The terrible diagnosis
- How have you found out a hepatitis?
- I have not had any symptoms associated withliver. There were heart problems. I went to a cardiologist, who said that I am healthy. The gynecologist, endocrinologist, other doctors said the same thing. And while I had such a state that I could not work, quit all the time lying, I had a strong weakness, several times a week I called an ambulance. Hepatitis was discovered by accident. At that time, I was taking a lot of tests, and once again the doctor ambulance recommend me to do a blood test on biochemistry. It was found that the spectrum of biochemical tests is very large, including liver, kidney and so on. Your doctor has decided that you need to check your liver. The analysis showed that the liver is sick. It was clear that this hepatitis, and now had to figure out what.
- What was your reaction?
- I immediately got into the Internet to find out what kind ofdisease. It became clear that it was not And since it is not chronic, and I have it for quite some time. When standing in the laboratory, reading stand dedicated to hepatitis, I read about all its forms, in addition to hepatitis C. Because I thought it was something terrible, distant and unreal, that it does not even need to read it not about me. "According to the first results, - the doctor told me, - it does not hepatitis B, this all good, we really hope that this is not the hepatitis C because it is deadly and can not be cured." And when after all it turned out that I had hepatitis C, it became clear that the need to change doctors. That is a truly deadly and is not treated or is there another doctor who can work with it. Then I turned to Igor.
Hepatitis C - a cure possible?
- What was the most difficult in the course of treatment?
- The most difficult part was to hear how much treatment. It was almost a greater shock than finding out that I had hepatitis C. That is, there are methods, treatment is, but it is not available to all.
Vick has found the opportunity to undergo treatment. Today, she is completely healthy. Before the end of the course there are still a few injections and tests show that the virus in the body anymore.
That is hepatitis C from a medical pointview, and how to deal with it correctly, we have talked with your doctor Vicki, Associate Professor Department of Infectious Diseases of the National Medical University. Bogomolets, MD, PhD Igor A. Anastasi.
Things to think about
- What are the symptoms of hepatitis C? That person can be alerted?
- First of all it should be noted that viralHepatitis C is the leading issue of modern health care. . Today 400-700 million people worldwide are infected with hepatitis C virus, this virus is the cause of 20% of the cases of acute hepatitis, 80% of chronic hepatitis B, 40% - terminal cirrhosis, 60% - hepatocellular carcinoma, 30% of cases of liver transplantation . Unless urgent action is taken, then in 10-20 years the death rate from hepatitis C and its effects will increase by 3 times and significantly exceeds the rate of HIV infection. During this time, according to forecasts by the World Health Organization, chronic viral hepatitis C will become a major problem of national health authorities. As for your questions ... is characteristic for symptoms of hepatitis C does not exist. A person can celebrate decreased performance, general weakness, appetite deterioration. But these symptoms may not appear. Viral hepatitis C, even in the medical literature as "gentle silent killer." Among all types of hepatitis virus hepatitis C has the highest percentage of chronic - 70-85%. That is, if a person is ill, it is very likely to get the chronic form of hepatitis. The natural history of hepatitis C virus (from infection to the development of cirrhosis of the liver) takes 10 to 15 years, and sometimes up to 25 years - depending on the person's lifestyle. Therefore, it often happens that when a person goes to a doctor, it is already a very advanced forms of chronic hepatitis, often already at the stage of cirrhosis.
- What are the problems treated people, if they are not diagnosed with hepatitis C in the past?
- A person may qualify for elective surgery,be treated in the therapeutic, gastroenterological department in connection with heart disease, stomach and so on. n. An examination revealed accidentally hepatitis C. Chronic hepatitis usually turns into cirrhosis in 20% of cases. Among all patients with cirrhosis in 20% to decompensation of the disease, slow the progression of cirrhosis - 75%, primary liver cancer - 1-4% per year. To clear the problem was: one of the first places in the world the United States take a liver transplant. So, among the causes leading to liver transplant, the first place is hepatitis C. And this in a country with well-developed diagnostics.
- How often do you recommend to do the analysis on hepatitis C?
- I recommend to be surveyed for the presence of the virus once a year or at least every two years. People at risk - often. Then the chance of stopping the disease will be more.
- What are the ways a virus infection?
- Hepatitis C virus belongs to a group of infectionswith the parenteral route of transmission. That is, the infection occurs through blood and sexual contact. Danger are all manipulations with blood: tattoo, piercing, manicure, pedicure, medical procedures. If a person had surgery or blood transfusion before 1989, it must be tested for the presence of hepatitis C virus, as it has been opened in this year. At-risk groups include the same individuals as for HIV or hepatitis B: they are people who produce blood transfusions, parenteral interventions, taking drugs and so on.
- In what cases is a specific therapy of hepatitis C?
- Until recently, according to internationalTreatment Protocol treatment was carried out necessary resorting to specific antiviral therapy if diagnosed with viral replication (PCR positive) and ALT (alanine aminotransferase) above normal. ALT level is the main criterion cytolytic (inflammation) of the liver cells. Today these criteria are reviewed to treatment assignment. Since it was found that only 44% of patients with normal ALT levels at the long-term observation of morphological changes were observed in the liver. Therefore, to date, the European Association for the Study of Liver decision is made: indications for treatment of viral hepatitis C - a positive test for the polymerase chain reaction (PCR), that is, the presence of virus in the blood. ALT is no longer a criterion.
- Where can I do the analysis for hepatitis C?
- To say there is a problem or not,First you need to be tested for the presence of antibodies to hepatitis C virus, making PCR and blood chemistry. This can be done in any city commercial laboratory, or in a district clinic. If the analysis gives a negative result, and blood biochemistry, primarily ALT will be OK - it means everything is fine today. If PCR positive result - should see a specialist.
- If hepatitis C is detected in a pregnant woman, what to do?
- This is a separate and very serious topic. If a woman is ready to become pregnant, then she had to be tested for hepatitis C.
- And yet, if it happened?
- Complete statistics on fetal transmission of the virus there. The risk exists. But a woman with hepatitis C can have a healthy baby.
- Can the infection during birth?
- I'll try to explain with an example hepatitis B and HIV,which are characterized by the same transmission means. Here it is necessary to take into account the difference between them - the risk of infection if infected needle prick for HBV is 30% for hepatitis C 3% and 0.3% for HIV. The minimum infectious dose for HIV is 0.1 ml (this is enough) and for hepatitis B is 0.00004 ml. (Literally on the tip of the needle). To date, in the order of the Ministry of Health for the management of pregnant women with hepatitis B, there is no direct evidence of health personnel by Caesarean section because the statistical difference, according to evidence-based data on the infection of the child during cesarean section and natural childbirth does not exist. At the moment it is difficult to say when and how to catch the fruit, it is, again, a complex is a separate issue.
- Can a man with hepatitis C become the father of a healthy baby?
- A man with hepatitis C, is set to becomefather, must undergo therapy and six months after its successful completion, if it is not detected the virus, plan conception of the child. Could an infected man to conceive a healthy child - I can not tell you, because the statistical data on this issue does not exist. And no doctor, I think, would not recommend to a patient diagnosed with hepatitis C plan conception of the child prior to a specific therapy.
Treatment of Hepatitis C
- Then turn to the question of therapy. The still treat hepatitis C, how long does the treatment, how much it costs?
- Treatment of hepatitis C has undergone a number of modifications to theSince the opening of the virus. Initially, therapy was only interferon, then - interferon combined with ribaverinom, to date, the gold standard of care is the appointment of pegylated interferon, that is, those of interferons, which are used 1 time per week (thus achieving higher efficiency of therapy and decrease the frequency of adverse events) and ribaverina daily. Duration of therapy logged European Association for the Study of Liver (EASL) in 2002. Depending on the genotype of the virus (the virus is genetically very heterogeneous, and this is one of the reasons why there is no vaccination against hepatitis C) therapy lasts 24 or 48 weeks. The essential point is that the rather expensive treatment. Pegylated interferons, produced only two pharmaceutical companies in Switzerland and in the USA. The average cost of a single injection of this drug is 374 dollars. The good news today is that patients who undergo this therapy, received subsidized ribaverin, that is for him, he does not pay.
- And what about the domestic alpha-2 recombinant interferon?
- This is a short interferon, and interferons such therapy efficacy is within thirty percent.
- What is the efficacy of therapy with pegylated interferon?
- The effectiveness of such therapy depends on the genotype of the virus is from 40 to 80 percent.
- I saw the advertising of so-called "efferent therapy", which is offered by private clinics for patients with hepatitis C.
- It's nothing to do with the internationalProtocol management of patients with hepatitis C do not have. The methods of efferent therapy can prepare patients for treatment, remove toxicity, improve the biochemical parameters. For Hepatitis C virus the immune system produces antibodies, why the immune system in the end can not kill the virus, as in the case of hepatitis A and B. Due to the genetic heterogeneity of the virus and due to its minimal antigenic stimulation of the immune system, simply put the hepatitis C virus is constantly manages to evade the immune response. Hence, such a difference in chronic diseases. With chronicity hepatitis B 20%, that is, the remaining 80% will recover, even if you do not carry out active treatment. In hepatitis C chronicity 80%, so it is very important to identify the disease at an early stage. The sooner a patient diagnosed hepatitis C virus, the greater the chance of recovery.