Chronic hepatitis: symptoms, treatment. Treatment of an acute form of the disease. Treatment of chronic hepatitis B

According to statistics from the World Health Organization, chronic hepatitis In the near future may become a threat to the lives of the population in most developed countries. According to WHO data, about 700 thousand people die every year on the planet, and the cause of such deaths is not only hepatitis B, but also chronic hepatitis C.

general information

The causative agent is the hepatitis B virus, which contains a DNA code, sometimes referred to as HBV, HBV, or HBV. The characteristic of the virus is its resistance to external stimuli, chemicals, low and high temperatures, the effect of acid. Healthy man is able to catch the virus from a patient with any form of the disease: acute or chronic, or simply from a carrier of the virus. Infection occurs through the blood with wounds, is transmitted from mother to child during childbirth, through damaged mucous membranes. After the virus enters the body, it does not manifest itself immediately. This period of time from infection to the manifestation of the disease is called the incubation period and for hepatitis B it lasts 30-90 days.

Forms of chronic hepatitis B

After a while after infection, the first symptoms appear. The disease lasts about 2 months and ends either with a complete cure or with a transition acute form hepatitis into chronic, which is considered the most dangerous. The chronic form can proceed imperceptibly for the body and the person, do not affect the work internal organs, but most often the destruction of the liver continues to progress. There are several forms chronic virus GV, which differ in the cause of the onset of the disease.

Causes of chronic hepatitis and risk factors

The main ways of transmission of hepatitis are reduced to one - through the blood. But there are other reasons for the development of chronic hepatitis B:

• Sexually. Therefore, the risk group includes mainly those who lead a dysfunctional lifestyle.
• Another method of transmission is through a non-sterile needle. Hepatitis B is a fairly common occurrence among drug addicts.
• Transmission from mother to child during childbirth.
• Shared hygiene items with the patient.
• Work related to patients with hepatitis.
• Non-sterile instruments in tattoo parlors, nail parlors, hospitals.

The main risk factors for contracting the virus are:

• HIV/AIDS disease;
• hemodialysis;
• frequent change of sexual partners;
• homosexuality;
• stay in a disadvantaged region where the risk of infection is high (for example, at work or on a business trip).

Symptoms of the disease

Due to the long incubation period, the disease does not show any symptoms and therefore some do not even realize that they need to be treated. Symptoms of chronic hepatitis are initially mild:

• fast fatiguability;
• increase in body temperature;
• pain in the right hypochondrium (rare);
• stomach pain, nausea, diarrhea;
• aches in muscles and bones;

When the disease passes into an advanced stage, the patient develops jaundice, weight decreases sharply, muscles atrophy. Urine acquires dark color, blood clotting worsens, bleeding gums appear, depression, the patient loses interest in life, what is happening, intellectual abilities (thinking, memory, attention) deteriorate critically, sometimes it even reaches coma. It is terrible that the first symptoms of the disease sometimes appear already at an advanced stage.

The presence of hepatitis is indicated by special markers in the blood, so it is imperative to undergo routine medical examinations and take a blood test.

Features of the disease in children and pregnant women

Such a formulation of the diagnosis as chronic viral hepatitis B should not cause concern for women in the position or those who want to become a mother. Only an acute form of hepatitis can provoke a miscarriage during pregnancy. If markers of chronic hepatitis are found in the blood of a pregnant woman, doctors can simply prescribe maintenance medications - hepatoprotectors, and the woman can safely give birth. In the first 12 hours of life, the child will be vaccinated with a hepatitis vaccine, and all subsequent ones will be done according to the plan in the children's clinic.

The peculiarity of the course of the disease in children is that they become infected only from the mother and the outcome is the same - complete cure, but very rarely the disease progresses to chronic stage. If a child had hepatitis in childhood, then antibodies and immunity to this disease are formed in his blood. In addition to the transition to another stage, cirrhosis is also considered a complication of hepatitis. To avoid unpleasant consequences, you need to constantly pass scheduled inspection at the pediatrician and get vaccinated, because only they can give 90% protection against the likelihood of getting sick - for 15 years.

Diagnostics

If the ailments complained of by the patient cause doubts in the doctor, then for exact definition disease, he will be prescribed a blood test to identify markers of the disease. After that, the patient will be assigned an ultrasound of the liver to determine its condition and extent of damage. A biopsy may be performed to determine the degree of virus activity. Differential Diagnosis chronic hepatitis is necessary in order to distinguish it from other serious illnesses liver and other body systems.

Treatment of the disease

Hepatitis is curable, but only if you see a doctor and follow his instructions. It is important to remember that hepatitis is not a death sentence. AT severe cases diseases of patients are treated at a day hospital in the infectious diseases department. The main goal of therapy is to stop the reproduction of the virus, then its reactivation will be practically impossible. In addition, the treatment is aimed at removing toxins from the body, restoring the affected organs and complications on other organs.

Medications

Treatment of chronic hepatitis B is based on several groups of drugs:

• Interferon drugs. Interferons are proteins secreted by the body when viruses enter it. In the treatment, "Peginterferon alfa-2a" is used. It is administered as injections to patients with good liver condition.
• Mandatory application antiviral drugs- nucleoside reverse transcriptase inhibitors. Often they are used if the previous one was ineffective. This category includes such drugs: Adenofir, Lamivudine, Tenofovir, Entecavir, etc.

Diet in the treatment of hepatitis

Proper nutrition in hepatitis is an important component Get well soon. Doctors insist that patients adhere to diet table No. 5. You need to reduce the amount of fat in the diet; dishes are only boiled and baked, sometimes stewed; the use of cold dishes is prohibited; Limiting the amount of salt consumed is essential. The diet will help to properly plan the diet and make sure that the body gets the maximum amount of useful substances that speed up recovery.

Meals should be divided into 4-5 per day, but eat in small portions. Exclude semi-finished meat products from the diet, that is, sausages, rolls, sausages, and it is better to replace them with low-fat varieties of poultry - turkey, chicken. The same with fish - you can only eat lean varieties. Dairy products are allowed, but only fat-free. Greens should be included in the diet irreplaceable source vitamins. It is worth excluding only green onions, radishes and garlic, because they increase the formation of bile (contraindicated in patients with KSD - urolithiasis). You need to use vitamins, they have a positive effect on the body and help with transmission nutrients on the body.

Hepatitis- inflammatory disease of the liver, which can occur acutely or chronically.

Classification of hepatitis

Classification of hepatitis is made according to the type of virus, the depth of the lesion and other signs. Viral hepatitis A, B, C, D, E, F is isolated. The disease can be acute or go into chronic form. Liver damage in this case is focal or diffuse. The severity of the disease is classified as mild, moderate and severe. In the development of the disease, incubation, preicteric, icteric, posticteric and recovery periods are distinguished.

Hepatitis symptoms

This disease is usually manifested by symptoms characteristic of the flu: fatigue, headache, loss of appetite, nausea or vomiting, fever up to 38.8 C. If the condition worsens, jaundice may appear (the skin, as well as the whites of the eyes become yellow), urine Brown color, colorless feces, pain and tightness under the ribs on the right. But sometimes there are cases when the disease is asymptomatic.

Acute hepatitis. Causes acute hepatitis are viruses (for example, viruses of hepatitis A, B, hepatitis "neither A nor B"), pathogens inf. diseases (leptospirosis, salmonellosis, typhoid fever, malaria, brucellosis, etc.), chemicals (trinitrotoluene, carbon tetrachloride, etc.), insecticides and metals (lead, phosphorus, arsenic, beryllium, mercury compounds), drugs (some psychotropic drugs, antibiotics, sulfonamides, etc.), poisons plant origin such as mushroom poisons.

The course of acute hepatitis is usually cyclic. The disease lasts from several weeks to several months. The clinical picture of acute hepatitis is often characterized by symptoms such as fever, pain in the right hypochondrium, dyspepsia, jaundice, enlarged liver, and in some cases spleen. In cases severe course acute hepatitis can be complicated by edema, ascites, hemorrhages, hepatorenal syndrome; in acute hepatitis caused by chemicals and poisons (for example, mushroom poisons), neurological disorders are often observed.

AT clinical practice produce acute alcoholic hepatitis, which manifests itself general malaise, weakness, fever, abdominal pain, dyspepsia, anorexia, nausea, vomiting, bitterness in the mouth. This form of hepatitis can be severe. Jaundice, symptoms liver failure, the liver is enlarged and painful, the spleen may be enlarged; in the blood - leukocytosis, hyperbilirubinemia, cholesterolemia, an increase in the content alkaline phosphatase. In some cases, the disease is asymptomatic, jaundice is absent. Acute alcoholic hepatitis can be combined with fatty hepatosis, chronic alcoholic hepatitis, cirrhosis of the liver, i.e., with disorders also caused by the action of alcohol. Sometimes the disease can occur with cholestatic syndrome, which is characterized by itching of the skin, as well as an increase in the activity of alkaline phosphatase and the content of cholesterol and phospholipids in the blood.

chronic hepatitis. If a pathological process in the liver continues without improvement for at least 6 months, the disease qualifies as chronic hepatitis. Allocate chronic persistent (low-active, benign), chronic active and chronic cholestatic hepatitis.

In chronic persistent hepatitis, in some cases, there is a decrease in appetite, dyspepsia, a feeling of heaviness and pressure in the right hypochondrium. The main objective symptom is an increase in the size of the liver and its moderate compaction. As a rule, indicators are changed functional tests liver: there is a slight increase in the activity of alanine aminotransferase in the blood, low hyperbilirubinemia, mainly due to an increase in the content of the associated pigment fraction; less often, a slight decrease in the content of albumin and an increase in y-globulin in the blood.

In chronic active hepatitis, weakness, fatigue, intolerance to some food products(for example, fat), dyspepsia, nosebleeds, jaundice, fever, sometimes skin itching, spider veins on the skin may occur, erythema is characteristic. The liver and spleen are enlarged. special clinical form chronic active hepatitis is lupoid hepatitis characterized by malignant course, expressed immune and autoimmune disorders. The disease is characterized by various non-specific manifestations: fever, furunculosis, lymphadenopathy, arthralgia, vasculitis, serositis, abdominal pain, glomerulonephritis, as well as a variety of hormonal abnormalities.

Chronic cholestatic hepatitis is characterized by jaundice (half of the patients have bright jaundice) and excruciating itching of the skin, which often precedes jaundice; generalized hyperpigmentation and xanthelasmas are noted on the skin - soft nodular formations.

Hepatitis treatment

13. A decoction of herb St. John's wort perforatum. Pour one tablespoon of grass with a glass of boiling water, boil for 15 minutes, strain. Drink 1/4 cup 3 times a day. Choleretic and anti-inflammatory agent.

14. In case of inflammation of the liver, take 25 g of golden immortelle and 25 g of tripoli per 2 liters of cold boiled water, soar up to 1 liter and take 50 ml 3 times a day one hour before meals. The course of treatment is 1 month.

15. Rose hips - 3 parts, corn silk- 3 parts, horsetail shoots - 3 parts, sandy immortelle flowers - 4 parts, white rose petals - 2 parts, wild strawberry fruits - 2 parts, chamomile flowers - 2 parts, white birch leaf - 1 part, common juniper fruits - 1 part, grass cudweed forest - 1 part, underground part of calendula officinalis - 1 part.

One tablespoon of the mixture (crushed) brew 0.5 liters of boiling water, simmer for 30 minutes, strain. Drink 150 ml 3 times a day 10-15 minutes before meals. It is used for diseases of the liver, gallbladder.

16. Infusion of St. John's wort. One tablespoon of grass pour 1.5 cups of boiling water. Drink 1/3 cup 3 times a day 30 minutes before meals.

17. In chronic hepatitis nice results gives a mixture of stalked moss with patrinia. Mix 100 g of patrinia roots and 100 g of moss grass. Brew one tablespoon of the mixture with 1 cup of boiling water, sweeten and, after insisting, drink it warm 30 minutes before meals and after it every 1.5-2 hours. The tool is very effective, especially in liver disease in children.

18. Rhizomes of couch grass - 20 g, nettle leaves - 10 g, rose hips - 20 g. Brew one tablespoon of the mixture in a glass of boiling water, leave for an hour. Drink 1 glass 2-3 times a day.

19. Horsetail herb - 25 g, St. John's wort herb - 25 g, common chicory root - 25 g, common yarrow herb - 25 g. Pour one tablespoon of the mixture with 1 glass of water, steam for 20 minutes, then boil for 10-15 minutes, strain. Drink 1 glass during the day.

20. For diseases of the liver and biliary tract, take the following mixture: honey, lemon juice and some olive oil. After taking it is necessary to lie on the right side for 25-30 minutes.

21. A mixture of 1 tablespoon honey and 1 teaspoon pollen also helps. Take twice a day, after breakfast and lunch.

22. With cirrhosis of the liver and chronic hepatitis, it is recommended to take 30-50 g of honey in the morning and evening with the addition of 1 spoon (like a spoon for mustard) royal jelly.

23. Mix 1 kg of honey with 1 kg of blackcurrant. Take 1 teaspoon 30 minutes before meals. Continue until the end of the mixture.

24. With medical and preventive purpose for liver diseases, honey is recommended to be used in the morning (30-50 g) with the addition of royal jelly (one spoon for mustard), and in the afternoon - a tablespoon of honey with one teaspoon of bee bread. A mixture of one spoonful of honey with apple juice, take in the morning and evening.

25. Calamus marsh. For hepatitis, an infusion of rhizomes is used, which is prepared as follows: pour a teaspoon of crushed raw materials with a glass of boiling water, leave for 20 minutes, strain. Drink 4 times a day for 1/2 cup 30 minutes before meals.

Prevention of hepatitis

1. Hepatitis A

Wash your hands thoroughly with soap and running water after using the toilet, changing baby diapers, and before preparing and eating food. This is the most important measure in preventing hepatitis A infection. If you are traveling to areas where hepatitis A is common and there is no sanitation, boil water, peel vegetables and fruits before drinking. Teach your children to wash their hands. Change baby diapers on surfaces that can be easily washed and disinfected (for example, 1 tablespoon of household bleach per liter of water). Never change diapers at tables where you eat or prepare food. You need to be careful when cooking shellfish, especially if you already have a chronic form of liver disease. Drink water only from approved sources.

Tell your doctor if someone in your family has hepatitis A. In some cases, the doctor may give immunoglobulin injections to family members.
Get vaccinated if you are in the zone high risk infected or plan to travel to a country with a high prevalence of hepatitis A.

2. Hepatitis B and C

Practice safe sex. Don't do drugs. Don't share your chewing gum. Do not contact open wounds, cuts, burns and the blood of an infected person. Use only your razor, toothbrush, nail scissors. Get vaccinated against hepatitis B, if you are at risk, consult your doctor. Many doctors believe that everyone should be vaccinated against hepatitis B. Children are now routinely vaccinated. At risk are healthcare workers, dental technicians, active monogamous couples, drug addicts, people with human immunodeficiency virus, and people who regularly undergo dialysis.

This disease is associated with inflammation of the liver. The consequences of chronic hepatitis disease depend on the degree and activity of the lesion of the main “body filter”, which is not always indicated by symptoms and signs. The terrible consequences of the disease are cirrhosis of the liver and the development of tumors. This can be avoided by finding out the causes, varieties and methods of treatment.

What is chronic hepatitis

The disease is characterized by the presence of diffuse inflammatory diseases in the liver (body filter) for a period of 6 months or more. Often this is asymptomatic, so a person may not be aware of the presence of damage to the hepatocytes of the parenchyma. If this is not diagnosed in time, liver cells are replaced by connective tissue. Cirrhosis appears, acute oncological, biliary disorders develop. Not all varieties of the disease develop into a chronic stage, for example, type A. Infectious variations B and C can become so.

The reasons

If an improper method is used to treat reactive hepatitis B, C, D, G, the disease becomes chronic. Type A is usually treated in a few weeks, the body develops strong immunity for the rest of its life. It is also called Botkin's disease - jaundice. The main danger is fraught with type C (80%). In addition, the disease develops due to such factors:

• metabolic disease;
• autoimmune hepatitis - is inherited, failures in protective processes;
• toxic - on the body long time affect harmful substances: alcohol, medications(tetracyclines, narcotics, anti-tuberculosis, sedatives), salt, benzenes, heavy metals, radioactive elements.

Classification

The three main types of liver damage are A, B, C. The first is common, at first it looks like the flu. After 2-4 days, the feces become colorless, and the urine, on the contrary, darkens. Prevention - Compliance hygiene standards. Variant E is similar to A, but the severe form affects the liver and kidneys. Type F has been little studied. At viral etiology hepatitis D, acute extrahepatic symptoms are observed: damage to the lungs, kidneys, joints, muscles. Type G is similar to C, but does not lead to cancer, cirrhosis. The acute form affects the body quickly. Classification of chronic hepatitis:

• cryptogenic - triggering mechanisms have not been studied;
• chronic persistent (inactive) - develops with drug, alcohol and toxic liver damage;
• lobular - a variant of the first with the localization of pathologies in the hepatic lobules;
• aggressive hepatitis (chronic active) - characterized by necrosis, there is a tendency to develop cirrhosis, occurs due to hepatitis B viruses, rarely C, may have a drug-induced, chronic alcohol etiology (nature of origin).

Diagnostics

To identify the pathogenesis chronic disease the doctor conducts an initial examination. An infected person has a small punctate rash, yellowish skin color, crimson tongue, red palms, spider veins. Along with the examination, palpation is performed in the area of ​​the spleen, liver: if they are enlarged, they will discomfort when pressed. Then an ultrasound of these organs is prescribed to establish the heterogeneity of their structure. Diagnosis of chronic hepatitis includes in some cases:

• a liver biopsy to determine the type of disease, whether there is cirrhosis / fibrosis or not;
• general analysis blood, which confirms the presence inflammatory processes;
• laboratory serological examination- detects certain markers of viral antigens;
• biochemical analysis blood - determines the level of bilirubin, liver enzymes, due to which the skin changes color;
• immunological examination - detection of antibodies to liver cells.

Symptoms of chronic hepatitis

These are complaints of bitterness in the mouth with cholestasis, bowel disorders, headaches, bleeding with hematomas, a feeling of weakness, fatigue. Feeling heaviness, discomfort in the liver area - under the right hypochondrium. It's a dull pain aggravated after eating fried food, fatty foods. Perhaps the development of asthenovegetative syndrome - a decrease in mental concentration, performance, drowsiness. Clinical manifestations sometimes include a decrease in body weight due to metabolic disorders, cholestatic syndrome.

Treatment of chronic hepatitis

Therapy is developed taking into account the individual characteristics of each patient. Medical complex determined by the degree of activity of the disease, the causes of occurrence. Drug therapy is complemented special diet, driving mode. Interferon preparations are used to suppress chronic viral hepatitis C. The liver is protected by hepatoprotectors that restore tissue structure in combination with vitamins and antioxidants, and relieve immune inflammation. The goal is remission of the disease (weakening).

Hepatitis B

It is also called the serum type. Infection occurs through the blood seminal fluid during intercourse, during labor activity. Immunostimulants are prescribed (for example, Timalin, Methyluracil), vitamins of groups B and C, folic, a nicotinic acid. The liver is restored by anabolic, corticosteroid hormones. The treatment of chronic hepatitis of this type is supplemented with drugs to protect the liver. After discharge from the hospital, you need to undergo an annual recovery in a sanatorium, and follow diets all your life.

Hepatitis C

After analyzing the degree of liver damage, the stage of cirrhosis, cancer, evaluation concomitant diseases an individual course of long-term therapy is prescribed. In modern practice, interferon and Ribavirin are used, which are effective against all genotypes of the disease. The main problem of a patient with HCV infection (type C) is poor tolerance drugs, their high cost.

Active

Treatment should begin after full verification of the correctness of the diagnosis of the chronic form. After waiting 3-6 months, histological control is repeated. The main elements of therapy are immunosuppressants and corticosteroids. If treatment is interrupted before the elimination of all clinical symptoms, a relapse with an exacerbation of the disease is possible. Therapy should be carried out under the strict supervision of a physician.

persistent

Chronic viral hepatitis with a minimal degree of activity is treated by reducing physical and nervous loads. Provided healthy sleep, calm environment, good food. With a favorable course of the disease, a special medical care need not. Antiviral and immunomodulatory drugs are used. Dispensary is necessary preventive measure.

Prevention of chronic hepatitis

Replication does not occur in the airborne and household way, so the carriers of the disease viruses do not pose a danger. For protection, it is important to use barrier contraception, do not take other people's hygiene items. Emergency prevention type B - the use of human immunoglobulin, vaccines. Drug lesions and autoimmune forms are curable, and viral chronic hepatitis transforms into cirrhosis. Eliminating alcohol from the diet will help to avoid alcohol lesions.

Video

Treatment of chronic viral hepatitis B is aimed at suppressing contagiousness, destroying the virus, preventing the development of cirrhosis of the liver and, possibly, hepatocellular carcinoma. No method of treatment relieves the patient of the virus, however, successful antiviral therapy can reduce the severity of the process and the resulting necrosis of hepatocytes.

Interferon-a

Consideration should be given to the use of interferon-a(IFN-a), both lymphoblastoid and recombinant. Interferon improves the expression of HLA class I proteins and can increase the activity of interleukin-2 (IL-2) and thus destroy the affected hepatocytes.

Interferon in the treatment of HBeAg-positive patients: a meta-analysis (15 studies)

Interferon-a is used only in patients with replicating HBV, which is determined by positive tests on HBeAg and HBV-DNA and, if necessary, HBeAg in hepatocytes.

According to the scheme adopted in the USA, 5 million IU daily or 10 million IU are administered subcutaneously 3 times a week for 16 weeks. These doses are higher than those accepted in Europe and cause many side effects, and therefore the frequency of treatment interruption is high. An increase in the duration of treatment or the use of higher doses of the drug does not affect the effectiveness of treatment.

Early systemic side effects are usually transient, occur within the 1st week of treatment 4-8 hours after injection and are stopped by paracetamol. Late complications in the form mental disorders, especially against the backdrop of the already existing mental illness are indications for discontinuation of interferon treatment. The presence of a history of mental disorders is a contraindication to the appointment of interferon. Autoimmune changes develop 4-6 months after the start of treatment and include the appearance of antinuclear, antimitochondrial and antithyroid antibodies. The presence of antibodies to microsomes thyroid gland before treatment is a contraindication to the appointment of interferon. It is also possible to develop bacterial infection especially in cirrhosis of the liver.

A positive response is characterized by the disappearance of HBeAg and HBV-DNA and a transient increase in serum transaminase activity around the 8th week, which is due to the lysis of infected hepatocytes. Liver biopsy reveals a decrease in inflammation and hepatocellular necrosis. Replicative forms of HBV disappear from the liver. Anti-HBe appear after about 6 months. HBsAg disappears in only 5-10%, usually when treatment is started in the earliest stages of the disease. Elimination of HBsAg can be delayed for many months.

side effects of interferon

• flu-like syndrome
• Myalgias, usually transient
• Headache
• Nausea

Late

• Weakness
• Myalgia
• Irritability
• Anxiety and depression
• Weight loss
• Diarrhea
• Alopecia
• Myelosuppression
• Bacterial infections
• The emergence of autoimmune antibodies
• Optic neuropathy
• Exacerbation of lichen planus

Treatment with interferon is undoubtedly effective. In a meta-analysis of 15 interferon controlled trials, HBeAg-positive patients are 4 times more likely to lose HBsAg and 3 times more likely to lose HBeAg than controls.

Patients with decompensated cirrhosis suffer from side effects, especially infections, which serve as a reason for stopping interferon treatment or reducing the dose. In Child A group, even low doses (eg, 1 million IU 3 times a week) of fractionated interferon-a can be effective, but in groups B or C, the results of treatment are poor and there are many side effects.

The effectiveness of treatment with interferon-a was expressed in a long-term remission of liver disease in 8 out of 15 patients with chronic HBV infection and glomerulonephritis. Improvement is usually noted during the course of kidney disease.

These results are obtained in white adult patients with good general condition and compensated liver disease. Less favorable results were obtained in patients of Chinese origin, among whom exacerbations after remission achieved with interferon are observed in 25%, and HBV-DNA ceases to be detected only in 17% of patients in whom HBeAg disappears.

Interferon may be effective in children. A total dose of 7.5 million units/m 2 administered 3 times a week for 6 months led to the development of HBeAg seroconversion to anti-HBe in 30%.

Low success rate coupled with high cost of treatment and side effects complicate the selection of patients for treatment with interferon. It is shown medical workers(surgeons, dentists, nurses, medical students, laboratory assistants) and persons who frequently change their sexual partner. The greatest effectiveness of treatment is observed in people who have had acute viral hepatitis, who have high ALT activity and low level viremia.

Nucleoside analogs

The efficacy of nucleoside analogues in the treatment of chronic HBV infection is currently being investigated. Adenine arabinoside 5-monophosphate (ARA-AMP) is a synthetic purine nucleoside with antiviral activity against HBV. Early observations confirmed this effect, but further studies were not conducted due to neurotoxicity (myalgia, peripheral neuropathy) noted throughout the treatment. Recent studies have shown that as a result of treatment with ARA-AMP in 37% of patients with chronic HBV infection, HBV-DNA disappears in the blood, but a complete and stable response is achieved only with a low level of HBV replication. Myalgia was the reason for discontinuation of treatment in 47% of patients.

Nucleoside analogues have no intrinsic activity against HBV and are activated by enzymes present in cells. These enzymes are highly specific for each host species (human or animal), each cell type and each stage. cell cycle. This makes it difficult to compare data. experimental studies carried out, for example, on a cell culture of animals infected with hepadnaviruses, with data obtained from human examinations. Species characteristics can also cause differences in the toxicity of these compounds.

New oral nucleoside analogues include fialuridine, lamivudine, and famciclovir. The toxicity profile is determined by their affinity for mitochondrial and nuclear DNA. If affinity for nuclear DNA predominates, then toxicity appears within a few weeks. However, if affinity for mitochondrial DNA prevails, symptoms toxic action appear only after a few months from the start of treatment. This can be explained by a large functional reserve of mitochondria and a significant number of DNA copies per mitochondria. Severe manifestations toxic syndrome include myopathy, neuropathy, pancreatitis, liver dysfunction and lactic acidosis.

In a preliminary study, good results of treatment with fialuridin with significant decline HBV-DNA level. However, the long-term study was justifiably suspended due to the development of severe mitochondrial toxicity and death in volunteers.

Lamivudine inhibits reverse transcriptase required for transcription of the HBV-RNA pregenome into HBV-DNA. Treatment at doses of 100-300 mg/day for 12 weeks gives encouraging results. HBV DNA disappears. Controlled studies are currently ongoing. Particular attention should be paid to possible mitochondrial toxicity. Cancellation of the drug may be accompanied by an exacerbation of hepatitis.

Lamivudine and famciclovir have been used to prevent reinfection after transplantation in HBV-DNA-positive cirrhotic patients.

Corticosteroids

Corticosteroids enhance viral replication, and after their withdrawal, an “immune rebound” is noted in the form of a drop in the concentration of HBV-DNA. After corticosteroids, a full course of treatment with interferon is prescribed. But it is not prescribed for seriously ill patients, since an increase in the immune response can lead to hepatocellular insufficiency. Moreover, a controlled trial comparing interferon monotherapy with prednisone followed by interferon showed no benefit. combination therapy. However, in patients with initial serum transaminase activity less than 100 IU/l, the addition of prednisolone to treatment improved its results.

HBV mutations

Specific mutations in the core protein prevent T cells from performing their function in advanced chronic HBV infection and may reduce the effectiveness of interferon treatment. These mutations develop over the course of the disease and affect the immune recognition capacity of the host. Data from some studies on the association of mutations with a poor response to interferon are contradictory and not confirmed in other studies. The appearance of pro-core mutants during therapy usually portends failure in attempts to get rid of the virus, but changes in the core region do not affect the overall outcome of the disease. Pre-core mutants can cause severe relapses of HBV infection after liver transplantation.

Factors determining the response of patients with chronic hepatitis B to antiviral therapy

• Favorable
  • Female
  • Heterosexuality
  • Treatment adherence
  • Short duration of infection
  • High activity of serum transaminases
  • Presence of histological signs of activity
  • Low HBV DNA
• Adverse
  • Homosexuality
  • HIV infection
  • Long-term infection
  • Eastern origin

When followed for 3-7 years for 23 patients who responded to treatment with interferon, an exacerbation was detected in 3, while 20 remained HBeAg-negative and asymptomatic, and 13 became HBsAg-negative.

HBeAg- and HBV DNA negative patients

These patients are characterized by older age and a later stage of liver disease. specific treatment there are no patients for this category, it is mostly symptomatic and includes the whole complex known means. Ursodeoxycholic acid is a safe, non-toxic hydrophilic bile acid that reduces the effects of toxic bile acids lingering in patients with hepatocellular damage. In a daily dose of 500 mg, it reduces the activity of serum transaminases in patients with chronic hepatitis. In some cases, anti-HBe is detected, but in the presence of HBV-DNA in the serum.

Screening of patients for hepatocellular carcinoma

HBsAg-positive patients with chronic hepatitis or cirrhosis, especially men over 45 years of age, should be regularly screened for early detection hepatocellular carcinoma, when liver resection is possible. The study of serum a-fetoprotein and ultrasound procedure carried out at 6-month intervals

Chronic hepatitis C is a viral inflammatory liver disease caused by a blood-borne virus. According to statistics, in 75-85% of cases it becomes chronic, and it is infection with the C virus that occupies a leading position in terms of the number of development severe complications. This disease is especially dangerous because for six months or several years it can be completely asymptomatic, and its presence can only be detected by performing complex clinical blood tests. Subsequently, the disease may lead to the development or.

In this article, we will introduce you to the causes, manifestations, methods of diagnosis and treatment of chronic hepatitis C. This information will help you understand the essence of this dangerous disease and you will be able to make the right decision about the need for treatment from a specialist.

It is known that in different countries In the world, about 500 million cases of hepatitis C infection have been identified. In developed countries, the incidence rate is about 2%. About 5 million infected have been identified in Russia. Unfortunately, these figures are increasing every year, and the risk of infection is especially high among drug addicts using drugs for intravenous administration.

Experts are concerned about the rate of spread of this infection and suggest that in 10 years the number of patients with complications of this dangerous disease may increase several times. According to their calculations, now cirrhosis of the liver is detected in approximately 55% of patients, and liver cancer in 70%. Subsequently, these figures may increase, and the number of deaths will increase by 2 times. The World Health Organization pays close attention to the study of this dangerous disease and conducts regular research related to hepatitis C. All the data obtained is constantly shared with the public to help fight this disease.

How dangerous is this disease

Because of the severity of its complications, chronic hepatitis C is often called a gentle killer, and in this regard, many people ask the question: "How many years can you live with such a disease?" The answer to it cannot be unambiguous.

The virus itself, which provokes this disease, is not a direct cause of death. However, later this disease leads to the development of severe and irreversible complications that can lead to disability and death of the patient.

According to experts, men are most susceptible to this disease, they develop complications several times more often than women. In addition, doctors' observations show that patients with chronic hepatitis C can live for many years if they receive adequate supportive treatment.

Simultaneously with this fact, experts note that in some patients life-threatening complications develop during short term(10-15 years) after infection. Of no small importance in matters of treatment effectiveness and prognosis is the patient's lifestyle - non-compliance with doctor's recommendations and alcohol consumption significantly increase the risk of death.

The reasons

Chronic hepatitis C is caused by infection with the hepatitis C virus (or HCV infection). The source of infection is a sick person suffering from various forms of this disease. The causative agent is found in the blood and other body fluids (sperm, urine, etc.).

When infected, the hepatitis C virus enters the bloodstream. Ways of infection can be as follows:

• non-observance of sanitary and hygienic standards during invasive medical manipulations or cosmetic procedures(injection, dental and surgical interventions etc.);
• transfusion of donor blood not tested for this infection;
• unprotected sex;
• visits to salons that perform manicures, piercings or tattoos in unsanitary conditions;
• use of other people's personal hygiene products (razors, manicure devices, toothbrushes, etc.);
• use of one syringe by persons suffering from drug dependence;
• from mother to child (in rare cases: when the child comes into contact with the mother's blood when passing through birth canal or if the integrity of the placenta was compromised during pregnancy).

The hepatitis C virus cannot be transmitted through normal household contact, through saliva, shared utensils, or hugging or shaking hands. Infection is possible only when the pathogen enters the bloodstream.

The causative agent of hepatitis C has genetic variability and is capable of mutations. Specialists managed to identify 6 main types and over 40 subtypes of HCV infection. These properties of the virus lead to the fact that it very often manages to "mislead" the immune system. Subsequently, such its variability leads to the transition of this disease into a chronic form.

In addition, acute hepatitis C is often not diagnosed, since it occurs in a latent form and can only be detected by chance when determined in the blood according to the method enzyme immunoassay a marker of acute viral hepatitis C anti-HCV-IgM, which remains in the patient's blood for no more than 6 months.

The transition of the disease to a chronic form occurs imperceptibly. Over the years, the patient's damage to the liver tissues is becoming more and more aggravated and fibrotic changes leading to dysfunction of this organ.

Symptoms

The transition of acute hepatitis C to chronic is always long. Over the course of several years, the disease causes destruction of liver tissues, leads to the development of fibrosis, and proliferation occurs at the site of damage. connective tissue. Gradually, the organ ceases to function normally, and the patient develops cirrhosis of the liver, which manifests itself with symptoms characteristic of this disease.

The first signs of chronic hepatitis C are in many ways similar and as nonspecific as those that occur during acute stage disease symptoms:

• signs of intoxication;
• frequent weakness and increased fatigue;
• decrease in working capacity;
• susceptibility to viral colds, allergic reactions;
• digestive disorders;
• fluctuations in temperature: from an increase to insignificant numbers to the appearance of intense heat;
• frequent nausea (sometimes vomiting);
• loss of appetite and weight loss;
• (may resemble a migraine).

Patients with chronic hepatitis C may develop diseases of the heart and blood vessels, joints, skin and genitourinary system. When probing, an enlarged liver and spleen can be determined, and when conducting blood tests, signs of a decrease in liver function are revealed.

The main symptoms of chronic hepatitis C usually appear only at the stage of cirrhosis of the liver:

• pain and heaviness in the right hypochondrium;
• jaundice;
• the appearance of telangiectasias on the upper body;
• an increase in the volume of the abdomen;
• increased feelings of weakness and general malaise.

In some patients, chronic hepatitis C provokes the growth of hepatocellular carcinoma, which is manifested by the following symptoms:

• progressive weakness and symptoms of general intoxication;
• sensations of pressure and heaviness in the liver;
• rapidly growing;
• a neoplasm that is palpable on the surface of the liver and cannot be separated from the organ;
• pain in the liver;
• significant weight loss.

For more late stages development of the tumor, the patient develops jaundice, ascites develops and veins appear on the anterior surface of the abdomen. In addition, there may be an increase in temperature and the appearance of signs of indigestion: vomiting, nausea, loss of appetite.

According to statistics fatal outcome from chronic hepatitis C occurs in 57% of total patients who have already developed cirrhosis of the liver, and in 43% of patients with hepatocellular carcinoma.

Complications of chronic hepatitis C

Against the background of the chronic course of HCV infection, the following severe pathologies can develop:

• liver fibrosis;
• decreased blood clotting;
• cirrhosis of the liver;
• ascites;
• hepatocellular carcinoma.

Diagnostics

Due to the fact that chronic hepatitis C can be asymptomatic for a long time, to detect this disease, complex diagnostics. When interviewing a patient, the doctor must specify possible episodes from the patient's life that could lead to infection with the virus, and information about the lifestyle. In addition, the specialist carefully studies the patient's complaints and examines him (probes the liver and spleen, evaluates the color of the mucous membranes and skin).

To confirm the diagnosis of chronic hepatitis C, the patient is prescribed:

• serological tests: ELISA test for HCV antigens and RIBA immunoglobulin test;
• PCR - a test for the detection of virus RNA (performed twice, since it can give false positive results).

After performing the tests, the patient is carried out to check the level of ALT (alanine aminotransferase - an enzyme that reflects damage to liver cells) and to detect antibodies to HCV. Such laboratory research recommended at least once a month. At normal AlAT against the background of the presence of antibodies to HCV detected for several months, the patient is considered a carrier of the hepatitis C virus.

If the test indicators indicate the development of chronic hepatitis, then a PCR test is performed to assess the viral load and activity, which allows you to determine the activity and rate of reproduction of viruses. The higher this indicator, the more likely the forecasts for the low effectiveness of antiviral therapy. At low rates viral load chances for successful treatment above.

To assess the condition of the liver, patients are assigned the following types of examinations:

• blood chemistry tests to evaluate liver samples;
• coagulogram;
• Ultrasound, CT, MRI of the liver;
• (in difficult cases).

After making a diagnosis, before prescribing treatment, the patient must undergo a course of preparatory examination:

• blood tests to detect HIV infection, syphilis and other infectious and sexually transmitted diseases;
• coagulogram;
• analysis for thyroid hormones.

When detected in a blood test high level hemoglobin, the patient is assigned an additional study to assess the level of serum iron.

Treatment

Treatment of chronic hepatitis implies the mandatory appointment of antiviral therapy and diet. To improve the results of the fight against the disease, hospitalization of the patient in a specialized clinic is recommended. Such medical centers there are all the necessary means for treatment (drugs and equipment), which are prescribed by highly qualified specialists (infectionists, hepatologists and gastroenterologists).

Medical therapy

Antiviral drugs are given to all patients with a confirmed diagnosis and patients who have signs of moderate or severe necrotic lesions. Etiopathogenetic treatment is indicated when liver fibrosis is detected, accompanied by an increase in the level of ALT.

The following medications may be included in a chronic hepatitis C treatment plan:

• interferons and other agents with antiviral activity;
• immunosuppressants (Prednisolone, Azathioprine, etc.);
• combined funds;
• pathogenic drugs, etc.

Interferons are prescribed in courses, the duration of such monotherapy can be about 12 months (until the antibodies to the virus completely disappear from the patient's blood 3 months after the start of taking the drugs).

The appointment of interferons can not be carried out in the following clinical cases:

• frequent seizures of epilepsy;
• convulsions;
• depressive state;
• psychical deviations;
• decompensated cirrhosis of the liver;
• tendency to thrombosis;
• severe pathologies of blood vessels and heart;
• the patient has transplanted donor organs.

Monotherapy with interferons can be prescribed to women in such cases:

• low concentration of hepatitis C virus antibodies;
• the age of the patient is not more than 40 years;
• normal iron levels;
• minimal changes in liver tissues;
• the patient is not overweight;
• increase in the level of ALT, etc.

The rest of the patients are prescribed combined treatment for 6 or more months. Against its background, at least once a month, the patient must take blood tests to assess the effectiveness of the prescribed drugs. If after 3 months there is no significant improvement, the doctor reviews and changes the treatment plan. During such courses of therapy, the patient may experience various adverse reactions in the form of nausea, anemia, dizziness, etc.

Antiviral agents are prescribed for the treatment of chronic hepatitis C. They cannot be accepted in the following cases:

• period of pregnancy and lactation;
• pathology of the heart and blood vessels;
• hemoglobinopathy;

In addition, when appointing medicines for the treatment of hepatitis C, the doctor must take into account the concomitant diseases present in the patient.

For combined antiviral treatment The most common combination of the following is used:

• Ribavirin;
• Interferon-alpha.

Numerous studies show that individually these drugs do not have high activity, but when administered together, their effectiveness increases significantly and they are able to fight the hepatitis C virus. Their separate intake is recommended only if the patient has contraindications to taking one of the drugs.

In addition, in last years used to treat hepatitis C innovative drugs direct antiviral action, significantly increasing the effectiveness of the fight against the disease. The method of their application is called "triple therapy". Such funds are already registered in Russia and are sold in specialized pharmacies. Their appointment is especially recommended for those patients who:

• already developed cirrhosis of the liver;
• the disease was caused by infection with the 1st genotype of the HCV virus;
• prescribed antiviral therapy was not effective;
• after successful antiviral treatment, a relapse developed.

For triple therapy, the following newer antiviral agents that are protease inhibitors can be prescribed:

• Telaprevir;
• Victrelis.

These innovative drugs for the treatment of hepatitis C are prescribed by a doctor in the absence of contraindications and are accepted only according to individual schemes drawn up by a specialist. As with other antiviral drugs, the patient periodically takes blood tests, and the duration of treatment is determined by the indicators of the virological response.

To restore liver function against the background of the main treatment of chronic hepatitis C, patients are prescribed hepatoprotectors. In addition, for investment general condition symptomatic remedies are recommended:

• antispasmodics;
• enzymes;
• probiotics;
• detoxification and antihistamines;
• vitamins.

If necessary, plasmapheresis can be performed to detoxify the body.

After the appointment of a course of treatment, the patient must take blood tests for the level of antibodies of the hepatitis C virus:

• 1st study - 14 days after the start of taking the drugs;
• 2nd study - a month after the start of therapy.

Subsequent analyzes are carried out at least once a month.

If, after the start of treatment, the patient has an exacerbation of existing chronic diseases, then the doctor appoints him consultations of specialized specialists. After analyzing all the data received, he carries out a correction of the therapy plan.

With the development of complications of the disease (cirrhosis or liver cancer), the course of therapy is supplemented by appropriate methods.

Diet

Patients with chronic hepatitis C are advised to follow a lifelong diet number 5, which helps to facilitate the functioning of the liver. The patient should change the meal schedule and switch to fractional meals. Meals should be taken 6-7 times a day in smaller portions. In addition, you should drink enough water. All patients with chronic hepatitis C should get rid of bad habits: smoking, alcohol and drug use.