Like rubella, mumps or chickenpox, jaundice is widely heard. The status of a disease is attributed to her among the people, which is fundamentally wrong. It is also a mistake to place this symptom in the list of "childhood" diseases, harmless and harmless for the most part. Jaundice can actually turn into a clinic of hepatitis C. He, in turn, without proper treatment becomes the cause of he alth-threatening complications. As a result, the disease associated with a name reeking of carelessness and childhood turns into a deadly killer whose goal is to decompose the liver.
Hepatitis C - what is it?
In medicine, the concept of "Hepatitis" appeared relatively recently. It wasn't until the early 1970s that scientists were able to discover its A and B varieties. Some time later, in 1989, the causative agent of hepatitis C was also discovered. It is a microscopic viral particle (up to 70 nm) that contains RNA covered with a protein coat. By its nature, hepatitis C is a viral disease, the causative agent of which can only parasitize in the human body.
What is dangerous and how is hepatitis C transmitted? About 400 thousand people die every year in the world because of the virus. The reason for this is life-threatening complications (cancer and cirrhosis of the liver), which develop against the background of a chronic variety of the disease. According to statistics, every year 24 out of 100,000 people become carriers of the virus. The prevalence of the disease in the European Region is 1.5%. In total, about 71 million people are infected with chronic hepatitis C in the world.
How the disease is transmitted
For a long time, people were massively infected with HCV after blood transfusions. This trend came to naught only when transfused donor blood began to be tested for the presence of hepatitis C. As for the present, this disease is often observed in drug addicts for the same reason. HCV in most cases is transmitted through the blood. This is accompanied by a violation of the principle of single use of needles and syringes. Dangerous in terms of the spread of hepatitis C are hospitals and other medical institutions that do not comply with the requirements regarding the sterility of the instruments used.
Much less often, the cause is sexual contact with a carrier of the virus, since the number of pathogens in the excreted secret is most often minimal. Hepatitis can be passed from mother to newborn baby, but only if she had an acute form of hepatitis immediately before childbirth. It is not transmitted with milk, as well as with close contact: withhugs, kisses, in case of sharing utensils.
Symptoms and signs of hepatitis C
An interesting feature of the disease is that the human immune system is able to cope with the virus without outside help. However, this does not happen often: only 20% of those infected get rid of the virus on their own. Moreover, more than half of those infected do not even suspect about it - everything is asymptomatic. The fight against the virus takes place in the body over a period of two weeks to six months. A person can become a carrier of the virus, while there are no symptoms, even the level of bilirubin in the blood does not increase. However, if the virus successfully adapts, an acute form of the disease may appear.
The acute hepatitis C clinic is similar to the regular flu clinic. Starting with a general malaise, the patient subsequently has a feverish state. It is accompanied by a sharp increase in body temperature and chills, body aches, pain in the joints and muscles. The picture of influenza is observed for several days, which is replaced by symptoms characteristic of hepatitis C. First of all, this is a manifestation of jaundice - staining of the eye sclera and skin in a pale yellow color, which is due to an increase in the level of bilirubin in the blood. The acute stage of hepatitis C is characterized by an increase in the size of the liver. There are sharp and aching pains under the right rib. The patient loses his appetite, he is sick after meals. The color of excretion products changes: urine becomes dark, feces become light.
With adventjaundice negative symptoms are weakened. About 30% of patients recover, while the rest develop a chronic form of the disease. It is the most dangerous for human he alth and life in general. Accompanied by a recurring feeling of fatigue, lethargy, headaches, disorders of appetite and digestion. High fatigue and physical weakness negatively affect the quality of life. However, the chronic stage of hepatitis C is dangerous, primarily due to the high risk of developing life-threatening diseases such as cirrhosis, fibrosis, and liver cancer. During the first 20 years after infection, the risk of developing cirrhosis is between 15 and 30%.
Diagnosis of disease
Hepatitis C is sometimes called the "gentle killer" for a reason. He, firstly, can skillfully disguise himself as other diseases. And secondly, in many cases, patients do not have any symptoms. For decades, they may not suspect that they are carriers of a dangerous disease. Therefore, the diagnosis and treatment of hepatitis C are difficult tasks. Often a person learns that he has hepatitis by accident. For example, when donating blood.
Diagnosis of this disease implies laboratory methods of examination, including tests and special procedures. First of all, it is necessary to donate blood for AsAT and AlAT, bilirubin - the so-called biochemical blood test. You also need to donate blood for the presence of anti-HCV bodies. The list of laboratory tests also includes PCR for hepatitis C, which detects the presence ofvirus RNA in the body. As for research, ultrasound (to establish the fact of an increase in internal organs) and a liver biopsy (to assess the degree of its damage) are mandatory to identify the symptoms of the disease.
Indicative are the results presented by the analysis for the presence of anti-HCV bodies in the blood. If they are present in the body, that is, if the result is positive, then most likely the person is sick with a chronic form of the disease. However, the presence of antibodies can also indicate other things. What do antibodies to hepatitis C mean in other cases? On the one hand, they may indicate that a person had once suffered from hepatitis, but his immune system itself was able to cope with the virus. On the other hand, a positive result may be false for reasons other than hepatitis.
Hepatitis C treatment
As already mentioned, the disease in 20% of cases does not require treatment due to a strong immune response that destroys the virus. In this case, patients do not even show the first signs of hepatitis C. Moreover, even if a person has a chronic form of hepatitis, signs of liver damage may not be observed. Therefore, treatment in this case is not vital. If the need exists, then treatment is carried out with antiviral drugs, PPD - direct-acting drugs. The cure rate with qualified medical care is 95%.
The very standards of treatment in the modern world are rapidly changing. HoweverUntil now, the combination of Sofosbuvir and Ledipasvir remains the drug with the best result for the treatment of hepatitis C. These medicines have been introduced into use quite recently, but have already proved their effectiveness. They allow you to achieve recovery in a shorter time, an average of 12 weeks. In medical practice, the drug "Ribavirin" also often appears, but the World He alth Organization recommends gradually phasing out its use. Treatment of hepatitis C "Daklatasvir" seems to be more modern and effective.
As for surgery, it is only necessary in case of severe damage to the liver. Then the patient needs a graft transplant. Transplantation will not have the desired effect if the pathogen has not been destroyed in the body. Then the clinic of hepatitis C in 98% of cases reappears already 3-5 years after the transplant. Provided that the virus is eliminated before transplantation, antiviral treatment can be continued after surgery.
Clinical Treatment Guidelines
Development of key recommendations for the treatment of infectious diseases rests with the World He alth Organization. Regarding hepatitis, the recommendations are consistent. The first step is the implementation of screening of people who live in the least favorable areas with a high concentration of cases. Further, if the presence of the virus has been confirmed,separate screening for the possibility of chronic infection should be performed. Clinical guidelines for hepatitis C include specific screening for alcohol consumption in people with HCV. The results of the test are accompanied by behavioral therapy aimed at reducing the amount of alcoholic beverages consumed. This is important because alcohol, combined with the progressive effects of hepatitis, is the most damaging to the liver.
These consequences include fibrosis and cirrhosis of the liver. One of the key recommendations is to assess their neglect. In areas where there is a shortage of medical resources, low-cost testing such as FIB4 or APRI is suggested. As for hepatitis C and clinical guidelines for its treatment, the latter should be based on the use of antiviral drugs instead of those based on interferon. However, not all DAAs are recommended for use. For example, Telaprevir and Boceprevir, which appeared in the 2014 WHO reports as effective drugs, have now dropped out of this list. It has been proven that the harm from their use outweighs the benefits.
Disease prevention
It should be noted right away that there is no such type of hepatitis C prevention as vaccination at the moment. As of 2016, there are several prototype vaccines in the world that promise to be successful, but so far they are only at the development stage. Therefore, the most important task of prevention is to minimize the risk of HCV infection in thosecommunity groups most commonly affected by the hepatitis virus. These are mostly people who are addicted to injecting drugs, as well as people who lead a wild lifestyle and do not have a permanent sexual partner. In total, HCV prevention is divided into 3 types: primary, secondary and tertiary.
The hepatitis virus in most cases is transmitted through the blood, so the primary prevention is the use of sterile syringes and injection needles, both medical and narcotic. Moreover, the equipment should be exclusively disposable. You can get infected in hospital conditions, in medical institutions. For example, when transfusing blood containing HCV. These cases, however, have become rare as each donor is screened for hepatitis C before blood donation. Personal hygiene, such as clean hands, is essential as part of primary prevention.
As for the secondary and tertiary varieties, they are aimed at those people who are already infected with HCV. First of all, this is regular consultations regarding possible options for medical care. This is a constant monitoring of the liver, the task of which is to assess the degree of damage to this organ. An extremely important principle in the framework of secondary and tertiary prevention is to prevent the development of coinfection in the body in the form of joining the hepatitis C clinic with symptoms of its varieties A and B.
WHO actions and plans
The challenges that WHO sets for itself are much larger than just an indicationpreventive measures. In 2016, the organization published a multi-pronged strategy to combat viral hepatitis. It is designed for 5 years and sets itself the task, first of all, of coordinating the efforts of all states and international he alth organizations to combat the spread of hepatitis. In the future, it is planned to reduce the death rate from hepatitis C by 65% by 2030. There are also plans for a hard crossover of new HCV infections, by as much as 90%, which should ideally remove hepatitis from the list of international he alth problems.
Already, the World He alth Organization is providing all kinds of support to countries interested in eliminating a dangerous disease. First, WHO uses its resources to screen and treat people with HCV. The organization also allocates resources for diagnostic procedures, for example, for PCR testing for hepatitis C. WHO also provides statistical reports. Their essence lies in the arrangement of information regarding the spread of hepatitis and the effectiveness of the fight against it. Mortality, chronic disease and life-threatening complications are also noted.
Social and financial aspects of the disease
Due to the fact that most of society does not have a clear understanding of hepatitis, the patients themselves end up suffering not only from the hepatitis C clinic, but also from the attitude of the surrounding society towards them, which is often biased. Often patients are subject to social isolation. They face a problemthe impossibility of employment, the establishment of new friendships and love relationships, the creation of a full-fledged family. As a result, the social adaptation of patients is under threat, which negatively affects their mental he alth and psychological well-being.
It is also worth noting the price issue. Implementation of a full 12-week treatment of hepatitis costs a lot of money due to the high cost of antiviral drugs. And it is considered especially expensive in the territory of the CIS countries. For example, in Russia, the treatment of hepatitis C, which uses interferon-free drugs, can reach 1 million rubles. The solution of this issue is hindered by the lack of a unified state policy aimed at combating the inaccessibility of treatment for the general public. State support is limited to medical propaganda, including the creation of websites and platforms, as well as public thematic associations.
The most effective way to combat the high cost of treatment was the introduction into circulation of generics - copies of real drugs that have the same features as the original, but are several times cheaper. They are available, however, only in those regions of the world that are recognized by the international community as extremely poor. Egypt and India received patents for the trade in generics in 2013.
From there, generics through individuals get to other countries, in particular, to the Russian Federation. They are prohibited for sale on the territory of Russia, but sales are still carried out. There is no other way out for patients - only 10 thousand infected people can receive treatment according to quotas forstate account. The rest buy Egyptian and Indian degenerics. In Russia, the price of a medicine for hepatitis C, or rather, its analogue, ranges from 20 to 70 thousand rubles.
General conclusion
Hepatitis C is a highly dangerous viral disease. Not only can he hide himself under the guise of other diseases, but he rarely speaks about his presence. Often people accidentally find out that they are infected with HCV. This can happen both six months after the penetration of the virus into the blood, and after several decades. You can find out about the presence of the virus in the blood using a rapid test for hepatitis C. Prices for it start at 250 rubles and cost no more than 3 thousand. Human immunity is able to defeat the virus either by itself or with the help of antiviral drugs used in the acute form of the disease.
If this does not happen, then hepatitis C becomes chronic. It is she who is extremely dangerous for human life, since at this time the risks of developing serious liver damage increase significantly. For example, fibrosis, cirrhosis, cancer. Therefore, early detection of hepatitis C is one of the important diagnostic tasks. If the results of examinations, including PCR for hepatitis C, showed a positive result, then treatment should begin immediately. On average, it lasts 12 weeks and, thanks to the achievements of modern medicine, 95% of patients who receive qualified help eventually recover.
One of the key problems in the fight against hepatitis C is the high cost of treatment. It is not cheap. In thissituations of the poor are saved by generics - effective copies of drugs. The price of a medicine for hepatitis C in Russia varies from 20,000 to 70,000 rubles. Moreover, it is not enough to help an individual, because the world needs more coverage of the issue of hepatitis C. Medical advocacy is now actively conducted in this direction, in which the World He alth Organization plays an important role.
