Hepatitis C | NIDDK

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What is hepatitis C?

Hepatitis C is a viral infection that causes liver inflammation and damage. Inflammation is swelling that occurs when tissues of the body become injured or infected. Inflammation can damage organs.

Viruses invade normal cells in your body. Many viruses cause infections that can be spread from person to person. The hepatitis C virus spreads through contact with an infected person’s blood.

Hepatitis C can cause an acute or chronic infection.

Although no vaccine for hepatitis C is available, you can take steps to protect yourself from hepatitis C. If you have hepatitis C, talk with your doctor about treatment. Medicines can cure most cases of hepatitis C.

Acute hepatitis C

Acute hepatitis C is a short-term infection. Symptoms can last up to 6 months. Sometimes your body is able to fight off the infection and the virus goes away.

Chronic hepatitis C

Chronic hepatitis C is a long-lasting infection. Chronic hepatitis C occurs when your body isn’t able to fight off the virus. About 75 to 85 percent of people with acute hepatitis C will develop chronic hepatitis C.¹³

Early diagnosis and treatment of chronic hepatitis C can prevent liver damage. Without treatment, chronic hepatitis C can cause chronic liver disease, cirrhosis, liver failure, or liver cancer.

How common is hepatitis C in the United States?

In the United States, hepatitis C is the most common chronic viral infection found in blood and spread through contact with blood.¹⁴

Researchers estimate that about 2.7 million to 3.9 million people in the United States have chronic hepatitis C.¹³ Many people who have hepatitis C don’t have symptoms and don’t know they have this infection.

Since 2006, the number of new hepatitis C infections has been rising, especially among people younger than age 30 who inject heroin or misuse prescription opioids and inject them. ^15,16

New screening efforts and more effective hepatitis C treatments are helping doctors identify and cure more people with the disease. With more screening and treatment, hepatitis C may become less common in the future. Researchers estimate that hepatitis C could be a rare disease in the United States by 2036.¹⁷

Who is more likely to get hepatitis C?

People more likely to get hepatitis C are those who

• have injected drugs
• had a blood transfusion or organ transplant before July 1992
• have hemophilia and received clotting factor before 1987
• have been on kidney dialysis
• have been in contact with blood or infected needles at work
• have had tattoos or body piercings
• have worked or lived in a prison
• were born to a mother with hepatitis C
• are infected with HIV
• have had more than one sex partner in the last 6 months or have a history of sexually transmitted disease
• are men who have or had sex with men

In the United States, injecting drugs is the most common way that people get hepatitis C. ¹³

Should I be screened for hepatitis C?

Doctors usually recommend one-time screening of all adults ages 18 to 79 for hepatitis C. Screening is testing for a disease in people who have no symptoms. Doctors use blood tests to screen for hepatitis C. Many people who have hepatitis C don’t have symptoms and don’t know they have hepatitis C. Screening tests can help doctors diagnose and treat hepatitis C before it causes serious health problems.

Doctors usually recommend one-time screening of all adults ages 18 to 79 for hepatitis C.

What are the complications of hepatitis C?

Without treatment, hepatitis C may lead to cirrhosis, liver failure, and liver cancer. Early diagnosis and treatment of hepatitis C can prevent these complications.

Cirrhosis

Cirrhosis is a condition in which the liver slowly breaks down and is unable to function normally. Scar tissue replaces healthy liver tissue and partially blocks the flow of blood through the liver. In the early stages of cirrhosis, the liver continues to function. However, as cirrhosis gets worse, the liver begins to fail.

Liver failure

Also called end-stage liver disease, liver failure progresses over months, years, or even decades. With end-stage liver disease, the liver can no longer perform important functions or replace damaged cells.

Liver cancer

Having chronic hepatitis C increases your chance of developing liver cancer. If chronic hepatitis C causes severe liver damage or cirrhosis before you receive hepatitis C treatment, you will continue to have an increased chance of liver cancer even after treatment. Your doctor may suggest blood tests and an ultrasound or another type of imaging test to check for liver cancer. Finding cancer at an early stage improves the chance of curing the cancer.

What are the symptoms of hepatitis C?

Most people infected with hepatitis C have no symptoms. Some people with an acute hepatitis C infection may have symptoms within 1 to 3 months after they are exposed to the virus. These symptoms may include

If you have chronic hepatitis C, you most likely will have no symptoms until complications develop, which could be decades after you were infected. For this reason, hepatitis C screening is important, even if you have no symptoms.

What causes hepatitis C?

The hepatitis C virus causes hepatitis C. The hepatitis C virus spreads through contact with an infected person’s blood. Contact can occur by

• sharing drug needles or other drug materials with an infected person
• getting an accidental stick with a needle that was used on an infected person
• being tattooed or pierced with tools or inks that were not kept sterile—free from all viruses and other microorganisms—and were used on an infected person before they were used on you 
• having contact with the blood or open sores of an infected person
• using an infected person’s razor, toothbrush, or nail clippers
• being born to a mother with hepatitis C
• having unprotected sex with an infected person

You can’t get hepatitis C from

• being coughed or sneezed on by an infected person
• drinking water or eating food
• hugging an infected person
• shaking hands or holding hands with an infected person
• sharing spoons, forks, and other eating utensils
• sitting next to an infected person

A baby can’t get hepatitis C from breast milk. ¹⁸

How do doctors diagnose hepatitis C?

Doctors diagnose hepatitis C based on your medical history, a physical exam, and blood tests. If you have hepatitis C, your doctor may perform additional tests to check your liver.

Medical history

Your doctor will ask about your symptoms and whether you have any history of blood transfusions or injected drug use.

Physical exam

During a physical exam, your doctor will typically examine your body to check for signs of liver damage such as

• changes in skin color
• swelling in your lower legs, feet, or ankles
• tenderness or swelling in your abdomen

What tests do doctors use to diagnose hepatitis C?

Doctors use blood tests to diagnose hepatitis C. Your doctor may order additional tests to check for liver damage, find out how much liver damage you have, or rule out other causes of liver disease.

Blood tests

Your doctor may order one or more blood tests to diagnose hepatitis C. A health care professional will take a blood sample from you and send the sample to a lab.

Blood tests for hepatitis C include the following:

• Screening test for antibodies to the hepatitis C virus. A screening blood test will show whether you have developed antibodies to the hepatitis C virus. A positive antibody test means you were exposed to the hepatitis C virus at some point. However, the virus may no longer be present in your blood if your body fought off the infection on its own or if you received treatment that cured the infection.
• Hepatitis C RNA test. If your antibody test is positive, your doctor will use a hepatitis C RNA test to detect RNA—a type of genetic material—from the hepatitis C virus. The hepatitis C RNA test can show whether you still have the hepatitis C virus and how much virus is in your blood. This information can help your doctor treat the infection. To see if you are responding to treatment, your doctor may order this test while you are undergoing treatment to find out if the amount of virus in your blood is changing.
• Genotype test. Your doctor can use this test to find out what strain, or form, of hepatitis C virus you have. At least six specific strains—called genotypes—of hepatitis C exist. Genotype 1 is the most common hepatitis C genotype in the United States.¹ Your doctor will recommend treatment based on which hepatitis C genotype you have.

Your doctor may order one or more blood tests to diagnose hepatitis C.

Additional tests

If you’ve had chronic hepatitis C for a long time, you could have liver damage. Your doctor may recommend additional tests to find out whether you have liver damage, how much liver damage you have, or to rule out other causes of liver disease. These tests may include

• blood tests
• transient elastography, a special ultrasound of your liver
• liver biopsy, in which a doctor uses a needle to take a small piece of tissue from your liver

Doctors typically use liver biopsy only if other tests don’t provide enough information about a person’s liver damage or disease. Talk with your doctor about which tests are best for you.

How do doctors treat hepatitis C?

Doctors treat hepatitis C with antiviral medicines that attack the virus and can cure the disease in most cases.

Several newer medicines, called direct-acting antiviral medicines, have been approved to treat hepatitis C since 2013. Studies show that these medicines can cure chronic hepatitis C in most people with this disease. These medicines can also cure acute hepatitis C. In some cases, doctors recommend waiting to see if an acute infection becomes chronic before starting treatment.

Your doctor may prescribe one or more of these newer, direct-acting antiviral medicines to treat hepatitis C:

Newer medicines are sometimes used along with these older hepatitis C medicines:

Doctors treat hepatitis C with antiviral medicines that attack the virus.

You may need to take medicines for 8 to 24 weeks to cure hepatitis C. Your doctor will prescribe medicines and recommend a length of treatment based on

• which hepatitis C genotype you have
• how much liver damage you have
• whether you have been treated for hepatitis C in the past

Your doctor may order blood tests during and after your treatment. Blood tests can show whether the treatment is working. Hepatitis C medicines cure the infection in most people who complete treatment.

Hepatitis C medicines may cause side effects. Talk with your doctor about the side effects of treatment. Check with your doctor before taking any other prescription or over-the-counter medicines.

For safety reasons, talk with your doctor before using dietary supplements, such as vitamins, or any complementary or alternative medicines or medical practices.

Cost of hepatitis C medicines

The newer direct-acting antiviral medicines for hepatitis C can be costly. Most government and private health insurance prescription drug plans provide some coverage for these medicines. Talk with your doctor about your health insurance coverage for hepatitis C medicines.

Drug companies, nonprofit organizations, and some states offer programs that can help pay for hepatitis C medicines. If you need help paying for medicines, talk with your doctor. Learn more about financial help for hepatitis C medicines.

How do doctors treat the complications of hepatitis C?

If hepatitis C leads to cirrhosis, you should see a doctor who specializes in liver diseases. Doctors can treat the health problems related to cirrhosis with medicines, surgery, and other medical procedures. If you have cirrhosis, you have an increased chance of liver cancer. Your doctor may order an ultrasound test to check for liver cancer.

If hepatitis C leads to liver failure or liver cancer, you may need a liver transplant.

How can I protect myself from hepatitis C infection?

If you don’t have hepatitis C, you can help protect yourself from hepatitis C infection by

• not sharing drug needles or other drug materials
• wearing gloves if you have to touch another person’s blood or open sores
• making sure your tattoo artist or body piercer uses sterile tools and unopened ink
• not sharing personal items such toothbrushes, razors, or nail clippers

Hepatitis C can spread from person to person during sex, but the chances are low. People who have multiple sex partners, have HIV or other sexually transmitted diseases, or who engage in rough or anal sex have a higher chance of getting hepatitis C. Talk with your doctor about your risk of getting hepatitis C through sex and about safe sex practices, such as using a latex or polyurethane condom to help prevent the spread of hepatitis C. 

Do not share drug needles or other drug materials.

If you had hepatitis C in the past and your body fought off the infection or medicines cured the infection, you can get hepatitis C again. Follow the steps above, and talk with your doctor about how to protect yourself from another hepatitis C infection. 

If you think you may have been exposed to the hepatitis C virus, see your doctor as soon as possible. Early diagnosis and treatment can help prevent liver damage.

How can I prevent spreading hepatitis C to others?

If you have hepatitis C, follow the steps above to avoid spreading the infection. Tell your sex partner you have hepatitis C, and talk with your doctor about safe sex practices. In addition, you can protect others from infection by telling your doctor, dentist, and other health care providers that you have hepatitis C. Don’t donate blood or blood products, semen, organs, or tissue.

Is a hepatitis C vaccine available?

Researchers are still working on a vaccine for hepatitis C. If you have hepatitis C, talk with your doctor about vaccines for hepatitis A and hepatitis B. These vaccines can protect you from hepatitis A and hepatitis B infections, which could further damage your liver.

What should I eat and drink if I have hepatitis C?

If you have hepatitis C, you should eat a balanced, healthy diet. Talk with your doctor about healthy eating. You should also avoid alcohol because it can cause more liver damage.

References

[13] Hepatitis C FAQs for health professionals. Centers for Disease Control and Prevention, Division of Viral Hepatitis website. www.cdc.gov/hepatitis/HCV/HCVfaq.htm. Updated July 21, 2016. Accessed October 19, 2016.

[14] U.S. Preventive Services Task Force. Final recommendation statement: hepatitis C virus infection in adolescents and adults: screening. www.uspreventiveservicestaskforce.org/Page/Document/RecommendationStatementFinal/hepatitis-c-screening1. Current as of March 2020. Accessed March 2, 2020.

[15] Suryaprasad AG, White JZ, Xu F, et al. Emerging epidemic of hepatitis C virus infections among young nonurban persons who inject drugs in the United States, 2006–2012. Clinical Infectious Diseases. 2014;59(10):1411–1419.

[16] Viral hepatitis and young persons who inject prescription opioids and heroin. Centers for Disease Control and Prevention website. www.cdc.gov/hepatitis/featuredtopics/youngpwid.htm. Updated March 30, 2016. Accessed October 19, 2016.

[17] Kabiri M, Jazwinski AB, Roberts MS, Schaefer AJ, Chhatwal J. The changing burden of hepatitis C virus infection in the United States: model-based predictions. Annals of Internal Medicine. 2014;161(3):170–180.

[18] Hepatitis B and C infections. Centers for Disease Control and Prevention, Division of Nutrition, Physical Activity, and Obesity website. www.cdc.gov/breastfeeding/disease/hepatitis.htm. Updated June 17, 2015. Accessed October 19, 2016.

Hepatitis C

Overview

What is hepatitis C?

Hepatitis C is an infection of the liver that is caused by a virus and spread through contact with the blood of an infected person. Some people can have hepatitis C for years without feeling sick, or may just have minor symptoms.

If the infection is not treated, it can cause the liver to swell and become inflamed. Over time, this can lead to cirrhosis of the liver, and possibly liver failure. As the disease develops, symptoms of liver damage may appear.

What are the types of hepatitis C infection?

There are two types of hepatitis C infection:

• Acute: a short-term infection that occurs within 6 months after a person is exposed to the virus. However, about 75 to 85 percent of people with the acute form go on to develop the chronic form.
• Chronic: a long-term illness that can continue throughout a person’s life. It can lead to cirrhosis (scarring) of the liver and other serious problems, such as liver failure or cancer. About 15,000 people a year die from liver disease associated with hepatitis C.

How common is hepatitis C?

Between 2.7 million and 3.9 million people in the United States have chronic hepatitis C. Hepatitis C is the leading cause of cirrhosis of the liver and liver cancer. It is the most common reason for liver transplants in the United States.

Symptoms and Causes

What causes hepatitis C?

Hepatitis C is caused when blood from an infected person enters the body of an uninfected person. These are the most common methods of infection:

• An infected person shares needles or syringes for injecting intravenous (IV) drugs. Even people who have used IV drugs infrequently may be at risk for infection.
• Healthcare workers who accidentally stick themselves with needles used on infected patients are at risk of getting hepatitis C.
• Patients who received donated blood or blood products or who had organ transplants before 1992 are at higher risk for hepatitis C.

Less common ways of spreading hepatitis C include the following:

• Sexual contact with an infected person. Although the risk of getting hepatitis C through sexual intercourse is low, the risk increases for people who have several sex partners or those with HIV infections.
• Sharing a razor, toothbrush or other personal item that may have come into contact with the blood of an infected person.
• Becoming infected through body piercing or tattooing, if the facility does not use sterile equipment or does not follow infection control practices.

Babies born to mothers who have hepatitis C might become infected, although this is not common. In addition, “baby boomers” (people born in the United States between 1945 and 1965) are at increased risk of having hepatitis C and should be screened for it.

Hepatitis C cannot be spread by simple contact (hugging, kissing, etc.) or by coughing or sneezing.

What are the symptoms of hepatitis C?

People who are infected with hepatitis C often do not have any symptoms. When symptoms do appear, they may be similar to those of flu. Symptoms usually take from 2 weeks to 6 months after exposure to the virus before they occur.

Symptoms of acute hepatitis C may include:

• Achiness in the joints or muscles
• Mild fatigue (feeling tired)
• Nausea (feeling sick to the stomach)
• Loss of appetite
• Tenderness in the area of the liver

Symptoms of liver damage associated with chronic hepatitis may include jaundice (yellowing of the skin and whites of the eyes), itching, and slowed thinking.

Diagnosis and Tests

How is hepatitis C diagnosed?

The doctor will take the patient’s medical history and perform a physical examination. As part of the physical exam, the doctor will look for signs of liver damage, including tenderness in the abdomen, swelling in the legs, feet or ankles, or signs of jaundice, such as yellowing of the skin and whites of the eyes.

Several blood tests may be used to test for hepatitis C. The first blood test is antibody testing for hepatitis C. (The body makes antibodies in response to an infectious substance, such as a virus.)

If antibodies are found, that means that the person was exposed to hepatitis C at some point. A blood test called a PCR RNA can determine if the blood is still infected with the active virus. If the result is positive, it means that the person is currently infected with hepatitis C. If the PCR RNA is negative but the antibody testing was positive, this means that the patient has been exposed to the virus in the past but currently does not have an active infection.

A person who has hepatitis C may have to have a liver biopsy or a liver fibrosis scan (also known as a fibroscan) to tell if the liver is damaged, and how much damage has occurred.

You should be referred to a specialist who has experience in treating hepatitis C as soon as you are diagnosed with active (chronic) hepatitis C infection.

Management and Treatment

How is hepatitis C treated?

There is no vaccine for hepatitis C. The aim of treatment for hepatitis C is to eradicate the virus from the blood completely, and to protect the liver from developing cirrhosis or liver cancer.

Several medications are available to treat hepatitis C. The hepatitis C virus has six different types or strains (also known as genotypes). The type and length of treatment may vary. Some hepatitis strains do not respond to antiviral medications as well as others. Some medications may not be suitable for all patients with hepatitis C, because of the side effects or the patient’s other medical conditions.

These are the medications approved for treatment of hepatitis C infection:

IMPORTANT: Ribavirin may cause birth defects. Both men and women taking Ribavirin MUST use two forms of birth control during therapy and for up to six months after stopping therapy. Patients should be monitored by their doctors when using these drugs.

Prevention

Can hepatitis C be prevented?

There is no vaccine against hepatitis C. The only way to prevent infection is to avoid contact with infected blood.

Hepatitis C cannot be spread by coughing, sneezing or sharing eating utensils. People should not be kept away from school, work, or other social settings because they have hepatitis C.

Here are some precautions that may prevent the spread of hepatitis C:

• Do not share personal care items, such as toothbrushes or razors, with others.
• Practice safe sex by using condoms.
• Don’t share needles or syringes.
• Wear gloves when handling another person’s blood.
• Use sterile equipment for body piercings or tattoos.
• If you are a healthcare worker, follow recommended safety measures.

People who are at greater risk for contracting hepatitis C should have their blood tested. The Centers for Disease Control recommends that Americans born between 1945 and 1965 be screened at least once for the disease.

Outlook / Prognosis

What is the prognosis (outlook) for someone who has hepatitis C?

You can continue to lead an active life even if you are diagnosed with hepatitis C. People with the disease can work and continue their regular daily activities. However, it is very important that you see a specialist as soon as you are diagnosed with hepatitis C. There are many treatments available that can cure the virus.

To maintain a healthy lifestyle, patients should:

• Exercise regularly
• Eat balanced, nutritious meals
• Limit how much alcohol they drink or abstain completely (depending on the extent of liver damage from the virus; check with your doctor).
• Check with a doctor before taking over-the-counter medications, such as acetaminophen (Tylenol®) or any other medications.

Hepatitis C – Disease Prevention and Control, San Francisco Department of Public Health

What is Hepatitis C?

Hepatitis C is a contagious liver infection caused by the hepatitis C virus (HCV).

The hepatitis C virus was discovered in 1989. Prior to that, it was associated with blood transfusions, but was called non-A, non-B hepatitis because the virus could not be identified. It is now known that there are several genetic types (genotypes) of the hepatitis C virus.

The natural course of hepatitis C disease varies from one person to another.

• The first phase of disease is called acute hepatitis C and covers the first 6 months after a person is infected. During this phase, most people show no symptoms at all. Among those who do have symptoms, the illness is usually so mild that most don’t even recognize that they have liver disease.
• In 15-40% of persons with acute hepatitis C, the immune system successfully fights off the infection, the virus is cleared from the body within 6 months, and the liver heals completely. In everyone else, the immune system cannot clear the virus, and hepatitis C infection persists past 6 months (usually for the rest of the person’s life). This persistent state is known as chronic hepatitis C.
• In chronic hepatitis C, the liver becomes more and more inflamed and scarred over a period of years. However, the speed at which inflammation and scarring take place varies between people. About 1/3 develop severe liver scarring and the liver stops functioning normally (cirrhosis) within 20 years. Another 1/3 take 30 years for cirrhosis to occur. In the remaining 1/3, liver disease progresses slowly and does not become a major problem during their lifetime.

Hepatitis C can be treated and cured. Almost everyone living with HCV can now be cured with a one-pill-a-day regimen in eight-to-twelve weeks. These new medications are generally well-tolerated. In order to access HCV treatment, it is necessary to see your doctor to discuss treatment options. Access to treatment continues to improve as new medication regimens are made available by private health insurers and public health programs like the VA Medical Centers, the AIDS Drug Assistance Program, Medicaid, and MediCal.

How do People Get Hepatitis C?

Hepatitis C virus is found in the blood of people with HCV infection. It enters the body through blood-to-blood contact.

Until reliable blood tests for HCV were developed (around 1992), people usually got hepatitis C from blood products and blood transfusions. Now that blood and blood products are tested for HCV, this is no longer the typical means of infection.

Currently, people usually get hepatitis C by sharing needles for injection drug use. An HCV-infected woman can pass the infection to her baby during birth. It is also possible to get hepatitis C from an infected person through sexual contact, an accidental needlestick with a contaminated needle, or improperly sterilized medical, acupuncture, piercing, or tattooing equipment.

Who is at Risk for Infection?

• People who inject drugs
• Hemodialysis patients
• Recipients of blood transfusions, blood products, or solid organ transplants before 1992
• Infants born to infected mothers
• Health care and public safety workers who may have contact with blood
• People having sex with an infected partner

How is Hepatitis C Infection Prevented?

Unfortunately, there is no vaccine to prevent hepatitis C. To reduce your risk of getting hepatitis C:

• Injection drug use is the most common way people get hepatitis C. Avoid injecting drugs to reduce your risk. If you do inject drugs, use sterile injection equipment. Avoid reusing or sharing.
• Avoid sharing personal care items that might have blood on them (razors, toothbrushes, nail clippers)
• If you are a health care or public safety worker, follow universal blood/body fluid precautions and safely handle needles and other sharps
• Consider the risks if you are thinking about tattooing, body piercing, or acupuncture – are the instruments properly sterilized?
• If you’re having sex with more than one partner, use latex condoms correctly and every time to prevent the spread of sexually transmitted diseases, including hepatitis C.

What are the Symptoms of Hepatitis C?

During the acute phase (first 6 months after infection) most persons have no symptoms or might experience a mild illness.  Symptoms of acute HCV infection, when present, may include:

• Jaundice (yellowing of the skin and eyes)
• Dark-colored urine, light-colored stools
• Fatigue
• Abdominal pain
• Loss of appetite
• Nausea
• Diarrhea
• Fever

During the chronic phase (> 6 months after infection) hepatitis C usually progresses silently, with no symptoms at all during the first 10-20 years. Signs of severe liver scarring (cirrhosis) may include:

• Ascites (accumulation of fluid and swelling of the abdominal cavity)
• Star-shaped vein pattern developing on the swollen belly
• Jaundice
• Itching
• Easy bruising and bleeding

Because symptoms of hepatitis C are usually absent, persons with risk for HCV infection should be tested. The blood test for hepatitis C infection is called the “hepatitis C antibody test.” People who have hepatitis C infection will show positive antibodies on this test. In many cases, it is necessary to confirm a positive hepatitis C antibody test with a more specific test, such as a test for HCV virus RNA.

If you think you have hepatitis C or have risk for hepatitis C, you should contact your doctor. The Communicable Disease Control Unit (415-554-2830) may be able to help answer your questions.

Additional Information

Hepatitis C symptoms & treatments – Illnesses & conditions

Hepatitis C can be treated with a single, or combination of, medicines that stop the virus multiplying inside the body. Traditionally hepatitis C was treated with interferon (an injection) and ribavirin. New, all-oral medicines are now available for everyone and treatment is usually only for 8-12 weeks.

Using these latest medications, around 95% or more of people with hepatitis C will be cured. However, it’s important to be aware that you won’t be immune to the infection and should take steps to reduce your risk of becoming infected again.

If the infection is diagnosed in the early stages, known as acute hepatitis, treatment may not need to begin straight away. Instead, you may have another blood test after a few months to see if your body fights off the virus.

If the infection continues for several months, known as chronic hepatitis, treatment will usually be recommended.

Your treatment plan

Treatment for hepatitis C involves:

• making lifestyle changes to help prevent further damage to your liver and reduce the risk of spreading the infection
• taking medications to fight the virus

You’ll normally need to take medication for 8-12 weeks. This length of time will depend on the exact medicines you’re taking and which version (strain) of the hepatitis C virus you have. Your doctor will advise you about this.

There are 6 main strains of the virus. In the UK, the most common strains are known as “genotype 1” and “genotype 3”.

During treatment, you should have blood tests to check if your medication is working. Using these latest medications, around 95% or more of people with hepatitis C will be cured.

Lifestyle measures

There are some things you can do to help limit or even undo any damage to your liver and before you start treatment you can prevent the infection spreading to others. These can include:

• eating a healthy and balanced diet
• exercising regularly
• cutting out alcohol or limiting your intake
• stopping smoking
• keeping personal items, such as toothbrushes or razors, for your own use
• not sharing any needles or syringes with others

Read some FAQs about living with hepatitis C for more information.

Hepatitis C medications

Until relatively recently, treatment for chronic hepatitis C usually involved taking 2 main medicines:

• pegylated interferon
• ribavirin

Newer medications

There are now a number of new medicines, called direct acting antivirals (DAA) that are always used to treat hepatitis C . DAA tablets are the safest and most effective medicines for treating hepatitis C.

These medications are taken as tablets once or twice a day, for between eight and 16 weeks, depending on the exact medicine you’re taking, your hepatitis C genotype and the severity of your condition.

Some types of hepatitis C can be treated using more than 1 type of DAA.

NHS-approved hepatitis C medicines include:

• sofosbuvir
• a combination of ledipasvir and sofosbuvir
• a combination of ombitasvir, paritaprevir and ritonavir, taken with or without dasabuvir
• a combination of sofosbuvir and velpatasvir
• a combination of sofosbuvir, velpatasvir and voxilaprevir
• a combination of glecaprevir and pibrentasvir
• ribavarin

For more information on a particular drug, see the NICE guidelines on treating chronic hepatitis C

How effective is treatment?

The new medications now available cure more than 95% of all infections, across all genotypes and levels of disease progression.

If the virus is successfully cleared with treatment, it’s important to be aware that you’re not immune to the infection. This means, for example, that you could become infected again if you continue to inject drugs after treatment.

If treatment doesn’t work, it may be repeated, extended or tried using a different combination of medicines.

Side effects of treatment

Treatments with direct acting antivirals (DAAs) have very few side effects. Most people find DAA tablets very easy to take.

You may feel a little sick and have trouble sleeping to begin with, but this should soon settle down.

Your nurse or doctor should be able to suggest things to help ease any discomfort.

You need to complete the full course of treatment to ensure you clear the hepatitis C virus from your body.

If you have any problems with your medicines, speak to your doctor or nurse straight away.

Side effects for each type of treatment can vary from person to person.

For a very small number of people, more severe side effects from hepatitis C treatments may include:

Hepatitis C medications may have unpredictable reactions when taken with other medicines or remedies. Always check with your specialist, GP or pharmacist before taking other types of medication.

Any side effects may improve with time as your body gets used to the medications. Tell your care team if any side effect is becoming particularly troublesome.

Treatment during pregnancy

The medications used to treat hepatitis C, particularly ribavirin, can be harmful to unborn babies and aren’t normally used during pregnancy.

If you’re pregnant when diagnosed with the infection, treatment will usually be delayed until you have given birth. Otherwise, you’ll be advised to use contraception throughout your treatment and you may need to have regular pregnancy tests.

If you’re a man taking ribavirin, you shouldn’t have sex with a pregnant women unless you use a condom. If your partner isn’t pregnant, you should ensure contraception is used during the course of your treatment and your partner may need to have regular pregnancy tests.

Deciding against treatment

Some people with chronic hepatitis C decide against treatment. This may be because they:

• don’t have any symptoms
• are willing to live with the risk of cirrhosis at a later date
• don’t feel the potential benefits of treatment outweigh the side effects treatment can cause

Your care team can give you advice about this, but the final decision about treatment will be yours.

If you decide not to have treatment but then change your mind, you can ask to be treated at any point.

Hepatitis C Basic Information | HHS.gov

• The number of reported acute hepatitis C infections have more than quadrupled from 2010 to 2018, primarily due to increased injection of opioids and other drugs.
• Safe and effective treatments can cure hepatitis C in almost everyone who takes them. They are called Direct Acting Antivirals or DAAs.
• One-time universal hepatitis C screening is recommended for all adults aged 18 years and older and for all pregnant women during each pregnancy.
• Regular hepatitis C testing is recommended for people with ongoing risk factors.

Topics on this page: What Is Hepatitis C? | How Many People Have Hepatitis C? | Who Is Most Affected? | Recent Increases in Hepatitis C Infections | HIV and Hepatitis C Coinfection | How Is Hepatitis C Transmitted? | Hepatitis C Prevention | Testing | Effective Treatments Are Available for Hepatitis C | Help Raise Awareness About Hepatitis C | Learn More About Hepatitis C

What Is Hepatitis C?

Hepatitis C is a liver infection caused by the hepatitis C virus (HCV). Hepatitis C is a blood-borne virus. Today, most people become infected with HCV by sharing needles or other equipment to inject drugs. For some people, HCV infection is a short-term or acute illness but for more than half of people who become infected with HCV, it becomes a long-term, chronic infection. Chronic HCV infection is a serious disease that can result in long-term health problems, even death. The majority of infected people might not be aware of their infection because they do not have any symptoms. There is no vaccine for hepatitis C. The best way to prevent HCV infection is by avoiding behaviors that can spread the disease, especially injecting drugs.

How Many People Have Hepatitis C?

During 2013-2016 it was estimated that about two and half million people were chronically infected with HCV in the United States. The actual number may be as low as 2.0 million or as high as 2.8 million.
Globally, hepatitis C is a common blood-borne infection with an estimated 71 million people chronically infected according to the World Health Organization .

Who Is Most Affected?

New HCV infections are most common among people who inject drugs. In 2018, the number of newly reported chronic hepatitis C cases was highest among males and among people born from 1981 through 1996 and among people born from 1945 through 1965.

Recent Increases in Hepatitis C Infections

In 2018, an estimated 50,300 new HCV infections occurred in the United States. Between 2010 and 2018, the reported number of acute HCV infections quadrupled. High rates of new infections were predominantly among young adults aged 20-29 years and aged 30-39 years.

HIV and Hepatitis C Coinfection

HCV infection is common among people with HIV who also inject drugs. Nearly 75% of people living with HIV who report a history of injection drug use are co-infected with HCV. All people who are diagnosed with HIV are recommended to be tested for HCV at least once. People living with HIV are at greater risk for complications and death from HCV infection. Fortunately, direct acting antivirals that are used to treat HCV work equally well in people with and without HIV infection. For more information about HIV and HCV coinfection, visit the HIV.gov’s pages about hepatitis C and HIV coinfection.

How Is Hepatitis C Transmitted?

Because HCV is primarily spread through contact with infected blood, people who inject drugs are at increased risk for HCV infection. HCV can also be transmitted from an infected mother to child at the time of birth, from unregulated tattoos or body piercings, and from sharing personal items that may be contaminated with infected blood, even in amounts too small to see. Much less often, HCV transmission occurs through sexual contact with an HCV-infected partner, especially among people with multiple sex partners and men who have sex with men. Currently in the United States, health care related transmission of HCV is rare, but people can become infected from accidental needle sticks and from breaches in infection control practices in health care facilities.

Hepatitis C Prevention

There is no vaccine to prevent hepatitis C. The best way to prevent HCV infection is to avoid contact with contaminated blood.

Hepatitis C can spread when a person comes into contact with blood from an infected person. Injecting drugs is the most common way HCV is transmitted in the United States. For people who inject drugs, the best way to prevent HCV is to stop injecting. Community-based prevention programs, such as medication-assisted treatment and syringe services programs, can also reduce the transmission of HCV.

Although the risk of sexual transmission of HCV is considered to be low, avoiding unprotected sexual exposure by using condoms has been shown to reduce the chance of sexually transmitted infections.

Testing

About 40% of people with chronic hepatitis C are unaware of their infection. The only way to find out if you have an HCV infection is to get tested through a simple blood test. Awareness of hepatitis C status is important because treatments are available that can cure HCV and reduce the chance of developing liver disease and liver cancer.

The following are the CDC Recommendations for hepatitis C screening among adults in the United States:

Universal screening:

• All adults aged 18 years and older
• Pregnant women during each pregnancy

One-time hepatitis C testing:

• People with HIV
• People who ever injected drugs and shared needles, syringes, or other drug preparation equipment, including those who injected once or a few times many years ago
• People with selected medical conditions, including:
  • people who ever received maintenance hemodialysis
  • people with persistently abnormal ALT levels
• Prior recipients of transfusions or organ transplants, including:
  • people who received clotting factor concentrates produced before 1987
  • people who received a transfusion of blood or blood components before July 1992
  • people who received an organ transplant before July 1992
  • people who were notified that they received blood from a donor who later tested positive for HCV infection
• Healthcare, emergency medical, and public safety personnel after needle sticks, sharps, or mucosal exposures to HCV-positive blood
• Children born to mothers with HCV infection

Routine periodic testing for people with ongoing risk factors, while risk factors persist:

• People who currently inject drugs and share needles, syringes, or other drug preparation equipment
• People with selected medical conditions, including:
  • People who ever received maintenance hemodialysis

Effective Treatments Are Available for Hepatitis C

New medication to treat for HCV have been approved in recent years. These treatments are much better than the previously available treatment because they have few side effects and do not need to be injected. There are several direct-acting antiviral HCV treatments that cure more than 95% of people who take them in 8 to 12 weeks. HCV treatment dramatically reduces deaths among people with HCV infection, and people who are cured of HCV are much less likely to develop cirrhosis or liver cancer.

Take Action! CDC’s National Prevention Information Network Service Locator helps consumers locate hepatitis B and hepatitis C prevention, care, and treatment services.

Help Raise Awareness About Hepatitis C

The CDC’s Know More Hepatitis Campaign has been developed to provide digital and printed materials to increase awareness about hepatitis C. Check out the campaign and download or order free materials to get started.

Learn More About Hepatitis C

Centers for Disease Control and Prevention, Division of Viral Hepatitis:

National Institutes of Health:

Find additional learning opportunities for both the public and healthcare providers.

Hepatitis C

Last Reviewed: October 2008

What is hepatitis C?

Hepatitis C is a liver disease caused by the hepatitis C virus (HCV), which is found in the blood of persons who have this disease. HCV is spread by contact with the blood of an infected person.

Who gets hepatitis C?

Persons at highest risk for HCV infection include:

• persons who ever injected illegal drugs, including those who injected once or a few times many years ago,
• people who had blood transfusions, blood products or organ donations before June 1992, when sensitive tests for HCV were introduced for blood screening, and
• persons who received clotting factors made before 1987.

Other persons at risk for hepatitis C include:

• long-term kidney dialysis patients,
• health care workers after exposures (i.e., needle stick or splashes to the eye) to the blood of an infected person while on the job,
• infants born to HCV-infected mothers,
• people with high-risk sexual behavior, multiple partners and sexually transmitted diseases,
• people who snort cocaine using shared equipment, and
• people who have shared toothbrushes, razors and other personal items with a family member who is HCV-infected.

How is the virus spread?

Like hepatitis B virus, hepatitis C virus is spread when blood of an infected person enters the body of a person who is not infected, such as through sharing needles or “works” when shooting drugs or occupational needle stick injury. The risk of sexual transmission has not been thoroughly studied but appears to be low in long-term, monogamous relationships. There is no evidence that the hepatitis C virus can be transmitted by casual contact such as hugging or shaking hands, through foods, by sharing eating utensils or drinking glasses, or by coughing or sneezing. Hepatitis C is not spread by breastmilk.

What are the symptoms and consequences of infection?

Approximately 20 percent of persons exposed to the virus develop symptoms which may include jaundice (yellowing of the skin and whites of the eyes), fatigue, dark-colored urine, stomach pain, loss of appetite and nausea. After the initial infection, 15-25 percent will recover and 75-85 percent will become chronically infected (life-long infection). Approximately 70 percent of persons chronically infected may develop liver disease, sometimes decades after initial infection.

How soon do symptoms occur?

Symptoms may occur from two weeks to six months after exposure but usually within six to nine weeks.

When and for how long is a person able to spread hepatitis C?

Persons with acute hepatitis C virus infection are generally contagious from one or more weeks before the onset of symptoms. The contagious period is indefinite in chronically infected persons. All persons who test positive should be considered to be potentially contagious.

What is the treatment for hepatitis C?

Drugs (anti-viral) are licensed for treatment of persons with chronic hepatitis C. Combination drug therapy, using pegylated interferon and ribavirin, can get rid of the virus in up to five out of ten of persons with genotype 1, the most common genotype in the U.S. and eight out of ten persons with genotype 2 or 3. It is important to know that not everyone will need treatment. The decision to treat hepatitis C is complex and is best made by a physician experienced in treating the disease.

Is donated blood tested for this virus?

Since the early 1990s, blood donation centers throughout the U.S. have routinely used a blood donor screening test for hepatitis C. Widespread use of this test has significantly reduced the number of post-transfusion hepatitis C infections.

How can the risk of chronic liver disease be reduced among persons infected with hepatitis C?

People who are infected with hepatitis C should not drink alcohol. They should talk with their doctor before taking any new medications, including over-the-counter and herbal medications. They should also talk with their doctor about getting the hepatitis A and hepatitis B vaccines.

How can the spread of hepatitis C be prevented?

People who have had hepatitis C should remain aware that their blood is potentially infectious.

• Do not shoot drugs; if you shoot drugs, stop and get into a treatment program; if you can’t stop, never share needles, syringes, water or “works”, and get vaccinated against hepatitis A and B.
• Do not share personal care items that might have blood on them (razors, toothbrushes).
• If you are a health care or public safety worker, always follow routine barrier precautions and safely handle needles and other sharps; get vaccinated against hepatitis B.
• Consider the risks if you are thinking about getting a tattoo or body piercing. You might get infected if the tools have someone else’s blood on them or if the artist or piercer does not follow good health practices.
• HCV can be spread by sex, but this is rare. If you are having sex with more than one steady sex partner, use latex condoms correctly and every time to prevent the spread of sexually transmitted diseases. You should also get vaccinated against hepatitis B.
• If you are infected with HCV, do not donate blood, organs or tissue.

Is there a vaccine for hepatitis C?

At present time, a hepatitis C vaccine is not available.

Hepatitis C – Fact Sheet

What is hepatitis C?
Hepatitis C is a contagious liver disease caused by the hepatitis C virus.  It can cause either “acute” or “chronic” illness.  Acute hepatitis C is a newly acquired infection that causes illness within six months or less of exposure to the hepatitis C virus.  Chronic hepatitis C results from the hepatitis C virus remaining in the body for six months or more.  Chronic hepatitis C infection can cause long-term illness including cirrhosis and liver cancer. 

How is hepatitis C spread (transmitted)?
Transmission occurs when blood or other body fluids from an infected person enters the body of an uninfected person. This may happen through sharing of needles or “works” when “shooting” drugs, through accidental needle sticks, or from an infected mother to baby during birth. Sexual transmission can occur but is much less efficient than transmission through blood exposure.  Hepatitis C is not spread through kissing, hugging, breastfeeding, sharing eating utensils or drinking glasses, coughing, sneezing, food, water, or casual contact.

What are the signs and symptoms?
Most people (80%) do not experience any symptoms. Some people experience abdominal pain, loss of appetite, fatigue, nausea and vomiting, dark urine, or jaundice (yellowing of skin and eyes).

How soon do symptoms appear?
Symptoms may occur from 2 weeks to 6 months after infection but usually within 2 months.

What are the long-term effects?
Most infected persons (75-85%) develop a chronic infection. With chronic infection, the virus is not cleared from the body and can lead to liver disease in about 70% of persons.

How long is a person able to spread hepatitis C?
Hepatitis C appears in the blood 1 or more weeks prior to symptoms. Chronically infected persons carry the virus indefinitely therefore may transmit it to others if prevention methods are not undertaken.

If I clear the virus, can I become re-infected?

Yes. Hepatitis C antibodies are not protective, unlike some other infectious diseases. Therefore, it is important not to expose yourself to the blood of others.

How is hepatitis C diagnosed?
Only a doctor can diagnose hepatitis C. Diagnosis is based on a laboratory test for hepatitis C.
(See Testing Information-Hepatitis C Fact Sheet)

What is the treatment and medical management for hepatitis C?
It is important that all persons who are hepatitis C positive be linked to care and evaluated by their provider. Treatment options can be complex and not everyone needs treatment. Presently, treatment options include combination therapy using ribavirin with pegylated interferon and/or with the addition of polymerase and protease inhibitors.  Additional treatment options are in development and may be available within the next few years. 

How can the risk of chronic liver disease be reduced among people chronically infected with hepatitis C?

See your doctor regularly.  Additional tests may be needed to check to see if you have liver damage.  Do not drink alcohol.  Check with your doctor before taking any medications, even over-the-counter and herbal medicines may be toxic to your liver.  You may need to get vaccinated against hepatitis A and B.

How can hepatitis C be prevented?

• People with hepatitis C should be aware that their blood and possibly other body fluids contain the virus.

• Do not shoot drugs. If you do, never share needles or works.

• Do not share toothbrushes, razors, needles, or other personal care items.

• If you are a health care worker, use standard barrier precautions.

• Hepatitis C can be transmitted through sexual contact, but is rare.  Use of condoms may help reduce the change of hepatitis C transmission.

• Persons with hepatitis C should not donate blood, tissues, or organs.

• There is no vaccine to prevent hepatitis C infection.

This fact sheet is for informational purposes only. It should not be used for self-diagnosis or as a substitute for consultation with a health care provider. If you think that you may have this infection, or have questions about the disease described above, you should consult your health care provider.

For additional information on this disease, visit the Centers for Disease Control and Prevention website.

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90,000 Viral hepatitis

October 1 is traditionally celebrated as World Hepatitis Day. Research of viral hepatitis is also carried out at the State Scientific Center of VB “Vector”.

Human viral hepatitis – a class of infectious liver diseases,
which are caused by a number of independent infectious agents with very
various characteristics. These agents differ from each other in type and
the type of viral particle and its genetic material, the mechanism of infection and ways
transmission, pathogenesis and immunogenesis, clinical manifestations, severity of the course and
outcomes, the likelihood of becoming chronic and cancers,
methods of laboratory diagnostics.The unifying beginning is the hard
liver damage.

History of discovery

Discovery by B. Blamberg in 1963 of the “Australian antigen”
subsequently the Nobel Prize, was the first in a chain of brilliant research,
proved the viral nature of hepatitis. To date, identified and
Several types of viruses are described in detail: hepatitis B virus (HBV)
was identified by D. Dayne in the blood and liver cells of the patient in 1970, viral nature
hepatitis A was proven in 1973, the hepatitis delta virus was discovered in 1977, the virus
hepatitis E (HEV) received “independence” in 1983.after an outstanding experience
Russian scientist M.S. Balayan with self-infection, and, finally, in 1989 he was
identified hepatitis C virus (HCV).

About 90% of all cases of viral hepatitis are caused by these viruses,
while for the remaining 10%, their callers remain unidentified.

Scary facts

The incidence of viral hepatitis in its scale and consequences is
unprecedented: according to WHO, only HBV in the world is infected about 2
billionpeople, the chronic form was found in 350 million people, and in the list of reasons
mortality rate HBV ranks 10th in the world, annually claiming 1.2 million
lives, being the second, after smoking, a factor causing cancer. Up to 70%
HBV infections are asymptomatic. Chronization rate in the adult population
is 10-20%, but with intrauterine infection, it increases to 90%. In Russia
the number of patients with viral hepatitis B is 4-8 million.

HCV, the so-called “affectionate killer”, entered the human population about
300 years ago.The disease has a very long incubation period (up to 20
years), during which a person is not even aware of his illness and
encounters it already at the stage of cirrhosis or primary liver cancer. Number
infected more than 200 million people. (about 3% of the world’s population), in
Russia – 4-7 million people, and the majority are hidden carriers. Level
chronicity is extremely high – up to 80%. Due to the high variability in the body
the patient produces millions of different variants of the virus.This explains his
“Escape” from the body’s immunological control: the winner is almost
there is always a virus.

HAV disease has also been known for hundreds of years. CAA is one of the most
small viruses, but spread throughout the world and is especially common in
developing countries in Asia, Africa and America, where disease outbreaks cover
all age groups of the population. There, by the age of 30-39 years, antibodies to HAV
found in the majority of the population.Does not bypass the CAA and us: according to the results
research conducted by “Vector”, up to 70% of the inhabitants of the science city of Koltsovo are older
40 years old have antibodies to HAV. At the same time, there are no cases of transition to a chronic infection.
noted, and after recovery, lifelong immunity is usually developed.

VGE – “indigenous” of Central and Southeast Asia, North and
East Africa, South America. In Novosibirsk, VGE was first isolated in 2002
by employees of “Vector” from migrants from Central Asia.Except man
infects some primates, as well as domestic and wild animals. HEV especially
dangerous for pregnant women, among whom the mortality rate for this infection
reaches 25%.

Routes of transmission

According to the mode of transmission, all viral hepatitis can be divided into two groups.
The first is hepatitis A and E, transmitted by the fecal-oral route (i.e.
through contaminated water, food, personal items
everyday life), the second – B, C, D and G, transmitted by parenteral or injection
by (that is, when used without thorough sterilization with medical instruments, when
multiple injections of blood and drugs obtained from donated blood,
sexually, etc.etc.).

The most widespread virus – HBV – is infected only from those infected with it
people, including patients in a latent form – carriers of the infection. Paths
HBV transmission is similar to that of HIV infection, but HBV contagiousness is 100
times higher. The main route of HBV transmission is through the blood, in which the concentration
virus is highest when blood transfusions, piercings, tattoos,
drugs. It is very important that according to the research of the employees of “Vector”
surgical operations, hemodialysis, general anesthesia and other med.procedures not
proved to be risk factors, which undoubtedly indicates
a high level of medical culture and compliance with biosafety rules in
medical institutions of Siberia. HBV concentration in saliva, semen and vaginal extract
lower, so sexual contact is the second most important route of transmission
HBV. The third way, household, is implemented much less often, since in urine, feces,
sweat, tears, breast milk, the virus is detected in low concentrations.

How to protect yourself?

Due to the large differences between hepatitis viruses, it is impossible to develop a single
a strategy for the diagnosis, prevention and treatment of these infections. Every virus
hepatitis is unique in its own way and requires separate consideration.

The development and use of highly effective vaccines has made it possible to achieve
great progress in HBV prevention: although only 8% of the population is vaccinated,
the effectiveness of vaccination is already making itself felt – only in the first half of 2008
G.the incidence of acute HBV decreased by 13% compared to 2007.
Few are covered by the state free HBV vaccination program
population groups, but everyone has the opportunity to be vaccinated for a fee,
protecting yourself and your loved ones, especially if the work is associated with an increased risk
injury, you have to give yourself a lot of injections or there is
infected with HBV. In addition, this vaccine also protects against the hepatitis virus.
delta.

When developing an HCV vaccine, the main problem is associated with the high
the variability of the virus and requires new non-standard solutions.However, within 10
years that have passed since the discovery of HCV, many treatment regimens with
different duration and dosage regimen of drugs, which brought
the effectiveness of treatment is up to 40-70%.

All known HAV strains belong to the same serotype, and they are reliably
are identified regardless of geographic origin. Vaccines provide
protection for at least 15 years. Vaccinations against hepatitis A are indicated for children and
adults who have not had hepatitis A, as well as people at increased risk
infections: traveling to areas with high levels of HAV circulation
(tourists, contract soldiers, military personnel), medical personnel of infectious diseases departments,
staff of preschool institutions, catering workers and
water supply.In Russia, vaccination against hepatitis A is not included in the National
the calendar of mandatory vaccinations, but this issue is periodically raised
scientists and health practitioners, because vaccination makes it possible
eradication of this disease in Russia.

Do not forget to follow the simplest hygiene rules to prevent
HAV infections – regular hand washing with soap and water (especially before meals), using
eat only well-washed vegetables and fruits, avoid close contact with
sick, drinking only boiled water.The same rules must be followed,
so as not to get infected and HEV.

“Hand on the pulse”

The study of viral hepatitis is not attributed to priority areas
activities of “Vector”, however, at the request of doctors of a number of clinics in Novosibirsk and
Novosibirsk region who need help diagnosing difficult cases
viral hepatitis, in the viral hepatitis laboratory was created and approved
Ethical Committee “Vector” initiative project “Monitoring the situation on
viral hepatitis in the Siberian region and participation in the investigation and study
complex cases of viral hepatitis infections ”(hands.Kochneva G.V.), which in
it has been ongoing for two years. This allows you not only to receive
new scientific results on prevalence and genetic diversity
hepatitis viruses, but it really helps doctors to clarify the diagnosis and outline
optimal treatment regimen. In addition, within the framework of a special project of the MIPT Foundation
(headed by SV Netesov), work is underway to create on the basis of “Vector” Regional
clinical reference laboratory for the diagnosis of viral hepatitis.On this
the way there were many difficulties in the design, planning and reconstruction
premises, but now the laboratory has actually already been built and is working in a pilot
mode, and from 2009 it will work in full force. And then, we hope, for Siberia
there will be no problem in diagnosing any complex cases of viral hepatitis.

Galina Vadimovna Kochneva,
Doctor of Biological Sciences,

head of the laboratory of viral hepatitis

FGUN SSC VB “Vector”

Pass the analysis for hepatitis C quantitative PCR

Method of determination
PCR with real-time detection.

Study material
Blood serum

Synonyms : Hepatitis C Virus (HCV), RNA quantification. Hepatitis C Virus RNA, Quantitative, Real-Time PCR; Blood, HCV Viral Load; Hepatitis C Virus RNA Quant.

Brief description of the study “Quantification of hepatitis C virus RNA by PCR [viral load] in serum”

Hepatitis C is caused by an RNA-containing virus of the Flaviviridae family – the hepatitis C virus (HCV, HCV).The virus is transmitted parenterally (using contaminated needles, syringes and other medical instruments), less often sexually, and also (4-6%) from an infected mother to a child (vertical route). The clinical course of acute hepatitis C is usually mild.

The hepatitis C virus shows great variability of the genome; in infected individuals, a rapid mutation of the virus occurs, which, possibly, explains its evasion from the mechanisms of immune defense and the high frequency of chronicity of this infection.Chronic infection with the hepatitis C virus is characterized, on the one hand, by constant viral replication, and on the other, by an active but insufficient immune response of the body. Unlike hepatitis B, hepatitis C virus antigens in the blood are not captured in sufficient quantities (they are found in liver biopsies). This limits the possibilities of laboratory assessment of the course and activity of the infectious process. The diagnosis of hepatitis C is currently based on the direct detection of viral RNA by PCR methods and the detection of anti-HCV antibodies.

Quantitative characterization of the hepatitis C virus RNA content in clinical samples is important for assessing the effectiveness of antiviral therapy and has prognostic value for determining the chronicity of this hepatitis.

In this study, the determination of hepatitis C virus RNA in blood serum is carried out by polymerase chain reaction (PCR) with real-time detection.

Analytical indicators:

• determined fragment – a specific region of the RNA of the hepatitis C virus;
• the specificity of the definition is 100%;
• detection sensitivity – 60 IU / ml;
• linear range: 102 – 1×108 IU / ml.

What is the purpose of the study “Quantification of hepatitis C virus RNA by PCR [viral load] in blood serum”

Detection of hepatitis C RNA in serum is used in the management of patients with chronic HCV infection to assess the virological response in the early stages of antiviral therapy.

90,000 Viral hepatitis C – what is it? Properties and indications

Features of infection

Hepatitis C is a viral disease characterized by liver damage and autoimmune disorders, often with a primary chronic and latent course.It occurs in icteric (5%) or anicteric (95%) forms. The hepatitis C virus (HCV) belongs to flaviviruses, it is quite stable in the external environment. The three structural proteins of the virus have similar antigenic properties, leading to the production of anti-HCV-core. Currently, 6 genotypes of the virus have been identified. The high degree of genetic variability of HCV contributes to the “escape” of the virus from the immune response. This is associated with difficulties in creating a vaccine and laboratory diagnostics (seronegative hepatitis C), as well as a frequent primary chronic course of the disease.

Hepatitis C is transmitted through blood and body fluids by the parenteral, sexual and transplacental routes. The high-risk group consists of persons practicing intravenous drug addiction, promiscuous sex, as well as medical workers, patients in need of hemodialysis or blood transfusions. Penetrating into the body, HCV enters the blood macrophages and hepatocytes of the liver, where it replicates. Liver damage occurs mainly due to immune lysis, and the virus also has a direct cytopathic effect.The similarity of the antigen of the virus with the antigens of the human histocompatibility system causes the occurrence of autoimmune (“systemic”) reactions. In the program of systemic manifestations of HCV infection, autoimmune thyroiditis, Sjogren’s syndrome, idiopathic thrombocytopenic purpura, glomerulonephritis, rheumatoid arthritis, etc. may occur. Compared with other viral hepatitis, hepatitis C has a less vivid clinical picture, more often turns into chronic forms. In 20-50% of cases, chronic hepatitis C leads to the development of liver cirrhosis and in 1.25-2.50% – to the development of hepatocellular carcinoma.Autoimmune complications occur with a high frequency.

The incubation period is 5-20 days. At the end of the incubation period, the levels of hepatic transaminases increase, possibly an increase in the liver and spleen. The acute period proceeds with weakness, decreased appetite. In a third of cases, fever, arthralgia, polymorphic rash occur. Dyspeptic symptoms and polyneuropathy are possible. Cholestasis is extremely rare (5% of cases). Laboratory indicators reflect cytolysis. With a high level of transaminases (more than 5 norms) and signs of hepatocellular failure, a mixed infection should be suspected: HCV + HBV.

Viral hepatitis C is caused by an RNA-containing flavivirus with a diameter of 55-65 nm, coated with a lipid-containing envelope. Its genome is represented by a single-stranded RNA containing about 9500 nucleotides and encodes the synthesis of a viral protein up to 3033 amino acids in size, which is then cleaved by cellular peptidases and viral proteases into at least nine proteins: core (nucleocapsid) protein (C), enveloped E1 protein, a coated protein integrated with the non-structural zone (E2 / NS1); and non-structural proteins NS2, NS3, NS4A, NS4B, NS5A, and NS5B.

Experts from the American Foundation for the Study of the Liver and the Centers for Disease Control (CDC) report that there are more than 3.9 million people infected with the virus in the United States alone, of which more than 2.7 million have become sick with chronic hepatitis C. From 8 to 10 thousand patients die. yearly.

Markers of infection

1. RNA of the virus (HCV RNA)

Detected by molecular hybridization methods in serum / plasma, leukocytes and puncture biopsies of the liver. Detection of HCV RNA may involve an upstream amplification step (polymerase chain reaction).As in the case of viral hepatitis B, the use of branched DNA technology (bDNA) produces very well reproducible results when compared to other hybridization methods.

Detection of HCV RNA confirms active viral infection. On the other hand, quantification of HCV RNA is important for evaluating the effectiveness of antiviral therapy. The detection of HCV RNA is the basis for the diagnosis of hepatitis C in cases of seronegativeness, for example, at an early stage of infection, when antibodies to the virus have not yet developed, as well as in patients with immunosuppression (in particular, after organ transplantation) in whom antitelogenesis is suppressed.

2. Antibodies to the virus (antiHCV)

AntiHCV indicate the patient’s contact with the virus and are found in both acute and chronic hepatitis. In most cases, their presence, established using third-generation enzyme-linked immunosorbent assay systems, correlates with the presence of HCV RNA in the blood. In about 5% of people with chronic hepatitis C, HCV RNA can be detected in the absence of antiHCV.
Testing of donated blood for the presence of antiHCV is mandatory in blood services in all countries.The detection of antiHCV in a blood sample is an indisputable reason for its rejection.

90,000 Find a Panacea: Why Hepatitis Remains a Dangerous Disease | Articles

Despite the achievements of recent years in the diagnosis and treatment of viral hepatitis, the problem of this disease remains very serious throughout the world. According to the WHO, 325 million people worldwide are living with viral hepatitis B or C, while 290 million are unaware of their diagnosis. From the consequences of chronic hepatitis B, 900 thousand people die every year.Hygiene literacy remains one of the most important problems today. Medical specialists tell Izvestia how to avoid contracting hepatitis through everyday contacts.

How are they usually infected with hepatitis

Viral hepatitis, as an independent nosological form, is caused by various hepatotropic (that is, affecting the liver tissue) viruses, namely hepatitis A, B, C, D and E viruses, says the infectious disease physician of the Russian Gerontological Research and Clinical Center of the Russian National Research Medical University named afterNI Pirogova Diana Zilfova. By the mechanism of infection, all viral hepatitis can be divided into two groups: hepatitis with a fecal-oral transmission mechanism (these include hepatitis A and E) and hepatitis with a parenteral transmission mechanism, which include hepatitis B, C and D.

The source of infection in In case of infection with hepatitis A and E, the patient’s feces are. You can get infected by drinking contaminated water and food, much less often infection occurs through contact and household, that is, through unwashed hands, which is usually typical for children’s groups.

Photo: RIA Novosti / Alexander Kryazhev

When infected with hepatitis with a parenteral transmission mechanism (hepatitis B, C and D), the penetration of the virus into the body occurs when the integrity of the skin and mucous membranes is violated. The ways of transmission of these viruses are: sexual, perinatal (transmission of the virus from mother to child during childbirth), through transfusion of blood components from an infected person, through instruments and personal hygiene items contaminated with the blood of an infected person (for example, when using one razor or manicure instruments, a common needle for intravenous administration of medicinal or psychoactive substances).

– Timely undiagnosed viral hepatitis, occurring in a chronic, latent form, can cause the development of such formidable complications as cirrhosis of the liver and hepatocellular cancer, says infectious disease doctor Diana Zilfova. – In addition, a person who is infected with viral hepatitis and does not know about his diagnosis becomes a source of infection for other people: after all, the disease is asymptomatic.

How to protect yourself from hepatitis in everyday life

Prevention of viral hepatitis infection comes down to several rules.In order not to become infected with viral hepatitis A and E, it is necessary to follow the rules of personal hygiene: be sure to wash your hands and use antiseptics before eating, and, of course, after visiting the restroom, drink only bottled or boiled water, eat only washed, heat-treated vegetables and fruits, explains infectious disease doctor Diana Zilfova.

– In order not to catch dangerous forms of hepatitis at public events and with household contacts, you need to drink only clean water, wash your hands and not use dirty dishes, – says Igor Nikitin, Science Advisor of the Natsimbio holding of Rostec State Corporation, Doctor of Medical Sciences.- This will protect you from hepatitis A and E. Although, the most reliable way to protect yourself from hepatitis A is vaccination, which gives stable lifelong immunity. There is also a reliable vaccine for hepatitis B. Hepatitis B, C and D are transmitted only through blood or sexually.

Photo: TASS / Mikhail Tereshchenko

Doctors advise: in order not to become infected with hepatitis B, C and D in everyday life, never use other people’s personal hygiene items (razors, scissors, washcloths, manicure supplies, tools for tattooing and piercing, etc.).and don’t lend your own to anyone. Also follow the safety rules for sexual intercourse.

Why vaccination is useful

For your information, in Russia the vaccine for the prevention of viral hepatitis B is included in the National Calendar of Preventive Vaccinations (NCPP). In 2020, more than 6.1 million doses of vaccines for children and adults were delivered to vaccinate the population under the NCPP. Against hepatitis A, immunization of high-risk groups of infection is carried out, which are determined by the Calendar of Preventive Vaccinations for Epidemic Indications.

– In our national calendar there is a vaccination against hepatitis B and D, and it is incredibly effective, – says the chief hepatologist of the Moscow region, head of the hepatology department of the Moscow Regional Research and Clinical Institute named after V.I. M.F. Vladimirsky Pavel Bogomolov. – Those born earlier than 2000 should be vaccinated on their own initiative. In the absence of vaccinations, the risks of chronic hepatitis are high. The most dangerous hepatitis D only recently became curable thanks, by the way, to Russian doctors. Already in 2019, the new therapy was approved in the Russian Federation, in 2020 in the EU, and this year it will be approved in the United States.Until 2016, this disease was treated with a neglected variant only by liver transplantation.

Photo: TASS / Mikhail Tereshchenko

Dr. Bogomolov notes that today hepatitis B is still an incurable disease. However, according to him, this disease is perfectly prevented by vaccination. Medicines in the format of lifelong therapy only allow this type of hepatitis to be kept in an inactive phase, thereby preventing the development of liver cancer or cirrhosis.As for hepatitis C, nowadays, timely diagnosis and its treatment can not only prevent the transition to the chronic stage, but also completely cure the disease. Well, a patient with hepatitis A or E almost always recovers, and he has lifelong immunity to infection.

But Dr. Nikitin again and again urges not to relax and be vigilant of illness – after all, unrecognized hepatitis in advanced cases can lead to oncology and other dangerous ailments.

Viral hepatitis | VOKB №1

Viral hepatitis – a group of infectious diseases with various mechanisms of transmission, characterized mainly by liver damage. They are among the most common diseases in the world.

Reason. Viral hepatitis is caused by viruses belonging to different families. They are designated by the letters of the Latin alphabet: A, B, C, D, E. Accordingly, the hepatitis caused by them are called.

Hepatitis A virus belongs to the picornavirus family.When boiled, it dies after 5 minutes. At room temperature in a dry environment it lasts a week, in water – 3-10 months, in excrement – up to 30 days.

Hepatitis E virus is a representative of a new, not yet established family of viruses. Compared to the hepatitis A virus, it is less resistant to various environmental factors.

Hepatitis B virus belongs to the hepadnavirus family. It is arranged in a complicated manner. The outer layer of the virus, made up of particles of the fatty protein coat, is called the surface antigen (HBsAg).An antigen is a foreign protein with the ability, once it enters the body, to induce a protective response of the immune system – the formation of antibodies. Initially, this antigen was called Australian, since it was first detected in the blood serum of Australian aborigines. The virus envelope contains its core, which includes two more proteins foreign to the body: insoluble – core antigen (HBcAg) and soluble – infectiousness antigen (HBe-Ag). The hepatitis B virus is highly resistant to low and high temperatures, chemical and physical influences.At room temperature, it lasts 3 months, in a refrigerator – 6 years, frozen – 15-20 years. Boiling will only kill the virus for more than 30 minutes. The virus is resistant to almost all disinfectants. Autoclaving at 120 90 180 about 90 181 C suppresses the virus after 5 minutes, exposure to dry heat (160 90 180 about 90 181 C) – after 2 hours

Hepatitis C virus belongs to the flavivirus family, unstable in the external environment.

Hepatitis D virus is an unclassified heat-resistant virus.

Hepatitis A and E combines the fecal-oral transmission mechanism. The source of infection is patients with any form of the disease: icteric, anicteric, erased, in the incubation and initial periods of the disease, in the feces of which the hepatitis A or E virus is found. the number of patients with icteric forms of the disease. Virus excretion with feces begins in the second half of the incubation period, and the maximum infectivity is observed in the last 7-10 days of incubation and in the preicteric period.When the patient turns yellow, he is, as a rule, not contagious. Infection most often occurs through sewage-contaminated water. The susceptibility of those who have not been sick to the virus is absolute. Hepatitis A mostly affects children, hepatitis E – mostly adults.

Hepatitis A is found everywhere, while hepatitis E is mainly found in tropical and subtropical regions, in the countries of Central Asia.

Hepatitis B, C and D are transmitted parenterally. Infection occurs with blood, its products, sperm, saliva, vaginal secretions, sweat and tears from persons with severe and unexpressed forms of acute and chronic hepatitis, cirrhosis of the liver, carriers of HBsAg (surface antigen of the hepatitis B virus or “Australian” antigen) and persons with the presence of anti-HCV (antibodies to the hepatitis C virus), 70-80% of which are chronic carriers of the hepatitis C virus.The virus penetrates through damaged skin and mucous membranes during intravenous drug administration, tattooing, medical and diagnostic manipulations, during pregnancy and childbirth, during sexual intercourse, during household microtraumas (manicure, combing with a hairdresser with sharp combs, shaving with someone else’s razor, etc.). ). Human milk is never contagious.

The process of the development of the disease. The causative agents of hepatitis A and E are introduced into the human body through the mucous membrane of the gastrointestinal tract and are brought into the liver by the blood stream, penetrate into its cells and reproduce in them.At the same time, viruses destroy them. Immunity builds up rapidly, the virus is rendered harmless, the affected cells and viral particles are removed from the body. After hepatitis A, lifelong resistance to the pathogen develops. After suffering hepatitis E, immunity is unstable and re-infection is possible.

The hepatitis B virus by the blood in which it enters is carried into the liver and, without damaging the hepatic cell, is incorporated into it. With a normal, sufficiently strong defense reaction of the body, lymphocytes destroy the infected cells and the virus is removed from the liver tissue.The patient suffers an acute form of hepatitis of moderate severity, gradually recovers and he develops a stable immunity.

With a weak defense reaction or its absence, the virus in the liver cells lives for months, and more often longer (for years, decades, all life). An asymptomatic or erased form of the disease develops with subsequent transition to chronic hepatitis (5-10%). Chronic carriage of HBsAg is an asymptomatic form of chronic hepatitis. In this case, the genetic program of the cell is gradually modified and it can be reborn into a tumor (0.1%).The most common reason for the lack of a protective reaction of the body to the hepatitis B virus is “addiction” to it while still in the womb, if a pregnant woman is a carrier of the virus.

The hepatitis D virus, as a rule, overlaps with hepatitis B, more often protracted or chronic (asymptomatic or severe), damages liver cells and sharply activates the process. At the same time, fulminant forms of the disease, pronounced chronic hepatitis, cirrhosis and even liver cancer develop more often.

The hepatitis C virus enters the liver cells and damages them.However, this does not lead to the rapid release of the body from the virus, as in hepatitis A. The hepatitis C virus “escapes” from the body’s defense mechanisms by continuous change, reproducing itself in ever new varieties. This feature of the virus determines the possibility of a long-term, almost lifelong survival of the virus in an infected organism. It is the leading cause of chronic hepatitis, cirrhosis and liver cancer. Immunity after hepatitis C is unstable, repeated infections are possible.

Signs. In viral hepatitis, according to the severity of the manifestations of the disease, the following forms are distinguished: icteric, anicteric, erased, asymptomatic. With icteric forms, the following periods are distinguished: preicteric, icteric and convalescence.

Hepatitis A. The incubation period is on average 15 to 30 days.

The preicteric period usually lasts 5-7 days. The disease begins acutely. The body temperature rises to 38-39 90 180 about 90 181 C and lasts 1-3 days.Flu-like symptoms appear – headache, severe general weakness, a feeling of weakness, muscle pain, chills, drowsiness, restless night sleep. Against this background, dyspeptic disorders appear – a decrease in appetite, a perversion of taste, a feeling of bitterness in the mouth, nausea, sometimes vomiting, a feeling of heaviness and discomfort in the right hypochondrium and epigastric region, aversion to smoking. After 2-4 days, a change in the color of the urine is noted. It takes on the color of beer or strong tea.Discoloration of feces is then observed. The jaundice of the sclera appears, indicating the transition of the disease to the icteric stage.

The icteric period lasts 7-15 days. First of all, the mucous membrane of the mouth (frenulum of the tongue, hard palate) and sclera acquires icteric staining, and later on – the skin. With the onset of jaundice, a number of signs of the preicteric period weaken and disappear in a significant part of patients, while weakness and loss of appetite persist for the longest time.

The outcome of hepatitis A is usually favorable.Complete clinical recovery in most cases (90%) occurs within 3-4 weeks. from the onset of the disease. In 10%, the recovery period is delayed up to 3-4 months, but chronic hepatitis does not develop.

Hepatitis E. The disease is similar to hepatitis A. Pregnant women have a severe course with a fatal outcome in 10 – 20%.

Hepatitis B. The duration of the incubation period is on average 3-6 months. The preicteric period lasts 7-12 days. The disease begins gradually with malaise, weakness, fatigue, a feeling of weakness, headache, sleep disturbances.In 25 – 30% of cases, joint pain is observed, mainly at night and in the morning. Itching of the skin is noted in 10% of patients. Many patients develop dyspeptic disorders – decreased appetite, nausea, often vomiting, a feeling of heaviness, sometimes dull pain in the right hypochondrium. At the end of the preicteric period, the urine darkens, usually in conjunction with the clearing of the stool.

The icteric period is characterized by the greatest severity of the manifestations of the disease. Jaundice reaches its maximum.Some patients with a severe course of the disease have bleeding gums, nosebleeds. The total duration of this period, depending on the severity of the disease, is 1-3 weeks.

The recovery period is longer than with hepatitis A and is 1.5-3 months. There is a slow disappearance of the manifestations of the disease and, as a rule, weakness and a feeling of discomfort in the right hypochondrium persist for a long time. Complete recovery occurs in 70%. In other cases, residual effects are noted in the form of a persisting enlargement of the liver in the absence of complaints and abnormalities in the blood.In addition, there is a lesion of the biliary tract or pancreas, manifested by pain in the right hypochondrium and epigastric region associated with food intake. Less commonly, functional hyperbilirubinemia, characterized by an increase in the level of free bilirubin in the blood serum and unchanged other parameters, can be noted. Residual effects do not threaten the development of chronic hepatitis.

The erased icteric form is characterized by a satisfactory state of health of patients and mild jaundice, which is limited by yellowness of the sclera, darkening of urine and lightening of feces with a slight icteric staining of the skin.This and the next two forms of hepatitis in most cases indicate the threat of chronic disease.

Anicteric form is manifested by weakness, malaise, rapid fatigue, impaired appetite, a feeling of bitterness in the mouth, unpleasant sensations in the epigastric region, a feeling of heaviness in the right hypochondrium. When examined by a doctor, an increase in the liver is determined, a laboratory examination reveals a change in the biochemical parameters of the blood.

The asymptomatic form is characterized by the complete absence of visible manifestations of the disease, in the presence of hepatitis B virus antigens in the blood.This form of the disease, as a rule, threatens the development of chronic hepatitis.

Hepatitis C. The incubation period lasts about 2-3 months. The disease in most cases (up to 90%) begins without distinct signs of the disease and remains unrecognized for a long time.

Manifestations of the disease consist in a deterioration in health, lethargy, weakness, fatigue, and a deterioration in appetite. When jaundice appears, its severity is very mild. There is a slight yellowness of the sclera, slight staining of the skin, short-term darkening of urine and lightening of feces.Recovery from acute hepatitis C more often occurs with an icteric variant of the disease.

The rest, most of the patients (80-85%) develop chronic carriage of the hepatitis C virus. Most of the infected persons consider themselves healthy. A smaller part of the infected periodically have complaints of decreased performance, the liver is slightly enlarged, and biochemical changes in the blood are determined.

Renewal of the disease occurs in 15-20 years in the form of chronic hepatitis.Patients are worried about rapid fatigue, decreased performance, sleep disturbance, a feeling of heaviness in the right hypochondrium, loss of appetite, weight loss. In 20-40% of patients with chronic hepatitis C, cirrhosis of the liver develops, which remains unrecognized for many years. The end link of the disease, especially with cirrhosis of the liver, can be liver cancer.

Disease recognition. The appearance of weakness, lethargy, malaise, fatigue, impaired appetite, nausea should always be a reason to see a doctor.A feeling of bitterness in the mouth, a feeling of heaviness in the right hypochondrium, especially the darkening of urine indicate liver damage and require urgent medical attention. Jaundice is first found on the sclera, the mucous membrane of the palate and under the tongue, then appears on the skin. Recognition of viral hepatitis is based on the manifestations of the disease and epidemiological data, as well as on the results of special laboratory tests (detection of antibodies to hepatitis A, C, D, E, hepatitis B virus antigens and corresponding antibodies in the blood serum).

Treatment. All patients with viral hepatitis, except for hepatitis A, are subject to treatment in infectious diseases departments of hospitals. The basis for the treatment of patients is a semi-bed regime, a diet (with the exception of alcohol, fried, smoked, refractory fats, canned food, hot spices, chocolate, sweets), multivitamins, which is enough to treat patients with mild forms of viral hepatitis A and E.

In case of viral hepatitis B and C, occurring with the threat of chronicity, interferon treatment is currently being carried out, aimed at suppressing the virus.

Among a significant number of interferon preparations, alpha-2b-interferon preparations are the most effective for hepatitis.

Clinical examination. The disappearance of jaundice with icteric forms of viral hepatitis is significantly ahead of the recovery processes in the liver. Therefore, for patients with acute hepatitis in the recovery period, they begin observation in a hospital and continue on an outpatient basis in order to identify a possible threat of chronic disease and timely conduct, if necessary, treatment with interferon.Clinical examination provides for repeated examinations by an infectious disease specialist, biochemical blood tests, with hepatitis B, C and D, the determination of antigen and antibodies to viruses.

All those who have had viral hepatitis within 30 days after discharge from the hospital undergo an initial dispensary examination by an infectious disease specialist.

After hepatitis A and E, in the absence of abnormalities in the state of health and biochemical parameters of blood, dispensary observation is terminated. If deviations from the norm persist, an additional examination is carried out after 3 months.

In case of hepatitis B, C and D, repeated examinations are carried out 3, 6, 9 and 12 months after discharge from the hospital. These terms can be changed depending on the results of the previous survey. Dispensary observation stops no earlier than a year later when the body recovers and is free from the virus. If signs are identified that indicate the formation of chronic hepatitis, follow-up and treatment continue.

In the recovery period after hepatitis, hard physical labor and sports are contraindicated for six months.At this time, it is recommended to exclude the above products from the diet. The use of any alcoholic beverages is categorically contraindicated. The use of drugs should be limited as much as possible. Within 6 months. prophylactic vaccinations are contraindicated, it is undesirable to carry out operations, except for urgent ones. By the decision of the infectious disease specialist, rehabilitation during the recovery period after viral hepatitis can be carried out in a sanatorium: Arshan in Buryatia, Goryachy Klyuch in the Khabarovsk Territory, Darasun or Shivand in the Chita Region., Essentuki or Pyatigorsk in the Stavropol Territory, Izhevsk Mineral Waters, Lipetsk, Bear Lake in the Kurgan Region, Nalchik in Kabardino-Balkaria, Sestroretsk in the Leningrad Region, Staraya Russa in the Novgorod Region, Khilovo in the Pskov Region, Shmakovka in the Primorsky Region , Yumatovo in Bashkiria, Yamarovka in Transbaikalia or other local sanatorium. After hepatitis B, women are not advised to become pregnant for a year – a child may be born with an infected liver.

Carriers of the surface antigen of the hepatitis B virus and patients with chronic hepatitis are under constant medical supervision and are examined by an infectious disease specialist twice a year.They are extremely vulnerable to harmful influences, primarily to alcohol.

Chronic hepatitis requires a complete diet. It should be fractional – 4-5 times a day, little by little. Dishes are mostly boiled, steamed or baked in the oven.

Chemical irritants are excluded from the diet – extractive, aromatic substances, foods rich in essential oils, cholesterol, refractory animal fats. You cannot eat meat, fish and mushroom soups, strong vegetable broths.Prohibited are egg yolks, brains, kidneys, liver, fatty meats and lamb, fatty pork, geese, ducks, veal, fatty fish, all fatty foods, smoked meats, canned food. Vinegar, pepper, mustard, horseradish, alcohol in any form are excluded. Salt, as little as possible. You should refuse muffins, pastries, cakes, chocolate, cocoa. Sugar, jam, honey, sweet juices, fruit drinks, syrups, watermelons, grapes are not contraindicated.

Recommended lean meat, low-fat fish, dairy products, fermented milk is better, all flour, except for muffins, yesterday’s bread, greens and vegetables in large quantities, both in boiled and stewed, and in raw form, dairy fats and more vegetable, tea or weak coffee with milk, fruit and vegetable juices, rosehip decoctions.

Prevention of disease.

Hepatitis A and E. Compliance with the rules of personal hygiene, the use of good-quality drinking water and food.

A vaccine is available for hepatitis A. Vaccination is recommended primarily for children. Immunity lasts for 10 years. Vaccinations can be made to everyone by purchasing the vaccine at their own expense in the vaccination center.

For persons who were in contact with a patient with hepatitis A, medical supervision is established for 35 days.Children visiting child care institutions, no later than 10-14 days after contact, are injected with normal human immunoglobulin containing antibodies to the virus. Immunoglobulin introduced before infection or during the incubation period of hepatitis A in 85% prevents its development or mitigates the course of the disease. Its protective effect is limited to 3-5 months.

The large number of sources of the hepatitis B virus in the form of people suffering from asymptomatic variants of the disease, multiple modes of transmission make vaccination the main means of preventing this disease.The incidence of acute hepatitis B among the vaccinated is 10-15 times less than among the unvaccinated.

Since 1996, vaccination against hepatitis B has been included in the calendar of compulsory preventive vaccinations for children in Russia. Vaccination is provided for all newborns, children aged 11 years, as well as adults belonging to groups at high risk of contracting hepatitis B: medical workers who have direct contact with the blood of patients, students of medical institutes and students of secondary medical schools, the family environment of patients with chronic hepatitis B and carriers of the surface antigen of the hepatitis B virus, drug addicts.

Vaccinations can be made to anyone who wants to buy the vaccine at their own expense in the vaccination center.

Vaccination against hepatitis B consists of 3 vaccinations: the first two with an interval of 1 month, the third after 6 months. The duration of immunity to hepatitis B after vaccination is 7 years. Therefore, every 7 years, a revaccination should be carried out.

Family members of a hepatitis B patient are under medical supervision for 6 months. An accelerated vaccination schedule can be given to prevent people at risk of contracting hepatitis B infection.

Human hepatitis B immunoglobulin is available. Used when there is a high likelihood of infection within 24 hours of suspected infection. It is usually given in combination with a vaccine.

Family members of patients with chronic hepatitis B and carriers of the surface antigen of the hepatitis B virus must strictly follow the rules of personal hygiene with the individualization of all its items (combs, toothbrushes, washcloths, towels, shaving razors, etc.). It is recommended that sexual partners use mechanical contraceptives.

Vaccination against hepatitis B protects against hepatitis D, since infection with hepatitis D, as a rule, requires the presence of a surface antigen of the hepatitis B virus in the body.

Hepatitis C. Prevention measures are the same as for hepatitis B, except for vaccination and administration of immunoglobulin, due to their absence.

Take care of yourself and be healthy!

Used material BUZ VO “Voronezh Regional Clinical Center for the Prevention and Control of AIDS”

Address: g.Voronezh Avenue Patriot 29b

Reception Parenteral viral hepatitis: +7 (473) 270-15-57 | +7 (473) 270-55-0

ABC of hepatitis viruses – analytical portal POLIT.RU

The 2020 Nobel Prize in Physiology or Medicine will be awarded to virologists Harvey James Alter (USA), Michael Houghton (UK – Canada) and Charles M. Rice for the discovery of the hepatitis C virus. The work allowed the creation of methods for testing donated blood and significantly reduce the risk of contracting hepatitis, as well as create effective antiviral drugs for the treatment of patients.The works that brought scientists the recognition of the Nobel Committee were published in 1975-1997.

2020 Nobel Prize Winners in Physiology or Medicine

Inflammation of the liver manifests itself in the form of decreased appetite, vomiting, fatigue, muscle weakness. A similar disease has been known to doctors since the time of Hippocrates. Nowadays, it is clear that hepatitis can be of a different nature. Therefore, doctors isolate infectious, metabolic, ischemic, autoimmune, genetic and toxic hepatitis (the latter is often caused by alcohol abuse).Some forms of hepatitis are especially dangerous because their symptoms are mild, but in chronic disease they often lead to severe liver damage, causing cirrhosis or hepatocellular carcinoma. When infected with hepatitis C, for example, spontaneous recovery is observed in 15–45% of cases, and chronic disease begins in 60–80%.

Infectious hepatitis is caused by viruses, the varieties of which are designated by Latin letters. Five of them are known (A, B, C, D, E), but three are the most important – hepatitis A, B and C viruses.It should be said that the viruses of various hepatitis are not at all close relatives to each other. Viruses A and C belong to different families, and virus B in the evolutionary sense is separated from A and C by a chasm. The difference between B on the one hand and A and C on the other is greater than the difference between animals and plants. The closest relatives of the hepatitis C virus are tick-borne and Japanese encephalitis and yellow fever viruses.

The C virus itself is subdivided into seven genotypes. The most common genotype 1 is found in Europe, North America and Australia.It causes about half of all diseases. The second most common is genotype 3, which is found mainly in South Asia. Genotypes, in turn, are divided into subtypes.

The hepatitis C virus is transmitted by contact with blood. Infection can occur through blood transfusion, contact with medical equipment (needles, instruments, including dental ones) if it has not been sufficiently sterilized. Risk groups include health care workers and drug addicts. But you can get the hepatitis C virus both in a regular hairdresser and in a tattoo parlor.There is also the likelihood of infection of the child from the mother during childbirth and from the partner during sexual intercourse.

According to the latest WHO report on hepatitis in 2015, the hepatitis A virus caused 114 million cases of acute hepatitis, with 257 million people living with chronic hepatitis B infection and 72 million people living with hepatitis C. Viruses B and C killed 1.34 million people that year, up 63% from 1990 figures. The number of deaths from viral hepatitis is comparable to that of tuberculosis (1.5 million in 2018).The most serious problem is the inconspicuous course of the disease. According to the WHO for 2017, in the world, only less than 20% of people with chronic hepatitis B and C received the correct diagnosis. Others are simply unaware of the disease and can easily transmit the virus to others. In developed countries, this figure is higher, but still does not exceed half of the infected, and in countries with an underdeveloped health care system, it drops to 5%.

Several regions of the world have a particularly high prevalence of hepatitis C.These include Central and East Asia, the Middle East, North and Central Africa. The record seems to be held by Egypt, where 22% of the population is infected. This is due to the fact that a large campaign for the treatment of schistosomiasis was carried out in the country, which used non-sterile syringes.

But all these details about hepatitis viruses became known, of course, gradually. In 1947, British hepatologist F.O. McCallum divided infectious hepatitis into two subtypes based on clinical presentation and modes of infection: hepatitis A and hepatitis B.Hepatitis A (“infectious, or epidemic, hepatitis”, “Botkin’s disease”) is transmitted through food and water, has a short incubation period, manifests itself as an acute disease, leaving lifelong immunity after recovery. The hepatitis A virus is an RNA virus from the Picornaviridae family.

In the early 1980s, a disease similar to hepatitis A was discovered, caused by a virus from the family Hepeviridae , called hepatitis E. It spreads primarily through contaminated drinking water and usually heals itself within 2–6 weeks.But in some cases, hepatitis E is a serious threat (the so-called fulminant, or fleeting hepatitis). Then the patient is threatened with acute liver failure and death. The risk of contracting hepatitis E is especially high for pregnant women in the second and third trimesters, among them the mortality rate reaches 20-25%.

The second type of hepatitis (“serum hepatitis”) spread through contact with blood or other body fluids and had a long incubation period during which apparently healthy people can transmit the disease.In a significant proportion of those affected, the infection became chronic and could lead to liver failure and cancer. It is now known that this disease is caused by at least three viruses from the family Hepadnaviridae (hepatitis B), Deltaviridae (hepatitis D) or Flaviviridae (hepatitis C)

A breakthrough in the study of viral hepatitis was associated with the name of the American geneticist Baruch Blamberg (1925-2011). In 1964, he discovered hepatitis B surface antigen in the blood of an Australian aborigine (“Australian antigen”).This allowed Blumberg and his colleagues to develop a test for the hepatitis B virus to prevent it from spreading through donated blood, as well as create a vaccine. In 1976, Baruch Blamberg received the Nobel Prize in Physiology or Medicine for his discovery.

As a young doctor, Harvey Olter worked for Baruch Blumberg’s team. He then continued his research on blood transfusion viruses at the US National Institutes of Health Clinical Center. Quite quickly, he discovered that testing donated blood for the B virus prevents only about 20% of hepatitis cases, the remaining 80% must have been caused by another, as yet unknown virus.This type of hepatitis was originally called “non-A, non-B” (non-A, non-B hepatitis). Observing patients, Olter found that new hepatitis has a shorter incubation period than hepatitis B, and milder symptoms in the acute phase. It was also found that one patient can be infected with both the first and the second virus.

Scientists initially suggested that “non-A, non-B hepatitis” is, in fact, hepatitis A, which under some conditions gives a different clinical picture.This hypothesis was refuted in 1973, when Stephen Feiston and Robert Purcell were able to detect the hepatitis A virus in monkeys and humans and learned how to grow it in tissue culture, which made it possible to quickly develop immunological tests to detect specific antibodies to this virus and soon after that create a vaccine against Hepatitis A. Olter, together with Feiston and Purcell, studied viral samples, and in 1975 they proved that “hepatitis A, neither B” is not associated with virus A or any other known virus.

An unknown virus posed a serious threat. It accounted for most cases of hepatitis following blood transfusion, there was no way to detect it, and most infected carriers did not have obvious symptoms of the disease. In the late 1970s, a group led by Olter found a way to investigate the mysterious virus. It turned out that the blood serum of people who had been ill infect chimpanzees with hepatitis – the only species other than humans that is susceptible to this infection. Working with chimpanzees, scientists were able to identify morphological changes in infected liver cells and characterize the infectious agent using classical virological methods.Olter and Purcell were able to establish that the virus has a protein-lipid membrane over its capsid, and determined that the size of viral particles is 30-60 nanometers.

In 1982, Michael Houghton of the California-based biotechnology company Chiron Corporation joined the hunt for an unknown virus. Together with colleagues Qui-Lim Chu, George Kuo and Daniel Bradley, he had to solve a difficult task – to isolate traces of the viral genome among all samples in the blood of infected chimpanzees and humans.To do this, it was necessary to separate the genetic material of the virus and its host. Houghton and his colleagues isolated RNA from the blood plasma of infected chimpanzees, obtained complementary DNA molecules, and propagated them by transferring them into bacteria using bacteriophages. Bacterial colonies were then checked for viral protein expression using patient serum, which was suspected to contain antibodies against the virus. Of the many bacterial colonies, one was found that did not contain chimpanzee or human DNA sequences.It corresponded to an RNA molecule of about ten thousand base pairs. Scientists have found that viral proteins can be synthesized directly from this RNA molecule, that is, the target virus belongs to the so-called “viruses with a positive RNA genome.” They established the relationship of this virus with the family Flaviridae and gave it the name “hepatitis C virus”. Experimental testing has shown that the new viral sequence encodes a protein that reacts with sera from chimpanzees infected with “neither A nor B virus” but not with sera from hepatitis A or B control animals.After identifying the virus, Houghton and colleagues created an immunological test to detect it in donated blood.

The number of hepatitis C infections in the United States has fallen sharply since the virus was discovered in the late 1980s thanks to screening of donated blood

Although Olter and Houghton and their colleagues already had a lot of evidence that the isolated virus causes “non-A, non-B hepatitis,” it was necessary to confirm its transmission through donated blood from infected people.This was done after the groups of Kunitada Shimotono at the National Cancer Research Center in Tokyo and Charles Rice at the University of Washington in St. play an important role in the replication of the virus. Based on this hypothesis, Charles Rice constructed a viral RNA with this non-coding region, injected the resulting virus into the chimpanzee’s liver, and began looking for evidence of viral replication.But the virus did not appear in the blood of infected chimpanzees. Then Rice suggested that inactivating mutations are present in the RNA of the virus. When he assembled a new construct of the viral genome, excluding the possibility of such mutations, the experiment was a success: the virus was found in the blood of the infected monkeys, and they themselves showed clinical signs of hepatitis.

Hepatitis C virus under an electron microscope

Another achievement of the current laureates is worth mentioning.In 1986, under the guidance of Michael Houghton, the genome of another hepatitis virus, D (delta), was read. This virus is rather unusual: it cannot build its own shell and therefore has to use the services of another virus. These viruses are called satellite viruses. For the delta virus, this role is played by the hepatitis B virus. The RNA of the delta virus is encapsulated in the glycoproteins of the B virus. Naturally, the delta virus infects only people infected with the B virus, while their hepatitis is more severe and the likelihood of liver failure and cirrhosis increases or hepatic carcinoma.

Research by Olter, Houghton, Rice and their colleagues began the search for an effective remedy against hepatitis C. Compared to viruses A and B, hepatitis C proved to be a much more difficult adversary. There is still no uniquely effective vaccine against it, since the strains of this virus mutate rapidly and are very diverse. As a result of mutations, the sequence of amino acids in viral proteins changes, so the virus avoids vaccine antibodies “tuned” to specific proteins.There is a natural variant of immunity from hepatitis C – the same 15–45% of patients who have a spontaneous cure. It is known that among such people with repeated infection with the virus, the same spontaneous cure is observed in 80%, while the immune response occurs faster and more actively. But the mechanism of their immunity is unclear.

Another challenge has been that hepatitis C only affects humans and chimpanzees, so researchers are constantly faced with a shortage of model animals to study the virus and preclinical trials of possible drugs or vaccines.In cell cultures, the isolated virus strains also reproduced with difficulty.

Therefore, an important step in further research on hepatitis C was the work of Ralph Bartenschlager and his colleagues from the University of Heidelberg, who in 1999 were able to obtain a viral strain that could multiply in cell cultures (hepatoma cells were used), which greatly facilitated further research. Only in the 21st century did they learn to multiply the hepatitis C virus in the body of mice, which were transplanted with human liver cells (this required genetically modified mice with severe immunodeficiency).In 2002, scientists also discovered that hepatitis B and C can infect hepatocytes of the Malay tupaya ( Tupaia belangeri ), a representative of a special order of mammals.

The drugs for hepatitis C were originally recombinant type I interferon and ribavirin, which were not effective enough and caused significant side effects. Less than half of the patients recovered, and in some cases the drugs caused autoimmune diseases, disorders of the cardiovascular system or thyroid function, so there was a possibility that the patient would die not from illness, but from treatment.

The situation began to improve only in the late 1990s – 2000s, when inhibitors of one of the viral proteins, the NS3 / 4A protease (beceprevir, teleprevir and simeprevir), appeared. But the real breakthrough in the treatment of hepatitis C was the appearance in 2013 of the NS5B RNA polymerase inhibitor (sofosbuvir), the NS5A protein (ledipasvir). Each of these drugs blocks an important part of the viral mechanism. For example, the NS3 / 4A protease is needed by the virus to split the large protein molecule, which it forced to synthesize the ribosome of the host cell, into ten separate viral proteins.RNA polymerase NS5B is involved in the production of copies of viral RNA. What the NS5A protein is for is not completely clear, but without it, viral replication and assembly of new viral particles are impossible. Very quickly, new substances appeared in each group of drugs. Protease inhibitors are traditionally given names ending in β-previr, RNA polymerase inhibitors in β-buvir, and NS5A protein inhibitors in β-asvir.

A set of new agents targeting proteins that are critical to the life cycle of the virus is collectively referred to as “direct-acting antivirals”.They proved to be highly effective, able to cope with different genetic types of hepatitis C viruses, requiring shorter courses of treatment (two to three months) and causing only minor side effects. Clinical studies have shown that short-term antiviral treatment cures more than 95% of patients, including advanced cases that did not respond to previous therapies. Direct-acting antiviral drugs are used in different combinations, sometimes combined with ribavirin, depending on the genotype of the virus in the patient and his sensitivity and resistance to specific drugs.

But until very recently, there was one more problem. New drugs were expensive, and the cost of a course of treatment was measured in tens of thousands of dollars. Only in the last few years, when the patent terms of a number of such drugs expired and their generics (mainly of Indian origin) appeared, the severity of this problem, if not completely disappeared, then at least significantly decreased.

In the 2010s, new hopes appeared for the creation of a vaccine against hepatitis C. Developers are designing vaccines based on the development of T-lymphocyte immunity.Human T cells must learn to recognize and kill liver cells infected with the virus to prevent further spread of the virus. To do this, modified viruses (most often adenoviruses) are introduced into the body, encoding some proteins of the hepatitis C virus, which are least susceptible to changes. As a result, it is possible to achieve a strong and long-term immune response. Some of these vaccines are currently being tested.

90,000 Viral hepatitis: varieties, symptoms, diagnosis

The liver is considered the largest gland in the human body.Its functions are diverse. It neutralizes toxins from outside. Utilizes substances formed by the cells themselves during metabolism. The organ participates in digestion, producing a burn. Many metabolic processes take place in the liver.

If its work is disrupted, there is not only pain in the right hypochondrium, but also numerous failures in the work of the whole organism. More often than others, the liver tissue is affected by viruses. To insert the correct diagnosis, you need to take blood tests for hepatitis.

What are viral liver damage

Viral hepatitis is a group of infectious liver diseases that occur with degenerative, proliferative and inflammatory changes in the liver cells. They are called hepatotropic viruses (A, B, C, D, E, G), which are detected by a blood test for hepatitis.

This infection is characterized by a manifest course, the duration of which is more than six months.Viral lesions occur more often in young people.

In the absence of adequate treatment, it leads to early cirrhosis and the development of liver cancer with the subsequent death of patients. The progression of the disease is enhanced by the use of drugs, alcohol, the simultaneous presence of several hepatitis and AIDS viruses in the liver cells. To identify mixed infections, tests for HIV and hepatitis are prescribed.

Types of viral liver damage

Now there are several types of viral forms of the disease.The types of hepatitis are as follows:

1. Hepatitis A – referred to as acute forms of the disease. The infection is transmitted by contact and everyday life. It is characterized by a cyclical course. It is characterized by a rapidly passing dysfunction of the liver and short-term manifestations of intoxication.
2. Hepatitis B is an acute or chronic liver pathology caused by a DNA-containing virus. The infection is transmitted by the parenteral route. Hepatitis proceeds in different ways from asymptomatic carriage to malignant variants.
3. Hepatitis C – the causative agent belongs to the flavivirus family. The hepatitis C virus is present in the plasma of patients in very low concentrations. The immune response to it is weak and late.
4. Hepatitis G – liver damage caused by the hepatotropic HGV virus. People become infected with it parenterally when they come into contact with infected blood.
5. Hepatitis D – the disease is caused by an RNA-containing virus of the genus Deltavirus. It is a co-infection with hepatitis B, which worsens the course of the disease.For him, the formation of liver failure is typical.

Most patients are characterized by infection with several types of viruses at once.

Symptoms of hepatitis

The clinical manifestations of the disease determine the degree of activity and the type of pathogen. The severity of symptoms depends on concomitant diseases, as well as the duration of the lesion. The following syndromes are characteristic of viral liver damage:

1. Asthenovegetative – increases fatigue.Emotional lability is present. Patients are irritable and aggressive. Sometimes disturbed sleep, headache.
2. Dyspeptic – the normal functioning of the liver, pancreas, duodenum is disrupted. There is heaviness in the upper abdomen, flatulence, nausea – the patient does not tolerate fatty foods. There is a tendency to diarrhea.
3. Hemorrhagic – in patients it is manifested by a tendency to skin hemorrhages, as well as nosebleeds.
4. Jaundice – rarely develops with viral liver damage.Sometimes sclera subicterity is noted. The yellowness of the skin increases with cirrhosis with liver failure.
5. Extrahepatic – Patients develop myalgia, arthralgia, polyneuropathy, and other symptoms.
6. Hepatosplenomegaly – liver enlargement. It protrudes from under the costal arch up to eight centimeters.

Often, with hepatitis C, the symptoms of the disease are not expressed. He becomes an accidental find in blood tests for hepatitis.

Diagnostics

Typical clinical manifestations help to suspect a disease. To confirm the diagnosis, additional studies are prescribed:

1. Markers. Analysis for hepatitis is carried out by ELISA, the presence of RNA viruses is determined using PCR diagnostics.
2. Blood biochemistry. The level in the blood of ALT, ASAT, gamma-glutamyl transpeptidase (GGT) and others is detected. Before taking an analysis for hepatitis, preliminary preparation is required, which the doctor will inform the patient about.
3. Visualization. Ultrasound of the liver reveals a violation of the structure of the tissues. Reohepatography studies hepatic hemodynamics. Hepatoscintigraphy is performed if cirrhosis is suspected.
4. Invasive methods. Liver biopsy followed by morphological examination of the biopsy is performed at the final stage of the examination.

Laparoscopy is prescribed to visually assess organ changes.