C is realized, it is necessary that the material containing the virus (the blood of an infected person) gets into the bloodstream of another person. More than 2% of the world's population is infected with this virus. The incidence of hepatitis C is growing every year. It is believed that this increase is associated with the spread of drug addiction, since 38-40% of young people who develop hepatitis C are infected with intravenous drug use. Approximately 70-80% of patients with hepatitis C develop a chronic form of the disease, which is the most dangerous, since it can lead to cirrhosis of the liver or the formation of a malignant liver tumor. A number of effective drugs for the treatment of hepatitis C. With timely and competent therapy, a complete cure is possible in 60-80% of cases. Unfortunately, there is no effective vaccine for hepatitis C yet.

Causes of the disease

The source of infection is a sick person or a virus carrier.

Infection with the hepatitis C virus is possible in the following situations:
- when drug addicts use one syringe for intravenous drug administration;
- when performing piercings and tattoos with tools contaminated with the blood of a patient or carrier of infection;
- when sharing razors, manicure accessories, toothbrushes;
- during the hemodialysis procedure (apparatus "artificial kidney");
- at medical professionals when carrying out any medical procedures related to blood;
- with transfusion of blood products (this route of transmission is becoming less and less important, since in developed countries blood products are mandatory tested for the presence of the hepatitis C virus);
- sexual transmission of hepatitis C (with unprotected sexual contact with a carrier of the virus, the probability of transmission is 3-5%);
- transmission of infection from an infected mother to a fetus (occurs in less than 5% of cases, infection usually occurs during childbirth, during the passage of the birth canal).
The risk of contracting hepatitis C virus through medical procedures may persist in developing countries. If sanitary standards are grossly violated, then any room where medical manipulations are performed can become a place of infection.
Hepatitis C is not transmitted by airborne droplets, shaking hands, hugging, sharing utensils, food or drinks. If there is a transmission of infection in everyday life, then a particle of blood from a patient or a carrier of the hepatitis C virus has necessarily entered the blood of the infected person.

Symptoms of hepatitis C

From the moment of infection to clinical manifestations lasts from 2-3 weeks to 6-12 months. In the case of an acute onset of the disease, the initial period lasts 2-3 weeks, accompanied by joint pain, fatigue, weakness, and indigestion. Rise in temperature is rare. Jaundice is also uncommon. Acute hepatitis C is diagnosed very rarely and more often by accident.
After the acute phase of the disease, a person can recover, the disease can turn into a chronic form or into a virus carrier. Most patients (in 70-80% of cases) develop a chronic course. The transition of acute hepatitis C to chronic occurs gradually: over the course of several years, damage to liver cells increases, fibrosis develops. In this case, liver function can be maintained for a long time. And the first symptoms (jaundice, an increase in the volume of the abdomen, spider veins on the skin of the abdomen, an increase in weakness) may appear already with cirrhosis of the liver.
Combination of hepatitis C with other forms viral hepatitis dramatically aggravates the course and prognosis of the disease.

Diagnosis of hepatitis C

To diagnose hepatitis C, it is necessary to perform a biochemical blood test (bilirubin, ALT, ASAT, prothrombin index, alkaline phosphatase, cholesterol), a blood test for antibodies to hepatitis C virus (anti-HCV), PCR for HCV-RNA (qualitative PCR, quantitative PCR , genotyping), complete blood count, ultrasound of the abdominal organs and a number of other studies.
RNA of the hepatitis C virus in the blood (HCV-RNA) is determined by PCR. This test helps confirm infection and provides information on the activity and rate of reproduction of viruses in the body.
The presence of antibodies of the IgM class (anti-HCV IgM) makes it possible to distinguish active hepatitis from carriage (when there are no IgM antibodies and ALT is normal).
Having all the results, the doctor will be able to make a complete diagnosis, determine the level of development of the viral process in the body, assess the state of the liver and the degree of its damage, and choose an effective and safe treatment.

Do not use other people's shaving razors, toothbrushes or any objects where there may be blood;
- at the dentist's office, check that all potentially dangerous manipulations are performed only with disposable instruments;
- visit only proven and high-quality manicure and tattoo parlors (the master must wash his hands, work in disposable gloves and use disposable tools);
- people who have sex with patients with hepatitis C or carriers of the virus are advised to use condoms.

What is it, how can you get infected? Hepatitis C is an inflammation of the liver that develops as a result of a person's infection with a specific virus.

Usually, the disease does not betray itself, showing up by chance, when examining a person for various purposes, but it can proceed in the form of an acute or chronic process.

Pathology tends to be chronic, often complicated by cirrhosis and primary cell carcinoma.

However, effective treatment regimens for this disease have been developed.

What it is? How the virus is transmitted

in women and men, it occurs when an infected biological fluid of one person (usually blood) gets on the damaged mucous membrane, skin or directly into the blood of another person.

The following infection possibilities can be listed:

• cosmetic procedures (manicure, ear piercing, pedicure, tattooing, piercing and others, in which the integrity of the skin or mucous membranes may be compromised;
• sharing syringes for injecting drugs;
• when transfusing blood products;
• with hemodialysis;
• during dental and other medical procedures, operations;
• when using common razors, toothbrushes (if the patient's blood got on them), manicure tools;
• unprotected sex (3-5% chance of getting infected); there is no data about oral sex;
• accidental pricks with infected needles;
• from mother to child - during childbirth, in 5% of cases;
• when breastfeeding - only if the nipples or breast skin is damaged or there are breast diseases (cancer) in which blood is excreted with milk.

How can you not get infected?

Hepatitis C is not transmitted when:

1. 1) Talking, sneezing and coughing;
2. 2) Eating / drinking from one dish;
3. 3) Hugs and kisses;
4. 4) Handshakes.

If a family member has contracted this virus, it should not be avoided or any special conditions for work or study should be created for him: he is not dangerous to others, except when you need to provide him with first aid by stopping the blood. It is also dangerous to use with it some manicure tools, razors.

If his blood gets on clothes, it is necessary to wash it for half an hour at 60 ° C, if it can be boiled, then the virus will die in 2 minutes. If the patient's blood gets on household items, they must be treated with chlorine-containing solutions (for example, "Dezactin").

Features of the hepatitis C virus - genotypes

The genome of the virus is represented by RNA, which may differ slightly. These differences are used to distinguish 6 genotypes of the virus, while each of them is divided into several subspecies (quasi-species).

So, for example, genotype 1 is divided into three quasi-species: a, b, c; in the second genotype there are four of them: a, b, c, d; in the third genotype, 6 quasi-species are distinguished (from a to f, respectively), in the fourth - 10 (a-j), the fifth and sixth types of genotypes have one quasi-species each.

Quasi-species have the ability to mutate, developing resistance to medicines (this explains why an effective vaccine has not yet been developed for hepatitis C).

What does the genotype affect?

1) Different genotypes are common in different regions. Typical for Russia: 1b, 3, 2a; genotype 4 is common in Africa and the Middle East, the fifth for South Africa, 6 for Asian countries.

2) The choice of treatment and its duration depend on the genotype. With type 1, one combination of drugs is prescribed, which must be taken from six months to a year, with 2 and 3 genotypes, treatment usually consists of taking Ribavirin and pegylated interferon, it must be taken for about 24 weeks.

3) Doses of drugs also depend on what genotype is caused by hepatitis C.

4) It has been proven that the rate of development of fatty inclusions that appear in infected with a virus liver (steatosis), also depends on the genotype of the virus. Hepatitis C caused by genotype 3 is especially often complicated by the development of hepatic steatosis, but if this disease is cured in time, steatosis can regress.

5) The course of hepatitis caused by this virus also depends on which genotype has entered the human body. It is believed that 1b causes the most severe course in a chronic process.

Risk factors. Who is more likely to get sick?

Not all people have the same chance of getting hepatitis C. Very high risk have the following categories of persons:

1. 1) Injectable drug addicts;
2. 2) People who received fresh frozen plasma transfusions or single clotting factors prior to 1987.

A slightly lower risk in such people:

• who need constant sessions of blood purification using an "artificial kidney" (hemodialysis);
• who received a transplant or blood transfusion before 1992;
• those who received blood transfusions from a donor who was subsequently diagnosed with hepatitis C;
• HIV-infected;
• people who have liver disease, the cause of which is unknown;
• children born to mothers infected with this virus.

The risk in such people is considered even lower:

• medical professionals;
• having sex with several partners in a short period of time;
• if the sexual partner is alone, but he is infected;
• frequent visitors to beauty salons, piercings, tattoos, invasive cosmetic procedures;
• used common shaving or manicure devices, toothbrushes with the patient.

Persons from the first two risk groups must undergo a blood test for markers of the hepatitis C virus.

Who is harder to tolerate hepatitis C?

These are the people:

• alcohol abusers;
• the elderly;
• faces weakened by severe illness;
• children.

It is not at all necessary that people of the above categories will have manifestations of a severe acute process. Rather, in such individuals, hepatitis will tend to become rapidly chronic and have a fairly frequent outcome of the disease c. In addition, it is often in these patients that there are contraindications for full treatment.

Infection of a woman during pregnancy usually does not affect the carrying of a child. Usually healthy uninfected children are born in this case.

Symptoms of hepatitis C in women and men

In women and men, from the moment of infection until the onset of any symptoms of hepatitis C, it takes 2-14 weeks (an average of 50 days). Further, such options are possible:

The preicteric period develops, characterized by symptoms that proceed according to one of the options:

• weakness, decreased appetite and performance, sleep disturbance;
• loss of appetite, aversion to food, feeling of heaviness "in the stomach";
• pain in large joints without changing their appearance;
• the appearance of an incomprehensible rash, reminiscent of an allergic, increased body temperature.

This period lasts about 7-8 days, then passes into the icteric period of the course of the disease, the symptoms of which will be described below.

1. 1) The disease may not manifest itself in any way, but be detected either by accident - by markers, or already at the stage of cirrhosis.
2. 2) After the development of the acute stage, 70-80% of hepatitis becomes chronic, which without treatment ends in cirrhosis or carcinoma.
3. 3) You can endure the acute stage of the disease, and then recover without any specific treatment. This usually happens in the first three months or throughout the year.
4. 4) A person can become infected, but not get sick, but become a carrier of the virus. At the same time, the function and structure of the liver does not suffer (there are no laboratory changes, or even cellular changes - if a liver biopsy is done).
5. 5) If a person has had acute hepatitis and recovered, or he was cured of a chronic process, there is a chance of re-infection with another virus of a different genotype.

In the case of the development of acute hepatitis C, the symptoms of the preicteric period are initially noted. These are described in the previous section. Further, the period of jaundice develops. It is characterized by:

• weakness, lack of appetite, drowsiness;
• darkening of urine (usually this is the first "serious" symptom to which a person pays attention);
• yellowing of the sclera and skin. After that, the person feels a relief of the general condition;
• heaviness and pain in the right hypochondrium;
• feces become light;
• symptoms from the kidneys (back pain, discoloration of urine), joints (pain and swelling in them), and a skin rash may appear.

This period can last 3-5 weeks. At some point, symptoms will fade away: jaundice disappears, urine brightens, feces darkens.

A fulminant form of acute hepatitis may develop, when signs of behavior change are first noted, the person's response to the environment changes; then the disturbance of consciousness deepens, drowsiness turns into stupor and coma. This course is very rare in hepatitis C, it is almost always fatal. The photo shows the effect of the disease on the liver.

Diagnosis of hepatitis C

For diagnostics this disease several blood tests from a vein are taken simultaneously. The results of the first of them - liver tests - can be obtained on the same day, and based on their results, start non-specific treatment... The results of other tests come a little later, after a few days.

So, with liver tests in the blood are determined:

• increased levels of total and direct bilirubin;
• increased levels of alanine aminotransferase in total and in dilution;
• decreased albumin levels;
• increased alkaline phosphatase and glutamyl transpeptidase;
• a coagulogram shows a decrease in the level of the prothrombin index.

But with chronic hepatitis C, all these numbers may not go beyond the normal range, or be changed only sometimes (and it is not a fact that a person will pass the analysis exactly when there is a deviation from the norm).

Specific diagnostics include:

1. 1) Determination of markers of hepatitis C by ELISA method. From 4-6 weeks of the acute period, class M immunoglobulins to this virus are determined, their titer increases, they can also appear when the virus is activated in a chronic process. From 11-12 weeks of infection, immunoglobulins G are determined. Their titer gradually increases by 5-6 months; if the person has recovered, the titer gradually begins to decline. In chronic hepatitis C, anti-HCV-IgG are determined for life.
2. 2) A positive ELISA result must be confirmed by the RIBA method.
3. 3) Determination of the RNA of the virus by PCR (if HCV RNA is determined - the diagnosis is established). RNA is also determined over time. Its early disappearance is considered a good sign in the treatment of chronic hepatitis C.
4. 4) Genotyping - determination of the quasi-type of the virus. Necessary for the selection of treatment.
5. 5) Using the quantitative PCR method - determination of the viral load. This test shows the number of viral particles in the blood. It is used not to assess the severity of the disease, but to understand how effective the treatment is. A high load is considered if ≥ 800 * 103 (or more than 3,000,000 copies / ml, or more than 800,000 IU / ml) are detected. In addition, the viral load can indirectly judge the degree of infectiousness of a person who has been diagnosed with the hepatitis C virus.
6. 6) In addition, the diagnosis is confirmed by the results of a puncture biopsy performed under ultrasound control.

Hepatitis C treatment

For both acute and chronic hepatitis C, treatment begins with diet. This is table number 5 with the exception of fatty and fried foods. Also, spicy, smoked foods, alcohol, foods rich in fiber are completely excluded from the diet. In the acute period, the food should not contain any animal proteins (meat, eggs, fish).

Acute hepatitis is treated with non-specific drugs:

• infusion therapy (droppers) with saline solutions, glucose, Rheosorbilactom;
• essential amino acid preparations: Glutargin, Hepa-Merz (Ornitox);
• lactulose preparations: Dufalak, Normaze and others;
• sorbents: Atoxil, Smecta, White coal;
• drugs that reduce the production of gastric juice: Omez, Ranitidine, Famotidine, Nolpaza;
• protease inhibitors: Contrikal, Contriven, Gordox.

Chronic hepatitis is treated after determining the genotype of the virus. The main drugs used in his therapy are interferon and Ribavirin.

Interferon Is a protein that is produced in the human body in response to the introduction of any virus into it. For the treatment of hepatitis C, a synthetic analogue of such a protein is used, that is, in fact, the natural immune response is activated, which the virus suppressed.

This interferon has a large amount side effects, therefore, treatment is carried out under medical supervision, and that is why constant monitoring of laboratory parameters is needed.

Ribavirinit is prescribed only in combination with interferon.

With the first genotype, a third drug is added to this therapy - a protease inhibitor (Contrikal, Gordox). Also, treatment includes correction of necessarily developing changes in the blood.

When treating a chronic process, the following are determined again:

1. 1) Complete blood count with the determination of platelets and reticulocytes;
2. 2) Coagulogram;
3. 3) Liver tests;
4. 4) The degree of viral load;
5. 5) RNA of the virus by PCR;
6. 6) Once every 3 months, control the level of thyroid hormones.

Contraindications to treatment

The specified antiviral therapy should not be carried out:

• people to whom an organ has been transplanted;
• persons suffering from autoimmune processes;
• untreated;
• decompensation of heart failure;
• pregnant women;
• children under 3 years old;
• decompensated;
• severe ischemia or arterial hypertension;
• aggravation.

Prognosis in the treatment of hepatitis C

There is quite a lot of chronic hepatitis C: up to 60-80% of patients can recover. It is easier to cure patients with genotypes 2 and 3 of the virus, the first is difficult to treat.

The effectiveness of treatment depends on:

• the age of the patient: the younger the person, the more effective the treatment;
• gender: a woman is easier to cure;
• if histologically minimal changes in the liver are detected, it is easier to treat this form;
• viral load: the lower it is, the more effective the treatment;
• body weight: people with low weight are easier to recover.

If after treatment the RNA of the virus is not detected, it is highly probable that the person has recovered.

In most cases, people accidentally find out that they are infected. dangerous virus Hepatitis C. During a routine medical examination or before surgery, a person will pass a standard test for markers (antibodies, AntiHCV) of hepatitis C.

Then the result comes. And like bolt from the blue the news - AntiHCV DETECTED.

What steps should be taken if a hepatitis C antibody test is positive?

Step 1. Take it easy.

Yes it is. Just take it easy. Life goes on. Detection of antibodies is startling news, but if you test positive for antibodies, it doesn’t mean that you are infected with hepatitis C.

AntiHCV (antibodies) IS NOT A VIRUS. It is part of the immune system, a healthy reaction of the body upon contact with the virus.

There are cases (rare) that the body independently defeats hepatitis C. Antibodies remain in the body for life, without affecting its vital functions.

Also keep in mind that the analysis for antibodies can be false-positive (i.e. there are antibodies, but there is no virus) or false-negative (the virus is present in the blood, but the body has not developed antibodies to it).

A false positive is most common in pregnant women.

Step 2. Pass a qualitative PCR test for hepatitis C.

After detecting antibodies, it is imperative to pass a qualitative PCR test to determine the RNA of the hepatitis C virus in the blood.

For PCR analysis, blood is taken from a vein. If you take a high-quality PCR analysis for a fee in a laboratory, then in Russia it will cost from 500 to 1000 rubles, depending on the region.

If the PCR gave a high-quality result "not found", then this may indicate that the body itself has overcome the virus (it happens in about 10-15 percent of patients) or that there is a latent (latent) course of the disease.

If the antibody test (AntiHCV) and the qualitative PCR test showed both "detected", it means that you are infected with the hepatitis C virus.

The most important thing now you need to do is calm down and not panic.

Hepatitis C can be treated.

Step 3. Obtain information about hepatitis C from reliable and trusted sources

There are many myths around hepatitis C. This is because people who do not study this disease are spreading unnecessary rumors. Even doctors can convey false information to patients. They take this information from outdated sources of the 90s. Or because doctors who are not directly related to hepatitis C, such as surgeons, dentists, gynecologists, often not even sharing hepatitis A, B, C, can talk about the disease based on rumors or some of their own conclusions.

See an infectious disease doctor. Watch videos from conferences on hepatitis C and its treatment.

Check all the information that you get on the Internet in official sources or from specialists.

Hepatitis C is not the worst disease. Some people suffer from it for decades, leading a completely normal lifestyle. Moreover, today hepatitis C can be treated.

Step 4. Visit an infectious disease doctor.

You need to undergo a liver examination and choose the optimal treatment regimen.

To do this, you need to visit an infectious disease doctor at a city polyclinic or a private medical center.

An infectious disease doctor will register you and prescribe tests to be passed.

Step 5. Determine the genotype of the hepatitis C virus.

The hepatitis C virus is subdivided into genotypes 1,2,3,4. Sometimes two genotypes of the virus are found in the body at once.

The treatment regimen depends on the genotype.

Step 6. Check your liver.

The hepatitis C virus primarily affects the liver. This can lead to serious pathological diseases such as cirrhosis or liver cancer.

The liver, like the brain, has no pain receptors. A person cannot feel that his liver is hurting.

The symptoms of hepatitis C are fatigue, weakness, irritability. A person can suffer from hepatitis for years without knowing it, writing off fatigue as stress and a busy rhythm of life.

Perform a complete liver exam. Get an ultrasound of the liver.

In order to find out whether or not you have liver fibrosis, you need to do a fibroscan. Fibroscan costs approximately from 3,500 to 10,000 rubles, depending on the region of Russia.

Interpretation of fibroscan results:

fibrosis F0 - no fibrosis
fibrosis F1 - portal fibrosis without septa
fibrosis F2 - portal fibrosis with rare septa
fibrosis F3 - significant number of septa without cirrhosis
fibrosis F4 - cirrhosis.

Step 7. Learn all about hepatitis C treatment

After passing the tests, the time comes to choose a treatment regimen for yourself (it is better if the doctor selects the regimen for you).

Medicines for the treatment of hepatitis C from India and Egypt: sofosbuvir, daclatasvir, ledipasvir, velpatasvir.

Do you want to know more about drugs?

Reference information can be obtained by contact:
1) phone: +78002005257 (call from all phones of the Russian Federation is free)
2) phone: +74993227294
3) WhatsApp: +201026809957
4) Viber: +201026809957
5) Skype: daklatasvir
6) email:

What to do with hepatitis C?

Can Hepatitis C Be Cured Permanently?

Can. The chances of curing chronic hepatitis C are greater than chronic hepatitis B. The actual rate of recovery after hepatitis C therapy reached 30-40% a few years ago.

Now, with properly planned and carried out treatment, recovery can reach 60-90% of patients with chronic hepatitis C. International studies often speak of 50-80% probability, depending on the characteristics of the disease.
But in order to "get" into these percentages, efforts of both the doctor and the patient are needed.

How to start with hepatitis C?

First of all, with a visit to a doctor and examination. During the examination, the type and phase of the infection will be established, and the state of the liver will be assessed. All this influences the choice of the treatment regimen, its effectiveness and safety.

When should you go to the doctor and start treatment?

You should go to the doctor immediately if signs of hepatitis C (at least anti-HCV) are detected for the first time. Treatment is started if there are changes in the liver (for example, an increase in ALT).

Which doctor should you go to?

Chronic hepatitis C should be treated by an experienced hepatologist.
This will ensure maximum treatment efficiency, good tolerance and avoid additional costs.

Many doctors take on hepatitis treatment given the high demand for it today. However, not many have the appropriate training and, most importantly, the clinical experience of modern therapy for chronic hepatitis C.

Modern drugs and schemes of effective combination therapy for chronic hepatitis C appeared not so long ago, and the experience of their use in our country was concentrated in several specialized centers. The greatest experience in the treatment of hepatitis C is possessed by hepatologists who participate in international clinical trials of those drugs that are currently accepted for treatment or will be widely used in the near future.

Modern strategy for the treatment of chronic hepatitis C

The mainstay of treatment for hepatitis C is combined antiviral therapy. International research and clinical practice have shown that at present the combination of two drugs - interferon-alpha and ribavirin - has been most justified. Individually, they are less effective.
However, in special cases of the disease (for example, contraindications to the appointment of one of the drugs), monotherapy with one drug may be prescribed.
Doses of drugs and duration of treatment are selected by the doctor individually, taking into account many factors.

There are no other proven treatments that can eliminate the hepatitis C virus today.

We will definitely write about all new methods with proven effectiveness in the treatment of chronic hepatitis C in this section as soon as they appear.

What other treatments can be used?

Hepatoprotectors (Essentiale, Phosphogliv, Lipoic Acid, Silymar, etc.) do not have an antiviral effect, they are support drugs, improving some functions of liver cells.
Prescribing immunomodulators with proven effectiveness helps to stimulate specific links in the immune response, allowing the body to more effectively fight infection (zadaxin).

Be wary of suggestions for other treatments, always discuss this with your doctor.
Today, you can find a lot of advertisements and statements about the supposedly effective methods of treating hepatitis C and new means - be it drugs that affect the immune system, "strengthen" the liver, vitamins, dietary supplements or methods of physiotherapy. Ignore big names and solid sounding recommendations. In the best case, these methods will not do harm, but their benefits have never been proven in practice.

The main thing is not to overlook the dangerous scenario for the development of the infection and to appoint it in time. effective treatment hepatitis C.

When is hepatitis C more difficult to treat?

According to statistics, it is more difficult to treat hepatitis C in men, people over 40 years old, in patients with normal transaminase activity, with a high viral load, with 1 b virus genotype. Of course, the presence of liver cirrhosis by the time of the start of treatment worsens the prognosis.

The effectiveness of antiviral treatment depends on many factors.
With a long course of hepatitis C, it is not easy to achieve complete eradication of the virus. The main task is to slow down the process of active multiplication of viruses. This is possible in most cases with the use of modern antiviral therapy regimens.
In the absence of active reproduction of viruses in the liver, the severity of inflammation is reliably reduced, and fibrosis does not progress.

What will happen if after the course of treatment the patient “does not get” in the percentage of cured?

Courses and special schemes of repeated therapy are provided for people in whom the result of treatment was not achieved or was incomplete (there was a relapse of infection immediately after treatment).

The drugs and treatment protocols for hepatitis C are constantly being improved, their effectiveness is increasing and may turn out to be higher than the previous treatment regimen, which did not give the desired result.

Will liver function recover after treatment?

The prognosis for treatment is favorable, even if it was not possible to completely suppress viral replication.
With antiviral treatment, the progression of hepatitis C (and liver damage) is reliably inhibited.
And if HCV-RNA is not detected in the blood within a year after the end of therapy, then in most cases one can consider oneself cured.
In this case, liver function is restored completely.

How long can treatment for hepatitis C last?

The choice of the scheme and the duration of the course of treatment depends on the course and stage of hepatitis C, which is determined by the doctor. Treatment with a combination of interferon and ribavirin can last 12 months.

Moreover, unlike many others infectious diseases, in chronic hepatitis C there is no single standard of treatment, individual planning is recommended in special cases.
Complex treatment protocols are provided, taking into account the genotype of the virus, the state of the liver (indicators of its function and changes in its tissue during biopsy), viral load.
Doses of drugs and their prescription schedule may vary, and also depend on the types of drugs (for example, different forms of interferon).

Is Hepatitis C Treatment Easy? Side effects of antiviral therapy

Against the background of combined therapy with interferon and ribavirin, patients naturally experience some side effects. Young people in most cases tolerate the treatment of hepatitis C quite well and quickly adapt to it.

Ribavirin is generally well tolerated. But quite often in general analysis blood phenomena of mild hemolytic anemia (destruction of red blood cells) are noted. Mild dyspepsia may occur, rarely headache, an increase in the level of uric acid in the blood, very rarely drug intolerance is noted.

If treatment with interferons is indicated, then side effects cannot be avoided, but they are predictable. After the first injections of interferon, most patients experience a flu-like syndrome. After 2-3 hours, the temperature rises to 38-39 0 С, there may be chills, pain in muscles, joints, severe weakness. The duration of this condition can be from several hours to 2-3 days.
Within a month, the body adapts to the introduction of interferon, so by this time the flu-like syndrome disappears. Weakness, fatigue persist, but we have to put up with this. In the second or third month of treatment, changes in the general blood count may be observed. The number of leukocytes (white blood cells) and platelets naturally decreases. It is important to monitor the extent of these changes; this is the doctor's task.
If necessary, the dose of interferon is reduced or completely canceled for a certain period of time until the blood counts return to safe values. A pronounced decrease in the number of leukocytes can contribute to the addition of bacterial infections, and a low number of platelets can cause hemorrhagic syndrome (bleeding). It is important to prevent these complications, therefore, all patients receiving interferon need to visit a doctor once a month and perform control blood tests (complete blood count and biochemical blood test).
Less often, against the background of the introduction of interferon, hair loss, decreased mood, depression, dry skin, weight loss can be observed, and in predisposed persons, dysfunction of the thyroid gland. Therefore, medical supervision in the treatment of hepatitis C with any drugs is necessary.

How to evaluate the effectiveness and safety of treatment?

The effectiveness of hepatitis C treatment is assessed by the biochemical parameters of the blood (decreased activity of transaminases) and the presence of HCV-RNA, by reducing the level of viral load.
The development of side effects is monitored by the results of a general blood test, the level of thyroid hormones.

Cost of hepatitis C treatment

The cost of modern drugs required for treatment can range from $ 550 to $ 2500 per month. The duration of the course of treatment is 12 months (respectively, $ 6,600-3,000 per year).
Newer, more effective, well-researched, more user-friendly drugs made by established companies are more expensive.

The main costs are for interferon preparations. Foreign-made pegylated interferons are more expensive than conventional interferons of any manufacturer.

To whom is the treatment contraindicated?

Currently, there are several categories of people for whom the combined antiviral treatment of hepatitis C is contraindicated:

• Patients suffering from common severe diseases, including decompensated diabetes mellitus, heart failure, severe coronary artery disease and hypertension, chronic obstructive pulmonary disease
• People who have had kidney, heart, lung transplants
• Patients in whom the administration of interferon exacerbates the autoimmune process in the liver or other organs
• Patients with untreated hyperthyroidism (thyroid disease)
• Pregnant women
• Children under 3 years old
• Individuals with individual intolerance to any drug for the treatment of hepatitis C

Do I need to prepare for hepatitis C treatment?

Before the introduction of the first doses antiviral drugs it is necessary to donate blood for general analysis, biochemical analysis, thyroid hormones, coagulogram, PCR for HCV -RNA (qualitative, quantitative genotyping, if these parameters have not been previously studied).
In the presence of a high level of hemoglobin (above 160 g / l) in patients with chronic hepatitis C, it is recommended to examine serum iron as well.

After 2 weeks of therapy, a general blood test, a biochemical blood test is performed, the presence of HCV-RNA in the blood serum can be monitored, since the early disappearance of HCV-RNA is considered a favorable prognostic factor for the effectiveness of treatment.

Then, after another 2 weeks and then once a month, the analyzes are repeated in this volume. Thyroid hormones should be monitored every 3 months. If necessary, the doctor can prescribe an additional examination.

To examine and evaluate the results of laboratory tests, monthly consultations of the attending physician are necessary so that the side effects of treatment or complications are recognized and corrected in time, or rather, so that undesirable phenomena of a threatening nature do not develop at all.

Do you need a diet and lifestyle when treating hepatitis C?

It is necessary to give up alcohol.

As a rule, Pevzner's diet No. 5 is recommended with restriction of fats in food and substances that enhance the secretion of digestive juices (salty, spicy, fried, preservatives, etc.). The diet itself, in the absence of cirrhosis, does not affect liver function.

No major lifestyle change is required. The use of various drugs for other comorbidities with a doctor. Sports are allowed in the amount of usual loads.

Hepatitis C is an inflammatory liver disease that develops under the influence of the hepatitis C virus. An effective vaccine that could protect against this virus simply does not exist in nature, and it will not appear soon.

It is of two types - acute and chronic. In 20% of cases, people with acute hepatitis have a good chance of recovering, and in 80% of cases, the patient's body is not able to overcome the virus itself and the disease becomes chronic.

The transmission of the virus occurs through infection through the blood. Today, there are 150 million people in the world who are carriers of chronic hepatitis C, and 350 thousand patients with hepatitis end up with death annually.

Basically, the first symptoms of hepatitis C appear 30-90 days after infection. That is why if you feel unwell, apathy, fatigue and other phenomena that are unusual for your body, then you better consult a doctor. This is necessary in order for the doctor to make an accurate diagnosis, and based on it, choose the most effective treatment.

How is hepatitis C spread?

What it is? Infection occurs mainly through contact with the blood of an infected person. Hepatitis C is also transmitted during medical procedures: collection and transfusion of blood, surgery, manipulations at the dentist.

The source of infection can be manicure tools, tattoo devices, needles, scissors, razors, etc. If the skin or mucous membranes are broken, contact with the blood of an infected person can lead to infection.

In rare cases, hepatitis C is transmitted through sexual intercourse. Infected pregnant women have a risk that the baby will also be infected with the virus during childbirth.

The most difficult to tolerate the course of the virus:

• alcohol abusers.
• persons suffering from others chronic diseases liver, including others.
• older people and children.

The disease hepatitis C is not transmitted in household contacts through hugs, handshakes, with this disease you can use common dishes and towels, but you cannot use shared personal hygiene items (razors, nail scissors, toothbrushes). The disease transmission mechanism is only hematogenous.

Symptoms of hepatitis C

In most situations, viral hepatitis C proceeds slowly, without pronounced symptoms, remaining undiagnosed for years and manifesting itself already with significant destruction of liver tissue. Often for the first time, patients are diagnosed with hepatitis C, when hepatocellular liver cancer is already taking place.

The incubation period for hepatitis lasts from 1 to 3 months. Even after this period, the virus may not manifest itself in any way until the liver damage becomes too obvious.

After infection, 10-15% of patients self-heal, the remaining 85-90% develop primarily chronic hepatitis C without any specific symptoms (such as pain, jaundice, etc.). And only in rare cases, patients develop an acute form with jaundice and severe clinical manifestations, which, with adequate therapy, leads to a complete cure of the patient from hepatitis C.

The first signs of hepatitis C in women and men

For a long time, the symptoms practically do not bother patients. In the acute period, the disease manifests itself only as weakness, fatigue, sometimes proceeds under the guise of a respiratory viral infection with pain in muscles and joints. These may be the first signs of hepatitis C in women or men.

Jaundice and any clinical manifestations of hepatitis develop in a very small percentage of those infected (the so-called icteric form of the disease). And this is actually excellent - patients immediately turn to specialists, and the disease has time to be cured.

However, the bulk of the infected carry hepatitis C on their feet: with an anicteric form, they either do not notice anything at all, or blame the malaise on a cold.

Chronic hepatitis

A feature of chronic hepatitis C is a latent or low-symptom course for many years, usually without jaundice. , detection of anti-HCV and HCV RNA in blood serum for at least 6 months are the main signs of chronic hepatitis C. Most often, this category of patients is discovered by chance, during examination before surgery, during medical examination, etc.

The course of chronic hepatitis C can be accompanied by such immune-mediated extrahepatic manifestations as mixed cryoglobulinemia, lichen planus, mesangiocapillary glomerulonephritis. late cutaneous porphyria, rheumatoid symptoms.

A photo

The photo shows liver damage with a long course of hepatitis.

Forms

According to the presence of jaundice in the acute phase of the disease:

1. Icteric.
2. Anicteric.

By the duration of the course.

1. Acute (up to 3 months).
2. Prolonged (more than 3 months).
3. Chronic (more than 6 months).

By severity.

1. Lightweight.
2. Moderately heavy.
3. Heavy.
4. Fulminant.

Complications.

1. Hepatic coma.

1. Recovery.
2. Chronic hepatitis C.
3. Cirrhosis of the liver.
4. Hepatocellular carcinoma.

By the nature of the clinical manifestations of the acute phase of the disease, typical and atypical hepatitis C are distinguished. Typical include all cases of the disease accompanied by clinically visible jaundice, and atypical - anicteric and subclinical forms.

Stages

The disease is divided into several stages, depending on which treatment is prescribed.

1. Acute - it is characterized by an asymptomatic course. A person often does not even suspect that he is the carrier of the virus and the source of infection.
2. Chronic - in the vast majority of cases (about 85%), after the acute stage, a chronic course of the disease begins.
3. Cirrhosis of the liver - develops with further progression of pathology. This is a serious disease that threatens the patient's life both in and of itself, and the fact that if it is present, the risk of developing other complications, in particular, liver cancer, increases significantly.

A distinctive feature of the virus is the ability to genetic mutations, due to which approximately 40 HCV subspecies can be simultaneously detected in the human body (within one genotype).

Virus genotypes

The severity and course of the disease depends on the hepatitis C genotype that infected the body. At the moment, six genotypes are known with several subtypes. Most often, viruses of 1, 2 and 3 genotypes are found in the blood of patients. It is they that cause the most pronounced manifestations of the disease.

In Russia, genotype 1b is most common. Less commonly - 3, 2 and 1a. Hepatitis C caused by genotype 1b virus is characterized by a more severe course.

Diagnosis of hepatitis

The main method for diagnosing hepatitis is to determine the presence of antibodies to hepatitis C virus (anti-HCV) and HCV-RNA. A positive result from both tests confirms the presence of infection. The presence of antibodies of the IgM class (anti-HCV IgM) makes it possible to distinguish active hepatitis from carriage (when there are no IgM antibodies and ALT is normal).

A PCR test for hepatitis C (polymerase chain reaction) allows you to determine the presence of hepatitis C RNA in the patient's blood. PCR is mandatory for all patients with suspected viral hepatitis. This method is effective from the first days of infection and plays an important role in early diagnosis.

When is hepatitis C more difficult to treat?

According to statistics, it is more difficult to treat hepatitis C in men, people over 40 years old, in patients with normal transaminase activity, with a high viral load, with 1 b virus genotype. Of course, the presence of liver cirrhosis by the time of the start of treatment worsens the prognosis.

The effectiveness of antiviral treatment depends on many factors. With a long course of hepatitis C, it is not easy to achieve complete eradication of the virus. The main task is to slow down the process of active multiplication of viruses.

This is possible in most cases when using modern antiviral therapy regimens. In the absence of active reproduction of viruses in the liver, the severity of inflammation is reliably reduced, and fibrosis does not progress.

Hepatitis C treatment

In the case of hepatitis C, combination therapy with interferon-alpha and ribavirin is considered the standard of care. The first drug is available in the form of a solution for subcutaneous injection under the trademarks Pegasys®, PegIntron®. Peginterferons are taken once a week. Ribavirin is sold under various brand names and is taken as a tablet twice a day.

1. Interferon alpha Is a protein that the body synthesizes on its own in response to viral infection, i.e. it is actually a component of natural antiviral defense. In addition, interferon alpha has antitumor activity.
2. Ribavirin as an independent treatment has low efficacy, however, when combined with interferon, it significantly increases its effectiveness.

The duration of therapy can be from 16 to 72 weeks, depending on the genotype of the hepatitis C virus, the response to treatment, which is largely associated with the individual characteristics of the patient, which are determined by his genome.

A course of antiviral therapy using the "gold standard" can cost a patient from $ 5,000 to $ 30,000, depending on the choice of drugs and treatment regimen. The main costs are for interferon preparations. Foreign-made pegylated interferons are more expensive than conventional interferons of any manufacturer.

The effectiveness of hepatitis C treatment is assessed by the biochemical parameters of the blood (decreased activity of transaminases) and the presence of HCV-RNA, by reducing the level of viral load.

New in hepatitis treatment

Protease Inhibitors are a new class of drugs for the treatment of HCV infection - drugs that act directly on the hepatitis virus, with the so-called direct antiviral effect, which suppress or block key intracellular stages of viral replication.

Currently, the US and the EU have approved the use of two such drugs - Telaprevir (INCIVEK) and Boceprevir (ViCTRELIS).

According to the results of clinical trials in May 2013, the effectiveness of these drugs is 90-95%, as for the standard treatment, its effectiveness does not exceed 50-80%.

Side effects of antiviral therapy

If treatment with interferons is indicated, then side effects cannot be avoided, but they are predictable.

After the first injections of interferon, most people experience the syndrome. After 2-3 hours, the temperature rises to 38-39 0 С, there may be chills, pain in muscles and joints, noticeable weakness. The duration of this condition can be from several hours to 2-3 days. Within 30 days, the body is able to get used to the introduction of interferon, so by this time the flu-like syndrome disappears. Weakness, fatigue persists, but we have to put up with this.

As for Ribavirin, it is usually well tolerated. But quite often in the general analysis of blood, the phenomena of mild hemolytic anemia are noted. There may be phenomena of mild dyspepsia, rarely headache, an increase in the level of uric acid in the blood, very rarely there is an intolerance to the drug.

How many people live with hepatitis C, if not treated

It is very difficult to say unequivocally how many people live with hepatitis C, as well as with HIV infection. In an average number of patients, cirrhosis of the liver may develop in about 20-30 years.

As a percentage, the ratio depending on the age of the person, cirrhosis develops:

• in 2% of patients infected before the age of 20;
• in 6% of those who received the virus at the age of 21-30;
• in 10% of those infected at the age of 31-40;
• in 37% of patients aged 41-50;
• in 63% of those infected over 50 years old.

Also, most studies have proven that the development of fibrosis depends on gender. In men, this pathology develops much faster and in a more severe form, even if treated.