follow a strict diet.

Features of HCV genotypes

Hepatitis C is one of the most dangerous viral hepatitis. The disease is caused by an RNA virus called Flaviviridae. The hepatitis C virus is also known as the "gentle killer". He received such an unflattering epithet due to the fact that at the initial stage the disease is not accompanied by any symptoms at all. There are no signs of classical jaundice, and there is no pain in the area of ​​the right hypochondrium. It is possible to detect the presence of the virus no earlier than a couple of months after infection. And before that, the reaction of the immune system is completely absent and it is impossible to detect markers in the blood, and therefore it is not possible to carry out genotyping. The peculiarity of HCV also includes the fact that after entering the blood during the process of reproduction, the virus begins to rapidly mutate. Such mutations prevent the infected person's immune system from adapting and fighting the disease. As a result, the disease can proceed without any symptoms for several years, after which cirrhosis or a malignant tumor appears almost immediately. Moreover, in 85% of cases, the disease from an acute form becomes chronic. The hepatitis C virus has an important feature - the diversity of the genetic structure. In fact, hepatitis C is a collection of viruses classified according to their structural variants and subdivided into genotypes and subtypes. The genotype is the sum of the genes encoding hereditary traits. So far, medicine knows 11 genotypes of the hepatitis C virus, which have their own subtypes. The genotype is indicated by numbers from 1 to 11 (although genotypes 1 ÷ 6 are mainly used in clinical studies), and subtypes, using the letters of the Latin alphabet:

• 1a, 1b and 1c;
• 2a, 2b, 2c and 2d;
• 3a, 3b, 3c, 3d, 3e and 3f;
• 4a, 4b, 4c, 4d, 4e, 4f, 4h, 4i and 4j;

In different countries, HCV genotypes are distributed differently, for example, in Russia it is most often found from the first to the third. The severity of the course of the disease depends on the variety of the genotype, they determine the treatment regimen, its duration and the result of treatment.

How are HCV strains spread around the world?

On the territory of the globe, hepatitis C genotypes are distributed heterogeneously, and most often you can find genotypes 1, 2, 3, and in some areas it looks like this:

• in Western Europe and its eastern regions, genotypes 1 and 2 are most common;
• in the USA, subtypes 1a and 1b;
• in northern Africa, genotype 4 is the most common.

At risk of possible HCV infection are people with blood diseases (tumors of the hematopoietic system, hemophilia, etc.), as well as patients who are being treated in dialysis units. Genotype 1 is considered the most common in the countries of the world - it accounts for ~ 50% of the total number of cases. In second place in terms of prevalence is genotype 3 with an indicator of slightly more than 30%. The distribution of HCV across the territory of Russia has significant differences from the world or European variants:

• genotype 1b accounts for ~50% of cases;
• for genotype 3a ~20%,
• ~10% of patients are infected with hepatitis 1a;
• genotype 2 hepatitis was found in ~5% of those infected.

But the difficulties of HCV therapy depend not only on the genotype. The following factors also influence the effectiveness of treatment:

• age of patients. The chance of a cure in young people is much higher;
• it is easier for women to recover than for men;
• the degree of liver damage is important - the favorable outcome is higher with less damage to it;
• the magnitude of the viral load - the less viruses in the body at the time of the start of treatment, the more effective the therapy;
• patient's weight: the higher it is, the more complicated the treatment.

Therefore, the treatment regimen is chosen by the attending physician, based on the above factors, genotyping and EASL (European Association for Liver Diseases) recommendations. EASL constantly keeps its recommendations up to date and, as new effective drugs for the treatment of hepatitis C appear, adjusts the recommended treatment regimens.

Who is at risk for HCV infection?

As you know, the hepatitis C virus is transmitted through the blood, and therefore the most likely to become infected can:

• patients receiving blood transfusions;
• patients and clients in dental offices and medical facilities where medical instruments are improperly sterilized;
• due to non-sterile instruments, it can be dangerous to visit a nail and beauty salon;
• lovers of piercings and tattoos can also suffer from poorly processed tools,
• high risk of infection in those who use drugs due to repeated use of non-sterile needles;
• the fetus can become infected from a mother infected with hepatitis C;
• during sexual intercourse, the infection can also enter the body of a healthy person.

How is hepatitis C treated?

The hepatitis C virus was not in vain considered a “gentle” killer virus. It is able to not manifest itself for years, after which it suddenly shows up in the form of complications accompanied by cirrhosis or liver cancer. But more than 177 million people in the world have been diagnosed with HCV. The treatment, which was used until 2013, combining injections of interferon and ribavirin, gave patients a chance of healing that did not exceed 40-50%. And besides, it was accompanied by serious and painful side effects. The situation changed in the summer of 2013 after the US pharmaceutical giant Gilead Sciences patented the substance sofosbuvir, produced as a drug under the Sovaldi brand, which included 400 mg of the drug. It became the first direct-acting antiviral drug (DAA) designed to combat HCV. The results of clinical trials of sofosbuvir pleased physicians with the effectiveness, which, depending on the genotype, reached 85 ÷ 95%, while the duration of the course of therapy was more than halved compared to treatment with interferons and ribavirin. And, although the pharmaceutical company Gilead patented sofosbuvir, it was synthesized in 2007 by Michael Sophia, an employee of Pharmasett, subsequently acquired by Gilead Sciences. From the name of Michael, the substance he synthesized was named sofosbuvir. Michael Sophia himself, together with a group of scientists who made a number of discoveries that revealed the nature of HCV, which made it possible to create an effective drug for its treatment, received the Lasker-DeBakey Award for Clinical Medical Research. Well, almost all the profit from the sale of a new effective tool went to Gilead, which set monopoly high prices for Sovaldi. Moreover, the company protected its development with a special patent, according to which Gilead and some of its partner companies became the owners of the exclusive right to manufacture the original DAA. As a result, Gilead's profits in the first two years of marketing the drug many times overcame all the costs that the company incurred to acquire Pharmasett, obtain a patent and subsequent clinical trials.

What is Sofosbuvir?

The effectiveness of this drug in the fight against HCV was so high that now almost no therapy regimen can do without its use. Sofosbuvir is not recommended for use as monotherapy, but with complex use it shows exceptionally good results. Initially, the drug was used in combination with ribavirin and interferon, which allowed in uncomplicated cases to achieve a cure in just 12 weeks. And this despite the fact that therapy with only interferon and ribavirin was half as effective, and its duration sometimes exceeded 40 weeks. After 2013, each subsequent year brought news of the emergence of more and more new drugs that successfully fight the hepatitis C virus:

• daclatasvir appeared in 2014;
• 2015 was the birth year of ledipasvir;
• 2016 pleased with the creation of velpatasvir.

Daclatasvir was released by Bristol-Myers Squibb as Daklinza, containing 60 mg of the active ingredient. The next two substances were created by Gilead scientists, and since neither of them was suitable for monotherapy, drugs were used only in combination with sofosbuvir. To facilitate therapy, Gilead prudently released the newly created drugs immediately in combination with sofosbuvir. So there were drugs:

• Harvoni, a combination of sofosbuvir 400 mg and ledipasvir 90 mg;
• Epclusa, which included sofosbuvir 400 mg and velpatasvir 100 mg.

In therapy with daclatasvir, Sovaldi and Daklinz had to take two different drugs. Each of the paired combinations of active substances was used to treat certain HCV genotypes according to the treatment regimens recommended by EASL. And only the combination of sofosbuvir with velpatasvir turned out to be a pangenotypic (universal) remedy. Epclusa cured all hepatitis C genotypes with almost the same high efficiency of approximately 97 ÷ 100%.

The emergence of generics

Clinical trials confirmed the effectiveness of the treatment, but all these highly effective drugs had one significant drawback - too high prices that did not allow them to be purchased by the bulk of the sick. The monopoly high prices for products set by Gilead caused outrage and scandals, which forced the patent holders to make certain concessions, granting licenses to some companies from India, Egypt and Pakistan to produce analogues (generics) of such effective and popular drugs. Moreover, the fight against patent holders offering medicines for treatment at biased prices was led by India, as a country in which millions of chronic hepatitis C patients live. As a result of this struggle, Gilead issued licenses and patent developments to 11 Indian companies for the independent production of first sofosbuvir, and then its other new drugs. Having received licenses, Indian manufacturers quickly set up the production of generics, assigning their own trade names to the manufactured drugs. This is how Sovaldi generics first appeared, then Daklinza, Harvoni, Epclusa, and India became the world leader in their production. Indian manufacturers, under a license agreement, pay 7% of their earnings to the patent holders. But even with these payments, the cost of generics produced in India turned out to be ten times less than that of the originals.

Mechanisms of action

As previously reported, new HCV therapies that have emerged are classified as DAAs and act directly on the virus. Whereas previously used for treatment, interferon with ribavirin strengthened the human immune system, helping the body to resist the disease. Each of the substances acts on the virus in its own way:

1. Sofosbuvir blocks RNA polymerase, thereby inhibiting the replication of the virus.

1. Daclatasvir, ledipasvir and velpatasvir are NS5A inhibitors that interfere with the spread of viruses and their entry into healthy cells.

Such a targeted effect makes it possible to successfully fight HCV by using sofosbuvir paired with daklatasvir, ledipasvir, velpatasvir for therapy. Sometimes, to enhance the effect on the virus, a third component is added to the pair, which is most often ribavirin.

Generic manufacturers from India

The pharmaceutical companies of the country have taken advantage of the licenses granted to them, and now India produces the following Sovaldi generics:

• Hepcvir is manufactured by Cipla Ltd.;
• Hepcinat - Natco Pharma Ltd.;
• Cimivir - Biocon ltd. & Hetero Drugs Ltd.;
• MyHep is a manufacturer of Mylan Pharmaceuticals Private Ltd.;
• SoviHep - Zydus Heptiza Ltd.;
• Sofovir is the manufacturer of Hetero Drugs Ltd.;
• Resof - manufactured by Dr Reddy's Laboratories;
• Virso - Releases Strides Arcolab.

Analogues of Daklinza are also made in India:

• Natdac from Natco Pharma;
• Dacihep by Zydus Heptiza;
• Daclahep from Hetero Drugs;
• Dactovin by Strides Arcolab;
• Daclawin by Biocon ltd. & Hetero Drugs Ltd.;
• Mydacla by Mylan Pharmaceuticals.

Following Gilead, Indian drug manufacturers also mastered the production of Harvoni, resulting in the following generics:

• Ledifos - releases Hetero;
• Hepcinat LP - Natco;
• Myhep LVIR - Mylan;
• Hepcvir L - Cipla Ltd.;
• Cimivir L - Biocon ltd. & Hetero Drugs Ltd.;
• LadyHep - Zydus.

And already in 2017, the production of the following Indian generics of Epclusa was mastered:

• Velpanat was released by Natco Pharma;
• the release of Velasof was mastered by Hetero Drugs;
• SoviHep V was launched by Zydus Heptiza.

As you can see, Indian pharmaceutical companies do not lag behind American manufacturers, quickly mastering newly developed drugs, while observing all qualitative, quantitative and medicinal characteristics. Withstanding including the pharmacokinetic bioequivalence in relation to the originals.

Requirements for generics

A generic drug is called a drug that, according to its main pharmacological properties, can replace the treatment with expensive original drugs with a patent. They can be released both with and without a license, only its presence makes the produced analogue licensed. In the case of issuing a license to Indian pharmaceutical companies, Gilead also provided them with the production technology, giving license holders the right to an independent pricing policy. In order for an analogue of a medicinal product to be considered a generic, it must meet a number of parameters:

1. It is necessary to observe the ratio of the most important pharmaceutical components in the preparation in terms of qualitative as well as quantitative standards.

1. Compliance with the relevant international standards should be adhered to.

1. Mandatory observance of appropriate production conditions is required.

1. The preparations should maintain an appropriate equivalent of the absorption parameters.

It is worth noting that WHO is on guard for ensuring the availability of medicines, seeking to replace expensive branded medicines with the help of budget generics.

Egyptian generics of sofosbuvir

Unlike India, Egyptian pharmaceutical companies have not become world leaders in the production of hepatitis C generics, although they have also mastered the production of sofosbuvir analogues. True, for the most part, the analogues they produce are unlicensed:

• MPI Viropack, manufactures Marcyrl Pharmaceutical Industries, one of the very first Egyptian generics;

• Heterosofir is manufactured by Pharmed Healthcare. Is the only licensed generic in Egypt. On the packaging, under the hologram, there is a hidden code that allows you to check the originality of the drug on the manufacturer's website, thereby eliminating its fake;

• Grateziano, manufactured by Pharco Pharmaceuticals;

• Sofolanork, produced by Vimeo;

• Sofocivir manufactured by ZetaPhar.

Hepatitis Generics from Bangladesh

Bangladesh is another country with a large production of generic HCV drugs. Moreover, this country does not even require licenses for the production of analogues of branded medicines, since until 2030 its pharmaceutical companies are allowed to produce such medicines without the appropriate license documents. The most famous and equipped with the latest technology is the pharmaceutical company Beacon Pharmaceuticals Ltd. The design of its production facilities was created by European specialists and meets international standards. Beacon markets the following generics for the treatment of hepatitis C virus:

• Soforal is a generic sofosbuvir containing 400 mg of active ingredient. Unlike traditional packs in bottles of 28 pieces, Soforal is produced in the form of blisters of 8 tablets in one plate;
• Daclavir is a generic of daclatasvir, one tablet of the drug contains 60 mg of the active ingredient. It is also released in the form of blisters, but each plate contains 10 tablets;
• Sofosvel is a generic Epclusa containing sofosbuvir 400mg and velpatasvir 100mg. Pangenotypic (universal) drug, effective in the treatment of HCV genotypes 1 ÷ 6. And in this case, there is no usual packaging in vials, the tablets are packed in blisters of 6 pieces in each plate.
• Darvoni is a complex drug that combines sofosbuvir 400 mg and daclatasvir 60 mg. If it is necessary to combine sofosbuvir therapy with daklatasvir, using drugs from other manufacturers, it is necessary to take a tablet of each type. And Beacon combined them into one pill. Packed Darvoni in blisters of 6 tablets in one plate, sent only for export.

When buying drugs from Beacon based on a course of therapy, you should take into account the originality of their packaging in order to purchase the amount necessary for treatment. The most famous Indian pharmaceutical companies As mentioned above, after obtaining licenses for the production of generic drugs for HCV therapy by the country's pharmaceutical companies, India has become a world leader in their production. But among the many companies, it is worth noting a few whose products are most famous in Russia.

Natco Pharma Ltd.

The most popular pharmaceutical company is Natco Pharma Ltd., whose drugs have saved the lives of several tens of thousands of patients with chronic hepatitis C. It has mastered the production of almost the entire line of direct-acting antiviral drugs, including sofosbuvir with daclatasvir and ledipasvir with velpatasvir. Natco Pharma appeared in 1981 in the city of Hyderabad with an initial capital of 3.3 million rupees, then the number of employees was 20 people. Natco currently employs 3,500 people in India at five Natco enterprises, and there are still branches in other countries. In addition to production units, the company has well-equipped laboratories that allow developing modern medicines. Among her own developments, it is worth noting drugs to combat cancer. One of the most famous drugs in this area is Veenat, produced since 2003 and used for leukemia. Yes, and the release of generics for the treatment of hepatitis C virus is a priority for Natco.

Hetero Drugs Ltd.

This company has set as its goal the production of generics, subordinating its own production network to this desire, including factories with affiliates and offices with laboratories. The production network of Hetero is focused on the production of medicines under licenses received by the company. One of its areas of activity is medicines that allow you to fight serious viral diseases, the treatment of which for many patients has become impossible due to the high cost of original drugs. The acquired license allows Hetero to quickly start producing generics, which are then sold at an affordable price for patients. The creation of Hetero Drugs dates back to 1993. Over the past 24 years, a dozen factories and several dozen production units have appeared in India. The presence of its own laboratories allows the company to carry out experimental work on the synthesis of substances, which contributed to the expansion of the production base and the active export of drugs to foreign countries.

Zydus Heptiza

Zydus is an Indian company committed to building a healthy society, which, in the opinion of its owners, will be followed by a change in the quality of life for the better. The goal is noble, and therefore, to achieve it, the company conducts active educational activities that affect the poorest segments of the country's population. Including through free vaccination of the population against hepatitis B. Zidus is in fourth place in terms of output in the Indian pharmaceutical market. In addition, 16 of its drugs were included in the list of 300 essential medicines of the Indian pharmaceutical industry. Zydus products are in demand not only in the domestic market, they can be found in pharmacies in 43 countries of our planet. And the assortment of drugs produced at 7 enterprises exceeds 850 drugs. One of its most powerful productions is located in the state of Gujarat and is one of the largest not only in India, but also in Asia.

HCV Therapy 2017

Treatment regimens for hepatitis C for each patient are selected by the doctor individually. For the correct, effective and safe selection of the scheme, the doctor needs to know:

• virus genotype;
• the duration of the illness;
• the degree of liver damage;
• presence / absence of cirrhosis, concomitant infection (for example, HIV or other hepatitis), negative experience of previous treatment.

Having received this data after a cycle of tests, the doctor, based on the recommendations of EASL, chooses the best therapy option. The EASL recommendations are adjusted from year to year, new drugs are added to them. Before recommending new therapy options, they are submitted to Congress or a special meeting for consideration. In 2017, a special EASL meeting in Paris considered updates to the recommended schemes. The decision was made to completely discontinue the use of interferon therapy in the treatment of HCV in Europe. In addition, there is not a single recommended regimen using a single direct-acting drug. Here are some recommended treatment options. All of them are given for informational purposes only and cannot become a guide to action, since only a doctor can prescribe therapy, under whose supervision it will then take place.

1. Possible treatment regimens proposed by EASL in the case of hepatitis C monoinfection or co-infection with HIV + HCV in patients without cirrhosis and not previously treated:

• for treatment genotypes 1a and 1b can be used:

- sofosbuvir + ledipasvir, without ribavirin, duration 12 weeks; - sofosbuvir + daclatasvir, also without ribavirin, treatment period 12 weeks; - or sofosbuvir + velpatasvir without ribavirin, course duration 12 weeks.

• in therapy genotype 2 used without ribavirin for 12 weeks:

- sofosbuvir + dklatasvir; - or sofosbuvir + velpatasvir.

• during treatment genotype 3 without the use of ribavirin for a period of therapy of 12 weeks, use:

- sofosbuvir + daclatasvir; - or sofosbuvir + velpatasvir.

• in therapy genotype 4 you can use without ribavirin for 12 weeks:

sofosbuvir + ledipasvir; - sofosbuvir + daclatasvir; - or sofosbuvir + velpatasvir.

1. EASL recommended treatment regimens for hepatitis C monoinfection or co-infection with HIV/HCV in previously untreated patients with compensated cirrhosis:

• for treatment genotypes 1a and 1b can be used:

— sofosbuvir + ledipasvir with ribavirin, duration 12 weeks; - or 24 weeks without ribavirin; - and another option - 24 weeks with ribavirin with an unfavorable response prognosis; — sofosbuvir + daclatasvir, if without ribavirin, then 24 weeks, and with ribavirin, the treatment period is 12 weeks; - or sofosbuvir + velpatasvir without ribavirin, 12 weeks.

• in therapy genotype 2 apply:

— sofosbuvir + dklatasvir without ribavirin, the duration is 12 weeks, and with ribavirin, with an unfavorable prognosis, 24 weeks; - or sofosbuvir + velpatasvir without combination with ribavirin for 12 weeks.

• during treatment genotype 3 use:

- sofosbuvir + daclatasvir for 24 weeks with ribavirin; - or sofosbuvir + velpatasvir again with ribavirin, the treatment period is 12 weeks; - as an option, sofosbuvir + velpatasvir is possible for 24 weeks, but already without ribavirin.

• in therapy genotype 4 apply the same schemes as for genotypes 1a and 1b.

As you can see, the result of therapy is influenced, in addition to the patient's condition and the characteristics of his body, also by the combination of prescribed drugs chosen by the doctor. In addition, the duration of treatment depends on the combination chosen by the physician.

Treatment with modern HCV drugs

Take tablets of drugs of direct antiviral action as prescribed by a doctor orally once a day. They are not divided into parts, they are not chewed, but they are washed down with plain water. It is best to do this at the same time, so that a constant concentration of active substances in the body is maintained. It is not required to be tied to the timing of food intake, the main thing is not to do it on an empty stomach. Starting to take drugs, pay attention to how you feel, since during this period it is easiest to notice possible side effects. The DAAs themselves do not have a lot of them, but the drugs prescribed in the complex have much less. The most common side effects are:

• headaches;
• vomiting and dizziness;
• general weakness;
• loss of appetite;
• pain in the joints;
• a change in the biochemical parameters of the blood, expressed in a low level of hemoglobin, a decrease in platelets and lymphocytes.

Side effects are possible in a small number of patients. But all the same, all noticed ailments should be reported to the attending physician so that he can take the necessary measures. In order to avoid an increase in side effects, alcohol and nicotine should be excluded from consumption, as they have a harmful effect on the liver.

Contraindications

In some cases, taking DAAs is excluded, this applies to:

• individual hypersensitivity of patients to certain ingredients of medicines;

• patients under the age of 18, as there is no accurate data on their effects on the body;

• women who are pregnant and breastfeeding babies;

• women should use reliable methods of contraception to avoid conception during the period of therapy. Moreover, this requirement also applies to women whose partners are also undergoing DAA therapy.

Storage

Store antiviral drugs of direct action in places inaccessible to children and direct sunlight. The storage temperature should be in the range of 15 ÷ 30ºС. When you start taking medications, check their manufacturing and shelf life indicated on the package. Expired drugs should not be taken. How to buy DAAs for residents of Russia Unfortunately, it will not be possible to find Indian generics in Russian pharmacies. The pharmaceutical company Gilead, having granted licenses for the production of drugs, prudently banned their export to many countries. Including all European countries. Those who wish to purchase budget Indian generics for the fight against hepatitis C can use several ways:

• order them through Russian online pharmacies and receive the goods in a few hours (or days) depending on the place of delivery. Moreover, in most cases, even an advance payment is not required;
• order them through Indian online stores with home delivery. Here you will need an advance payment in foreign currency, and the waiting time will last from three weeks to a month. Plus, the need to communicate with the seller in English will be added;
• go to India and bring the drug yourself. This will also take time, plus the language barrier, plus the difficulty of verifying the originality of the goods purchased at the pharmacy. To everything else, the problem of self-exportation will be added, requiring a thermal container, a doctor's report and a prescription in English, as well as a copy of the receipt.

People interested in purchasing medicines decide for themselves which of the possible delivery options to choose. Just do not forget that in the case of HCV, a favorable outcome of therapy depends on the speed of its initiation. Here, in the literal sense, the delay of death is similar, and therefore you should not delay the beginning of the procedure.

The most interesting:

CHEAP DRUGS FOR HEPATITIS C

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