Hepatitis C | Johns Hopkins Medicine

Viral hepatitis refers to infections caused by viruses that affect the liver. Viral hepatitis includes five distinct diseases, caused by five different viruses. The different viruses are called by a letter name:

Hepatitis C Symptoms

Hepatitis C may develop without any signs or symptoms, or symptoms may be nonspecific and short-lived.

There are three phases of hepatitis C, and symptoms may differ depending on the stage.

Early in the disease, called the prodromal phase , symptoms may include:

• Fever

• Joint pain or arthritis

• Rash

• Edema (swelling)

Symptoms of the next phase, the preicteric phase , include:

During the icteric phase :

• Jaundice (yellowing of the skin and whites of the eyes) develops

• Other symptoms may subside

• Anorexia, nausea and vomiting may worsen

• Irritated skin lesions may develop

Hepatitis C Diagnosis at Johns Hopkins

Often, patients with hepatitis C do not experience any symptoms. Many are diagnosed after routine blood works shows abnormal liver enzymes. Sometimes, patients are tested because of their risk factors, such as exposure to needles or a history of blood transfusions.

To diagnose hepatitis C, we may run the following tests:

Blood Tests

The hepatitis C antibody is found in almost every patient with hepatitis C. However, the antibody takes weeks or even months to develop, so if you are tested early after exposure, a false negative may result.

If the blood test is positive for hepatitis C antibody, we will confirm the findings with a sensitive test that can detect even minute amounts of hepatitis C in the blood. This test is called a PCR-based test.

Liver Biopsy

During a biopsy, some of your liver tissue is removed and sent to a pathology lab for analysis. A liver biopsy is an invasive procedure that carries some risk but allows your doctor to determine the exact nature and severity of your condition.

Sometimes, a biopsy can be helpful when deciding how to treat the disease. For example, if the biopsy is close to normal, you may decide to postpone treatment. If the biopsy shows extensive disease, you may choose to begin treatment immediately.

Hepatitis C Treatment at Johns Hopkins

Thanks to advances in medication options, many patients with hepatitis C can be cured. Learn more about treatment for hepatitis C at Johns Hopkins.

How hepatitis C damages the liver

Hepatitis C causes damage to the liver mainly in the form of inflammation, which then leads to scarring or fibrosis.

Hepatitis C results in the death of liver cells. It is uncertain whether the virus kills the cells or if it is the immune system’s response to invasion by the virus. At present it is thought that it is probably a combination of the two, but that the immune system’s response is what causes the most damage. The death of liver cells triggers the dispatching of inflammatory cells to the affected area. Inflammation leads to the enlargement of the liver (hepatomegaly) in over 60% of people infected with hepatitis C and can cause the fibroelastic sheath (Glisson’s capsule) surrounding the liver to stretch, which may be the cause of pain in the liver area.

Inflammation begins the processes that lead to fibrosis. Fibrosis is not a disease but is a condition caused by the body’s response to liver damage. Inflammation triggers a reaction by a group of cells in the liver called stellate (literally star-shaped) or fat cells. When the liver is functioning normally stellate cells store fat and vitamin A in the liver. They also help regulate the flow of blood through the liver. But when the liver is inflamed by the presence of hepatitis C, a reaction occurs amongst different liver cells. This leads stellate cells to dispense with vitamin A, altering their function.

Infected and inflamed liver cells release chemical signals called ‘cytokines’. These activate leukocytes (white blood cells) from outside the liver which travel to the area of infection. On arrival they team up with Kupffer cells (specialised white blood cells that neutralise and remove bacteria, viruses, parasites and tumour cells from the liver) and produce further chemical signals. These signals cause stellate cells to begin producing and laying down collagen fibres in the extra cellular matrix, which is the area between the cells.

Collagen is a fibrous protein which is fundamental to the formation of scar tissue. The body’s use of collagen in an area of injury is an attempt to limit the spread of infection to other cells. As an infection or injury resolves, the collagen matrix enclosing the injury is normally dissolved. The activated stellate cells then die off, allowing the tissue to return to normal.

In a chronic illness such as hepatitis C the collagen matrix grows too fast and cannot be properly dissolved. This results in a build up of scar tissue around cells. Liver cells lose vital access to the blood carrying nutrients and oxygen and so die. A vicious circle results in which inflammation and fibrogenic cells stimulate each other leading to increased fibrosis.

Free Radicals and Fibrosis

A further possible cause of fibrosis is due to damage by free radicals. Free radicals are highly reactive chemical substances. They are the by-product of a cell’s normal reactions such as energy generation and the breakdown of fats. During these reactions oxygen is transformed into the free radical superoxide. Normally cells have mechanisms for protecting themselves from the dangers of free radicals. When too many are generated, or if they are not controlled properly, there is a danger that they will cause cell and tissue damage.

Free radicals are of concern for people with hepatitis C for a number of reasons:

• Chronic liver inflammation may lead to over-production of free radicals within the liver.
• There is evidence that free radicals play a role in liver fibrosis. Free radicals can chemically alter fat in the body. This is called lipid peroxidation. The free radicals attack the cell membrane and can injure and eventually kill cells. If this happens to liver cells, this will lead to fibrosis.

If the liver function is already impaired and this has led to an overload of iron, the free radicals may interact with the iron causing further damage.

The liver is famed for its ability to regenerate, so why doesn’t liver regeneration prevent liver damage in hepatitis?

Hepatitis C is usually characterised by a degeneration of the liver through slow but progressive scarring. The liver has two responses to harmful agents which are capable of damaging its cell structure. Either there is regeneration with complete restoration of the liver structure and function or there is sustained scarring of liver tissue leading to damage. When the liver is damaged by a single strong injury, regeneration is highly likely even if a large area is affected. But if the injury is repetitive as is the case with hepatitis C infection – the liver cannot effectively cope. It does not have the time and space to heal and regenerate.

Hepatitis C Virus: Causes and Risk Factors

Hepatitis C virus (HCV) is an infection that causes inflammation of the liver. It spreads through contact with an infected person’s blood or body fluids. The most common ways that you could acquire HCV infection are through injected drug use, unprotected sex, a medical procedure using contaminated equipment, or through an injury or wound that exposes you to blood infected with HCV. 

Verywell

Common Causes

HCV enters the body and reproduces in the host’s (infected person’s) body, specifically targeting the liver. HCV often evades the body’s immune system and causes disease as a result of direct attack on the liver. The body’s own immune system response also produces harmful inflammation of the liver.

The liver is responsible for many body functions, such as blood clotting, digestion, food absorption and metabolism, so this is why HCV has such a wide impact on the body. 

There are several known mechanisms by which HCV invades the body.  

Injected Drug Use

Sharing needles, syringes, or the other equipment to inject drugs places you at extreme risk for developing HCV. Intravenous drug use is responsible for most of the HCV infections in the United States.  

The course of HCV illness may be different for those who acquire the infection through drug use than it is for people who acquire the infection in other ways. The reasons for this are unclear, but people who are frequently re-exposed to the virus through repeated drug use are more likely to become infected again after having been treated. 

Sexual Contact

Hepatitis C can spread through sexual contact, but it doesn’t happen often. Unlike the hepatitis B virus, which is known to be present in semen and vaginal fluids, HCV is not found in significant amounts in these fluids. The risk of developing HCV from sexual contact is increased if you have multiple sexual partners, have direct contact with blood, have a sexually transmitted disease, or are infected with HIV.

It is difficult to quantify the number of people who acquire hepatitis sexually versus other means. One study found that long-term monogamous partners of someone infected with hepatitis C became infected around 4 percent of the time.  

There has been research looking into whether gay men are at higher risk of HCV, and studies show that the population may be at higher risk of acquiring HCV in certain circumstances, such as unprotected sex with an infected partner. 

Mother-Infant Transmission

Only about 4 to 8 percent of infants born to mothers with hepatitis C will be infected with the virus. This is called vertical spread. The risk of vertical spread nearly doubles if the mother also has HIV or has a higher viral load (high amount of virus in her body) at the time of delivery. C-section does not seem to increase the risk of transmission, but prolonged rupture of membranes during delivery is associated with an increased risk of mother-to-child transmission of HCV. 

Nearly all children born to mothers with HCV have antibodies for the virus. This does not mean that the child is infected.

Antibodies are immune proteins produced by the body in response to disease-causing agents like HCV, and these immune proteins are transmitted to young babies from their mothers.

There is no evidence to suggest that breastfeeding can increase the risk of HCV transmission from mother to child. In fact, the Centers for Disease Control and Prevention (CDC) and the American Congress of Obstetrics and Gynecologists (ACOG) endorse breastfeeding for mothers with HCV.

Needlestick Injuries in Healthcare Settings

Nurses, physicians, and all healthcare professionals who routinely use needles while providing medical care are at risk for needlestick injuries. In fact, it is estimated that more than 600,000 needlestick injuries happen each year, with nurses being at highest risk. An average of about 2 percent of needlestick injuries where there has been exposure to the virus will result in acute hepatitis C.

Blood Transfusion

In the past, blood transfusion was a common way HCV was widespread. People who had hemophilia, thalassemia, or other disease requiring multiple transfusions were especially at risk for exposure. However, today, exposure to HCV through blood transfusions is very rare because donated blood is tested for HCV antibodies as well as HCV genetic material.

Experts believe that your chance of getting HCV from a blood transfusion is about one in 2 million.

Medical Procedures

Some medical procedures, such as organ transplants, can also expose you. As with blood transfusions, organ donors are tested for the virus as well as for antibodies, making the risk extremely low. Vaccinations with contaminated needles may also expose people to HCV. This is not common in developed countries because disposable needles are normally used. 

Household Contact

HCV may spread within a household, but this is rare. Living with someone who has HCV will slightly increase your chances of exposure to the virus. The risk of this type of spread can be reduced by taking certain precautions. For example, since razors and toothbrushes can, in theory, be a source of HCV exposure, it is a good idea not to share these items.

Some estimates indicate that 10 percent of acute hepatitis and 30 percent of chronic hepatitis result from unknown exposures.

Most experts believe that this type of spread comes from contact with a contaminated wound, a forgotten high-risk contact with someone infected with HCV, or exposure to HCV from a medical procedure. 

Because many people have developed hepatitis C without being exposed to any known risk factors, it is now recommended that all adults born between 1945 and 1965 be tested.

Lifestyle

There are several lifestyle risk factors that can increase your chances of becoming infected with HCV. These lifestyle factors increase your chances of coming into contact with contaminated blood. 

• Tattooing or Body Piercing: Some tattoos are placed using needles that have not been properly cleaned, potentially increasing the risk of HCV. 
• Injected Drug Use: Injecting any kind of drug into the skin, veins (IV), or muscles can increase your chances of acquiring HCV if you share needles. 
• Unprotected Sexual Activity: Sexual activity without the use of condoms or when sexual activity involves contact with blood, there is an increased risk of HCV.   
• Drug Use: A study showed that use of drugs or sexual partying associated with drug use may increase sexual risk. This risk appears to be separate from the risk of infection through injected drug use.  
• Healthcare Workers: Healthcare workers can become infected, especially when caring for patients in conditions that are not sanitary. 
• Medical and Cosmetic Procedures: Procedures that are done in a non-accredited environment may increase the chances of becoming infected with contaminated equipment. 
• Casual contact: There is no evidence that casual contact, in general, spreads hepatitis C. Casual contact includes kissing, sneezing, hugging, coughing, sharing food or water, sharing eating utensils or drinking glasses.

Heath Risks

There is no genetic tendency of acquiring HCV or of developing a more severe infection. The only health factor associated with HCV is immune system deficiency, which makes it difficult for your body to fight off the infection. The immune deficiency most often noted with HCV is HIV infection. 

HIV, like HCV, can be acquired through injected drug use with contaminated needles and by sexual contact. The immune deficiency of HIV can make it more difficult for your body to fight off HCV infection. In addition, you may need antiviral medications for each infection, which can make treatment decisions somewhat more complicated if you are co-infected.

Frequently Asked Questions

What causes hepatitis C?

Hepatitis C is caused by the hepatitis C virus (HCV), which primarily attacks liver cells. While many acute hep C infections will spontaneously resolve with no long-term consequences, more than half will become chronic and cause progressive damage to the liver over the course of years.

How is hepatitis C spread?

The hepatitis C virus is primarily spread through percutaneous (through the skin) exposure to infected blood. Injecting drug use is a major cause of transmission. HCV can also be passed from mother to child during pregnancy and potentially through sex. Tattooing, piercing, and blood transfusions are unlikely causes of transmission in the United States.

What are the risk factors for hepatitis C?

Risk factors for hepatitis C include:

How does hepatitis C cause liver damage?

Hepatitis C mainly causes damage by triggering inflammation in the liver, which over time leads to fibrosis (scarring). As the scarring progresses, the liver gradually loses its ability to filter blood, resulting in compensated cirrhosis (in which the liver is damaged but remains partially functional) and eventually decompensated cirrhosis (in which the liver no longer works).

What is the risk of liver cancer from hepatitis C?

If left untreated, chronic hepatitis C infection is associated with anywhere from a 1% to 7% risk of developing liver cancer. The risk increases in tandem with the severity of fibrosis. People with mild fibrosis rarely develop cancer.

Can you get hepatitis C more than once?

Yes. There are seven major genotypes (genetic strains) of hepatitis C virus, and infection with one genotype does not confer immunity against the others. This is important given that some hepatitis C drugs can only treat certain HCV genotypes.

Can hepatitis C kill you?

Yes, and it’s of growing global concern. Over 17,000 people in the United States die of hepatitis C-related complications each year, including liver failure and liver cancer. Around the world, over 700,000 deaths are attributed to hepatitis C annually.

Hepatitis C Testing | Lab Tests Online

Sources

A.D.A.M. Medical Encyclopedia. Venipuncture. Updated April 26, 2019. Accessed July 18, 2021. https://medlineplus.gov/ency/article/003423.htm

A.D.A.M. Medical Encyclopedia. Hepatitis virus panel. Updated October 29, 2020. Accessed July 18, 2021. https://medlineplus. gov/ency/article/003558.htm

A.D.A.M. Medical Encyclopedia. Antigen. Updated July 2, 2020. Accessed July 18, 2021. https://medlineplus.gov/ency/article/002224.htm

A.D.A.M. Medical Encyclopedia. Antibody. Updated July 2, 2020. Accessed July 18, 2021. https://medlineplus.gov/ency/article/002223.htm

ARUP Consult. Acute viral hepatitis. Updated April 2021. Accessed July 18, 2021. https://arupconsult.com/content/hepatitis-acute

ARUP Consult. Hepatitis C Virus: HCV. Updated April 2021. Accessed July 18, 2021. https://arupconsult.com/content/hepatitis-c-virus

Centers for Disease Control and Prevention. Interpretation of results of tests for hepatitis C virus (HCV) infection and further actions. Published 2013. Accessed July 18, 2021. https://www.cdc.gov/hepatitis/HCV/PDFs/hcv_graph.pdf

Centers for Disease Control and Prevention. Hepatitis C testing: What to expect when getting tested. Published April 2020. Accessed July 18, 2021. https://www.cdc.gov/hepatitis/HCV/PDFs/HepCGettingTested. pdf

Centers for Disease Control and Prevention. CDC recommendations for hepatitis C screening among adults: United States, 2020. Published April 10, 2020. Accessed July 18, 2021. https://www.cdc.gov/mmwr/volumes/69/rr/rr6902a1.htm

Centers for Disease Control and Prevention. Hepatitis C questions and answers for health professionals. Updated August 7, 2020. Accessed July 18, 2021. https://www.cdc.gov/hepatitis/hcv/hcvfaq.htm

Chopra S, Pockros PJ. Overview of the management of chronic hepatitis C virus infection. In: Bisceglie AMD, ed. UpToDate. Updated June 12, 2020. Accessed July 18, 2021. https://www.uptodate.com/contents/overview-of-the-management-of-chronic-hepatitis-c-virus-infection

Chopra S, Arora S. Screening and diagnosis of chronic hepatitis C virus infection. In: Bisceglie AMD, ed. UpToDate. Updated July 15, 2020. Accessed July 18, 2021. https://www.uptodate.com/contents/screening-and-diagnosis-of-chronic-hepatitis-c-virus-infection

Feld JJ. Clinical manifestations, diagnosis, and treatment of acute hepatitis C virus infection in adults. In: Bisceglie AMD, ed. UpToDate. Updated August 13, 2020. Accessed July 18, 2021. https://www.uptodate.com/contents/clinical-manifestations-diagnosis-and-treatment-of-acute-hepatitis-c-virus-infection-in-adults

Kumar S. Overview of hepatitis. Merck Manual Consumer Edition. Updated January 2021. Accessed July 18, 2021. https://www.merckmanuals.com/home/liver-and-gallbladder-disorders/hepatitis/overview-of-hepatitis

Kumar S. Overview of acute viral hepatitis. Merck Manual Consumer Edition. Updated January 2021. Accessed July 18, 2021. https://www.merckmanuals.com/home/liver-and-gallbladder-disorders/hepatitis/overview-of-acute-viral-hepatitis

Kumar S. Overview of chronic hepatitis. Merck Manual Consumer Edition. Updated January 2021. Accessed July 18, 2021. https://www.merckmanuals.com/home/liver-and-gallbladder-disorders/hepatitis/overview-of-chronic-hepatitis

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Hepatitis C and kidney disease – Risks, treatment and connections to kidney disease

Be Hep C Smart

Take a short quiz and test your knowledge of hepatitis C and kidney disease.

Hepatitis C is a viral disease that affects the liver. The liver is an organ in the human body that converts everything you eat or drink into nutrients and gets rid of toxins. There is a connection between hepatitis C and kidney disease. hepatitis C can cause kidney disease, and sometimes kidney patients can get hepatitis C from hemodialysis, a treatment for kidney failure, if a medical facility does not carefully follow guidelines for infection control.

Hepatitis C and the liver

Hepatitis C is a disease that attacks the liver. It is caused by the hepatitis C virus, which is spread by coming in contact with the blood of a person infected with hepatitis C. Learn more about hepatitis C and the liver.

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How do people get hepatitis C?

Hepatitis C is spread when the blood of a person who is infected with hepatitis C gets into the body of a person who does not have hepatitis C. Learn about the different ways people can get infected.

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Who is at risk?

Some people are more at risk than others for having or getting hepatitis C. Learn how age and other factors can increase risks.

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Symptoms of hepatitis C

When a person is first infected with hepatitis C, this is called an acute infection. During the acute infection, most people do not have symptoms. If symptoms do happen, they can include fever, fatigue, vomiting and more. Learn more about the symptoms of hepatitis C.

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Hepatitis C and kidney disease

There is a connection between hepatitis C and kidney disease. Hepatitis C can cause kidney disease, and sometimes kidney patients can get hepatitis C from hemodialysis, a treatment for kidney failure. Learn more about hepatitis C and kidney disease.

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Hepatitis C and hemodialysis

The most common form of treatment for end-stage renal disease (ESRD, or kidney failure) is hemodialysis. If your medical facility does not follow guidelines for infection control in the right way, it is possible to get hepatitis C from doing hemodialysis.

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Hepatitis C and kidney transplants

You can still be eligible (allowed) to get a kidney transplant if you have hepatitis C. Learn more about getting a transplant if you have hepatitis C.

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Testing for hepatitis C

If you are at risk for hepatitis C, ask your doctor about getting tested. The only way to know if you have hepatitis C is to get tested. Learn about the tests for hepatitis C.

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Treatment of hepatitis C

The goal of treatment for hepatitis C is to decrease the viral load (the amount of the virus) in your body until the virus is no longer found in your body. Learn about the different treatments for hepatitis C.

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Video: Be Hep C Smart

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Ask the Expert: What’s Hepatitis A, B and C?

Ester Little, MD, is a faculty physician with the Banner Advanced Liver Disease and Transplant Center. To schedule an appointment, call (602) 839-7000.

Question: Can you explain the difference between Hepatitis A, B and C (and other letters)? If I get a vaccination for hepatitis, which am I protected from?

Answer: “Hepatitis” means inflammation of the liver. It can have many causes, including viruses, medications and alcohol. Most commonly, however, we think of the viruses, called A, B and C. There are several other viruses that cause inflammation of the liver, including hepatitis D and hepatitis E, but they are not as common in the United States as in other parts of the world.

Hepatitis A virus causes an acute inflammation of the liver (hepatitis) that almost always gets better on its own. It can be more serious if we are older when we have the disease. It is easily spread from person to person, in food and water, and can infect many people at once (example: if a food handler at a restaurant is infected, many who ate the food can be infected).

Hepatitis B virus (HBV) can be both acute (short-term illness) and chronic (ongoing illness), and is spread through blood or other body fluids in various ways. Hepatitis B is very common in Asia and Africa and those who were born or lived in these areas should be checked for hepatitis B.

Hepatitis C virus (HCV) is almost always chronic and spreads only by blood. Hepatitis A and B can be prevented by vaccination, but not hepatitis C. There are now many good medications available to treat chronic hepatitis B and C.

The symptoms of acute hepatitis include yellowing of the skin and eyes, nausea, fever and fatigue. Chronic hepatitis may have no symptoms, and can last many years and lead to cirrhosis of the liver, which means the liver becomes heavily scarred and less functional.

Because chronic hepatitis may have no symptoms, it is important to know who is at risk to have chronic hepatitis C virus (HCV). Those who had a transfusion of blood or blood products before 1992 (when the HCV was identified), those who have experimented with intravenous drugs or have snorted cocaine, those who have gotten tattoos with a non-sterile needle, and those who have had unprotected multiple sexual partners are at risk to have HCV. But sometimes people who do not have any of these risks behavior can have chronic HCV. In 2013 the Centers for Disease Control and Prevention (CDC) recommended that anyone in the United States born between 1945 and 1964 should be tested for HCV because most patients with HCV in the the country are in that age group and some don’t have a history of risky behavior.

Chronic HBV and chronic HCV can lead to cirrhosis and can sometimes lead to cancer of the liver or liver failure, both of which may require a liver transplant.

Prevention is very important. Other than vaccination, people should be very careful about hygiene (such as hand-washing after using the restroom) to prevent hepatitis A. Hepatitis B and C can be transmitted by sex or sharing needles, razors, or toothbrushes with someone who has the disease.

According to the CDC, in the United States there are about 3.8 million people with hepatitis C and 1.2 million with hepatitis B. Both of these viruses are even more common in other parts of the world.

Viral Hepatitis—A Very Real Consequence of Substance Use

Left untreated, hepatitis can lead to cirrhosis, a progressive deterioration and malfunction of the liver. It can also lead to a type of liver cancer called hepatocellular carcinoma. In fact, HBV and HCV infections are related to about 65 percent of liver cancers worldwide. Nearly 50 percent of the cases are caused by HCV alone.² During the next 40 to 50 years, 1 million people with untreated chronic HCV infection will likely die from complications related to their HCV.³

Since 2012, there have been more deaths due to hepatitis C than all 60 of the other reportable infectious diseases combined.

In an effort to fight viral hepatitis in the United States, the U.S. Department of Health and Human Services developed the National Hepatitis Action Plan for 2017-2020. The plan outlines strategies to achieve the following goals:

1. Prevent new viral hepatitis infections.
2. Reduce deaths and improve the health of people living with viral hepatitis.
3. Reduce viral health disparities (differences among ethnicities, race, income, gender, etc.).
4. Coordinate, monitor, and report on implementation of viral hepatitis activities.

What is the relationship between drug use and viral hepatitis?

Drug and alcohol use places people at particular risk for contracting viral hepatitis. Engaging in risky sexual behavior that often accompanies drug use increases the risk of contracting HBV and, less frequently, HCV. People who inject drugs (PWID) are at high risk for contracting HBV and HCV from shared needles and other drug preparation equipment, which exposes them to bodily fluids from other infected people. Because drug use often impairs judgement, PWID repeatedly engage in these unsafe behaviors, which can increase their risk of contracting viral hepatitis. One study reported that each person who injects drugs infected with HCV is likely to infect about 20 others, and that this rapid transmission of the disease occurs within the first 3 years of initial infection.⁴ Drug and alcohol use can also directly damage the liver, increasing risk for chronic liver disease and cancer among those infected with hepatitis. This underscores that early detection and treatment of hepatitis infections in PWID and other people who use drugs is paramount to protecting both the health of the person and that of the community.

What are the other health challenges for people with hepatitis who inject drugs?

People with hepatitis who inject drugs often have several other health conditions at the same time, including mental illness and HIV/AIDS, thus requiring care from multiple health care providers. This is sometimes referred to as co-occurring disorders. Substance use disorder treatment is critical for PWID, as it can reduce risky behaviors that increase the chance of transmitting hepatitis. Research has shown that patients with hepatitis receiving medication-assisted treatment for their opioid addiction can be safely treated with antiviral medications.⁵

To enhance HCV care, NIDA is examining coordinated care models that utilize case managers to integrate HCV specialty care with primary care, substance use disorder treatment, and mental health services so that these patients get treatment regimens that address all of their health care needs. The Health Resources and Services Administration’s Ryan White HIV/AIDS Program developed a free, online curriculum about HIV/hepatitis C for healthcare providers and healthcare staff to increase knowledge about co-infection among people of color in the United States.

What treatments are available for viral hepatitis?

Many medications are available for the treatment of chronic HBV and HCV infection. For chronic HBV infection, there are several antiviral drugs. People who are chronically infected with HBV require consistent medical monitoring to ensure that the medications are keeping the virus in check and that the disease is not progressing to liver damage or cancer.

There are also antiviral medications available for HCV treatment and new treatments have been approved in recent years. Many antiviral HCV treatments can cure more than 90 percent of people who take them within 8 to 12 weeks. HCV treatment dramatically reduces deaths, and people who are cured are much less likely to develop cirrhosis or liver cancer. However, not everyone infected with HCV needs or can benefit from treatment. NIDA researchers have identified genes that are associated with spontaneous clearance of HCV. These genes also enable people who are unable to clear HCV on their own to respond more favorably to treatment medications. This new information can be used to determine which patients can benefit most from HCV treatment. More studies must be done, but this is a first step to personalized medicine for the treatment of HCV. 

How do I know if I am infected with viral hepatitis?

The number of new HBV and HCV infections has been declining in recent years, but the number of people living with chronic hepatitis infections is considerable, and deaths associated with untreated, chronic hepatitis infections have been on the rise. This is because most people don’t know they are infected until the disease has begun to damage the liver, highlighting why screening for viral hepatitis is so important. People with a history of drug use are generally at higher risk, and should discuss their substance use with their health care provider.

Initial screening for HBV or HCV involves antibody tests, which show whether you have been exposed to the hepatitis virus, although not necessarily whether you are still infected. A positive antibody test should then be followed up with a test that measures the amount of virus in your blood. If this follow-up test is positive, then you should seek advice from a physician that specializes in viral hepatitis treatment. Because screening for hepatitis is so critical for linking people who test positive to the care they need, NIDA is studying new rapid HCV antibody tests that can be used in drug treatment settings.

The CDC recommends that people who inject drugs be tested for hepatitis B and C as part of routine medical care. To determine if you are at risk for contracting hepatitis, HHS has created an online assessment tool to help you find out.

What do I do if I find out I have viral hepatitis?

After learning from your doctor that you have hepatitis, your first step will be to learn more about the virus. Read government resources, like the websites listed below, to find current, scientific information. Adopting a healthy lifestyle is important to prevent the virus from becoming serious. Don’t drink or misuse drugs because they are hard on your liver. Get plenty of rest, eat healthy foods, and exercise. Work to protect others by not donating blood or participating in risky behaviors, including sharing needles when using drugs or having unprotected sex.

References

1. Hardtke-Wolenski, M., et al., Genetic predisposition and environmental danger signals initiate chronic autoimmune hepatitis driven by CD4+ T cells.Hepatology, 2013.
2. Centers for Disease Control and Prevention. Viral Hepatitis and Liver Cancer Fact Sheet. https://www.cdc.gov/nchhstp/newsroom/docs/factsheets/viral-hep-liver-cancer.pdf. Accessed April 6, 2018.
3. Rein, D.B., et al., Forecasting the morbidity and mortality associated with prevalent cases of pre-cirrhotic chronic hepatitis C in the United States.Dig Liver Dis, 2011. 43(1): p. 66-72.
4. Magiorkinis, G., et al., Integrating phylodynamics and epidemiology to estimate transmission diversity in viral epidemics.PLoS Comput Biol, 2013. 9(1): p. e1002876.
5. Bruce, R.D., et al., A review of pharmacological interactions between HIV or hepatitis C virus medications and opioid agonist therapy: implications and management for clinical practice.Expert Rev Clin Pharmacol, 2013. 6(3): p. 249-69.
6. Centers for Disease Control and Prevention. Surveillance for Viral Hepatitis – United States, 2017 Report. https://www.cdc.gov/hepatitis/statistics/2017surveillance/index.htm. Accessed July 31, 2020.
7. S. Department of Health and Human Services, Office of Infectious Disease and HIV/AIDS Policy. Viral Hepatitis in the United States: Data and Trends. https://www.hhs.gov/hepatitis/learn-about-viral-hepatitis/data-and-trends/index.html. Accessed July 31, 2020.

90,000 Hepatitis C – causes, symptoms, diagnosis and treatment

IMPORTANT!

The information in this section cannot be used for self-diagnosis and self-medication. In case of pain or other exacerbation of the disease, only the attending physician should prescribe diagnostic tests. For a diagnosis and correct treatment prescription, you should contact your doctor.

Hepatitis C: causes, classification, symptoms, diagnosis and treatment.

Definition

Hepatitis C is a viral infection that causes inflammation of the liver, often leading to serious liver damage. The hepatitis C virus is spread through contaminated blood.

Until recently, hepatitis C treatment required weekly injections and oral medications that many people infected with the virus were unable to use due to other health problems or serious side effects.

Today the situation has changed – new generation drugs have been developed, and with their help chronic hepatitis C can be treated.

However, about half of people with hepatitis C are unaware that they are infected, as the disease is often asymptomatic.

Therefore, screening for hepatitis C should be done regularly, especially if there are risk factors for infection.

Reasons for the appearance of hepatitis C

The disease usually spreads when the blood of a person infected with the hepatitis C virus enters the body of an uninfected person.This happens especially often among drug addicts.

People who often receive blood transfusions and who are on hemodialysis for a long time are at risk.

Newborn children are susceptible to infection if their mother is sick with hepatitis C.

In addition, there are rare, but still possible situations of infection with the virus:

1. Sharing personal hygiene items that could come into contact with the blood of a sick person (razors, scissors or toothbrushes).
2. Sexual contact with a person infected with the hepatitis C virus.
3. Tattoos or piercings performed in inadequate sanitary conditions.

The hepatitis C virus is not transmitted by sharing cutlery, breastfeeding, hugging, kissing, holding the hand, coughing or sneezing, or through insect bites. It also does not spread through food or water.

Classification of the disease

Depending on the duration of the illness:

1. Acute hepatitis C is an early stage when hepatitis lasts less than six months.
2. Chronic hepatitis C is a long-term type in which the illness lasts more than six months.

Up to 85% of cases of acute hepatitis eventually become chronic.

Hepatitis is distinguished by the activity of the pathological process:

1. Minimum activity (hepatic transaminases (ALT and AST) in the biochemical blood test are increased by no more than 3 norms)).
2. Moderate activity (3-10 norms of hepatic transaminases).
3. High activity (> 10 norms).

According to the degree of fibrosis, that is, replacement of normal liver connective tissue during the inflammatory process:

1. F0 – no fibrosis.
2. F1 – portal fibrosis without septa (connective tissue septa).
3. F2 – portal fibrosis with single septa.
4. F3 – Numerous septa without cirrhosis.
5. F4 – cirrhosis (complete replacement of normal liver tissue with fibrous.It leads to severe dysfunction of liver cells, and also significantly slows down the movement of blood and bile through the liver).

Symptoms of hepatitis C

Chronic viral hepatitis C is usually a “silent” infection for many years until it damages the liver enough to show signs and symptoms of severe illness.

During the first 6 months from the onset of the disease, a person may not even suspect that he is sick, feeling only inexplicable fatigue, poor appetite, heaviness in the right hypochondrium, regular headache and dizziness.

During the same period, the color of feces (from light to white) and urine (from dark yellow to brown) may change. Some patients say they have joint pain.

As the disease progresses, spontaneous bleeding (nose, uterine, bleeding from the gums), jaundice of the skin, a tendency to form hematomas, itching, accumulation of free fluid in the abdominal cavity (ascites), edema of the legs join the initial symptoms. In addition, patients begin to lose weight, memory decreases, vision problems appear, and spider veins form on the skin.

Men may experience gynecomastia (enlargement of the mammary glands), decreased libido, and decreased testicular size.

Symptoms of acute hepatitis C include jaundice, fatigue, nausea, fever, and muscle pain. They appear 1-3 months after infection with the virus and last from two weeks to three months.

Acute HCV infection does not always progress to a chronic phase. In some people, the virus goes away after the acute phase in a process known as spontaneous viral clearance (cure).In studies of patients diagnosed with acute hepatitis C, the frequency of spontaneous viral clearance ranged from 15 to 25%.

Diagnostics of hepatitis C

The diagnosis is made on the basis of the patient’s complaints and anamnesis. If viral hepatitis C is suspected, the doctor must find out whether there have been blood transfusions, surgical procedures, whether the patient has used injecting drugs, whether he has done tattoos or piercings, or whether there have been unprotected sex.

To clarify the diagnosis, the following examinations may be needed:

1. Clinical blood test with expanded leukocyte count.

Treatment of hepatitis C in Krasnoyarsk: treatment regimen and features

Hepatitis C is a viral liver disease caused by the hepatitis C virus. The causative agent of the disease can lead to the development of acute and chronic forms of hepatitis of varying severity. At the same time, a significant part of people with hepatitis C subsequently die from cirrhosis or liver cancer – this is its great danger.

The disease is caused by an RNA-containing virus from the Flaviviridae family, which multiplies in hepatocytes – liver cells using an intracellular replication mechanism. Today, a large number of HCV varieties are known (6 genotypes and 90 virus subtypes), the most common types are: 1b, 3a, 2a, 2b. Determining the genotype of the virus is an important step in the process of choosing a treatment regimen for hepatitis C and the duration of therapy.

Hepatitis C symptoms

Hepatitis C is often referred to as the “affectionate killer” because at the initial stage it is almost asymptomatic or symptomatic.In the initial period of the disease (2 – 3 weeks), its manifestations are similar to those of ARVI: muscle weakness, joint pain, mild indigestion.

With the transition to the chronic stage, hepatitis C leads to the development of concomitant diseases that affect the genitourinary and vascular system. At the same time, 50–90% of cases of chronic hepatitis C pass into cirrhosis and liver cancer. The consequences are very serious, but it is worth remembering that today hepatitis C is completely curable if the disease is diagnosed in time and treatment is started.

Diagnostics of hepatitis C

In the diagnosis of hepatitis C, laboratory research methods play a leading role – a blood test provides the most information for determining the disease. Instrumental methods (CT, MRI, ultrasound) play an auxiliary role, they provide information about the state and structure of the liver, as well as the effectiveness of the treatment.

If you suspect hepatitis C, the following tests are usually prescribed:

1. general and biochemical blood test
2. analysis for antibodies IgM
3. analysis for the determination of the RNA of the virus by PCR, with its help you can detect the disease at an early stage and prevent its development into a chronic form
4. determination of interleukin 28 beta by PCR, is carried out to determine the possible effectiveness of treatment.

How Hepatitis C Spreads

Hepatitis C is an anthroponotic disease, it is transmitted exclusively from person to person. Infection most often occurs through blood, during treatment or in everyday situations:

• blood transfusion
• surgery or dental intervention
• using unsterilized reusable syringes
• use of non-sterile instruments in hairdressing salons, beauty salons, tattoo parlors, etc.d.
• during sexual intercourse
• during childbirth from mother to newborn baby.

Hepatitis C is not transmitted by airborne droplets, oral-fecal or through the skin. Sharing household items and utensils also does not lead to infection, the only exceptions are items that can get blood: razors, nail scissors, toothbrushes and towels.

A high risk of infection remains for healthcare workers who come into contact with the blood of patients and for people who use drugs.But breastfeeding is safe: a mother with hepatitis C can breastfeed her baby and not transmit the virus to him.

In this case, the activity of the virus increases as the disease progresses. A person with chronic hepatitis C is much more infectious than a virus carrier.

Hepatitis C treatment

Doctors of the Medyunion clinic pay great attention to the eradication of the virus when treating hepatitis C in Krasnoyarsk. The scheme for removing the virus from the body is approximately as follows:

• protection of healthy cells from virus damage
• prevention of virus reproduction
• strengthening the immune system

If it is impossible to remove the virus from the body, then the goals of hepatitis C treatment in Krasnoyarsk are to maintain liver function, slow down or stop inflammatory processes and prevent the transition of hepatitis C to cirrhosis or cancer.Methods of hepatitis C treatment in Krasnoyarsk at the Medyunion clinic depend on many factors: the patient’s gender and age, viral load, liver condition, and the nature of the course of the disease (acute or chronic).

Today, there are many direct-acting drugs for antiviral therapy, which are incorporated into the RNA of the virus, disrupting the synthesis of important proteins that are used in the process of its replication. Using these drugs, it is possible with a probability of 95% to suppress the virus in a period from 1 month to six months.

Along with antiviral therapy in the treatment of hepatitis C, hepatitis C is widely used hepaprotectors, which support the liver and slow down the processes of its degradation. They strengthen the walls of hepatocytes, prevent the accumulation of fat in the liver, stimulate the formation of bile – their goal is not to cure hepatitis, but to slow down the course of the disease and recover from it.

The effectiveness of treatment is also influenced by a properly selected diet, the purpose of which is to normalize liver functions, improve bile secretion and protect the stomach and intestines from any damage.By getting rid of bad habits and changing lifestyle, a person has a good chance of slowing down the development of hepatitis C.

Expert: More than 3.5 million people are sick with chronic hepatitis C in Russia – Society

MOSCOW, July 28. / TASS /. More than 3.5 million people in Russia live with chronic hepatitis C, Vladimir Chulanov, head of the Reference Center for Viral Hepatitis at the Central Research Institute of Epidemiology of Rospotrebnadzor, told TASS on World Hepatitis Day.

Viral hepatitis is an inflammation of the liver tissue caused by a virus. There are five main hepatitis viruses – A, B, C, D and E. The most common symptoms of hepatitis are yellowing of the skin and whites of the eyes, excessive fatigue, nausea, vomiting, and abdominal pain. However, very often viral hepatitis, especially hepatitis C, proceeds without jaundice and any other striking symptoms. In the absence of timely treatment, chronic viral hepatitis can lead to the development of fibrosis, cirrhosis, or liver cancer.

“Chronic viral hepatitis B and C are widespread. In the Russian Federation, according to various estimates, the proportion of people who have met the hepatitis C virus ranges from 2% to 4%. And about 3.5 million people are sick with chronic hepatitis C. But not all of them have been identified, many people live with this infection and do not know about it, “Chulanov said.

As the expert explained, chronic hepatitis in most cases occurs without obvious symptoms. “The person may have increased fatigue, but this is not a specific symptom, so he does not seek medical help.The virus is detected by chance when a person is tested for antibodies to it, for example, in preparation for hospitalization or for another reason. Therefore, many people who have not been tested may be infected, but are not aware of it. The peak incidence of chronic hepatitis B and C falls in the 35-50 age group. It is important to remember this because the disease progresses faster with age and leads to the formation of cirrhosis or liver cancer, “he said.

According to experts, in Russia about 27 thousand die from diseases directly related to chronic viral hepatitis B and C, in particular from liver cancer and cirrhosis.person per year. “According to our estimates, carried out according to WHO recommendations, about 14 thousand people die annually from liver cirrhosis as a result of chronic hepatitis C in Russia, about 1.6 thousand people die from liver cancer. 10 thousand people, and about 1.5 thousand people with liver cancer. These are quite high mortality rates and, of course, the problem of chronic viral hepatitis requires close attention, “Chulanov shared.

According to the expert, within 10-20 years, the virus damages and destroys liver cells, which are replaced by connective tissue, after which the liver ceases to function normally.”These two unfavorable outcomes of chronic viral hepatitis are the greatest danger because they lead to high mortality,” he added.

Transmission routes

One of the differences between hepatitis viruses is the way they are transmitted. So, hepatitis A and E can be infected through water, dirty hands or food contaminated with the virus, hepatitis B, C and D – through contact with blood. For example, with risky behavior – intravenous drug use, with non-observance of the necessary precautions to prevent the transmission of viruses during manicure, tattooing or in conditions of medical care, including dentistry.Also, the possibility of infection through blood transfusion is not excluded. However, according to Chulanov, this happens very rarely in Russia due to strict control measures in the blood service.

“Hepatitis B and C viruses can be sexually transmitted. Hepatitis B is easily transmitted sexually, since this virus is very contagious. But hepatitis C, although it can potentially be transmitted, is rare, and the risk of infection in this case is 2 -5%, that is, this risk is not very high “, – said the expert.

There is also a perinatal risk of mother-to-child transmission. In this case, infection can occur not in utero, but directly during childbirth, when the child comes into contact with the mother’s blood. Although the risk of hepatitis B transmission is high, the vaccination given within the first 24 hours after birth is fully protective of the baby. The hepatitis C virus is rarely transmitted from mother to child – the risk is no more than 2-5%. “Therefore, most babies who are born to mothers with hepatitis C are not infected,” Chulanov explained.

Vaccination and treatment

The head of the Reference Center noted that Russia has one of the world’s best hepatitis B vaccine prevention programs, which made it possible to reduce the incidence of acute hepatitis B to single cases per 100 thousand adults and practically save children from it. There is an effective vaccine against hepatitis A, which is included in the vaccination schedule in many regions of Russia. It is recommended primarily for those people who live in regions that are not very favorable for this infection or plan to travel to countries where it can be infected.

A vaccine against hepatitis C has not yet been developed due to the high variability of the virus. Therefore, as a preventive measure, doctors recommend observing the rules of personal hygiene, avoiding contact with someone else’s blood, using only their own manicure accessories, and avoiding risky behavior. “Regarding chronic hepatitis C, in the last five to seven years, there has been a revolution in the world with regard to the development of new drugs. Now in the arsenal of infectious disease doctors there are very effective drugs that allow most patients to be treated with an efficiency of more than 95%,” Chulanov added.

Regarding hepatitis B, according to him, the situation is “both more complicated and simpler.” “It is more difficult, because today we cannot completely rid a person of the virus, there are no such drugs yet. The existing drugs suppress the virus, its replication, thereby reducing the risks of unfavorable outcomes. There are quite a few of these drugs, they are no longer protected by patents and are relatively inexpensive. the availability of treatment for chronic hepatitis B and C is not yet high, and the mechanisms of drug provision for viral hepatitis require improvement, “he said.

Chronic hepatitis C in children

According to Rospotrebnadzor, in 2018 in Russia, chronic hepatitis C was detected in almost 425 children under 17 years old, hepatitis B – in 83. “As of 2017, about 17 thousand children with chronic forms of hepatitis were registered in the Russian Federation. Insidiousness the disease consists in the fact that it is diagnosed late due to the lack of a clear clinical picture and the absence of icteric forms in the vast majority of cases.In children, chronic hepatitis C proceeds more smoothly, without vivid symptoms, while in adults, various extrahepatic manifestations of the disease – from the joints, blood vessels, kidneys and other organs and systems “, – told TASS Doctor of Medical Sciences, Head of the Department of Pediatric Gastroenterology, Hepatology and Dietetics at the Clinic of the Federal Research Center (FRC) for Nutrition and Biotechnology, Tatyana Strokova.

In children, she said, extrahepatic manifestations in chronic hepatitis C are less common, the disease progresses slowly, and liver cirrhosis, in contrast to adults, develops only in 1-3% of cases. “Children very well compensate for their condition in different ways, they adapt better, they still do not have a baggage of diseases. Very often, the first and nonspecific signs of the disease are weakness, fatigue. But nowadays it is difficult to distinguish whether these symptoms are a manifestation of the disease or is it demeanor. child, an attempt to manipulate parents and a desire to achieve their goal, for example, not to go to classes, “added Strokova.

To date, the most effective therapy is drugs with direct antiviral action, but there are still limitations in their prescription: in children, they can be used only from the age of 12. “First, the safety and efficacy of the drugs in adult patients must be proven, then” optimal children’s doses “are investigated. years, are still being held.Therefore, the process of registration of medicines for children is always late, “Chulanov explained.

According to Strokova, in Russia, the first such drug for children from 12 years of age has been allowed only since February 2019. It significantly increases the effectiveness of therapy and shortens its duration to only eight weeks, and in the case of liver cirrhosis – to 12 weeks. “As for drugs with direct antiviral action, they directly act on the virus, preventing its reproduction in the body. The main thing is the high efficiency of therapy – 97-100% and virtually no side effects,” she added.

Chulanov, in turn, said that when hepatitis C is detected in children of younger age groups, WHO recommends postponing treatment until 12 years old, since the disease progresses very slowly and without much damage to the body. “When prescribing regimens with the inclusion of interferons (an old method of treatment that can be used up to 12 years old – approx. TASS), there are contraindications, including concomitant diseases. In addition, they cause a wide range of side effects. Among them, the most frequent is a deterioration in well-being. , fever, flu-like syndrome on the days of drug administration, “added Strokova.

According to a representative of the Federal Research Center of Nutrition and Biotechnology, the number of children infected perinatally has increased significantly in recent years. “We very much hope that the treatment of chronic hepatitis C in children will be included in the program of state guarantees. the risk of developing extrahepatic manifestations of the disease in adults, progression to cirrhosis, hepatocarcinoma (liver cancer – approx.TASS), which requires liver transplantation. Simple calculations show that these costs will be much higher for the health care system, “she concluded.
90,000 Up-to-date information on hepatitis C today – Effective treatment of infection

03/26/2020

Hepatitis C (ICD 10 – B 17.1, B 18.2) is a viral infection that affects the liver. Its manifestations can be very diverse – from a mild illness that disappears without special treatment after a few weeks, to a serious, chronic illness that persists throughout life without special therapy.Hepatitis C is usually described as “acute” for recent infection and “chronic” for an infection that lasts more than 6 months.

Unfortunately, about 75-85% of people who get hepatitis C chronic form, the remaining 15-25% recover without any special treatment. It is currently impossible to predict which of the patients will self-heal.

If antibodies to the virus and its RNA are detected in a person for the first time and he has not previously been examined, it is extremely difficult to say exactly when the infection occurred, whether the infection is acute or chronic.We can only guess the time of infection based on epidemiological data – episodes when a person was at risk of infection.

Hepatitis C is usually transmitted when the blood of a person infected with the virus enters the blood of a healthy person. The largest number of cases of infection are associated with the use of shared needles or other tools when preparing and using drugs. Until the early 1990s, hepatitis C was also often transmitted through blood transfusions or organ transplants.After the introduction of mass screening of blood components, this route of transmission of infection has become extremely rare.

People can become infected with the hepatitis C virus in the following cases:
• When using shared needles, syringes or other instruments for the preparation and use of drugs
• Manipulation of instruments contaminated with the blood of an infected person in medical institutions
• When a child is born to a mother with hepatitis C.

Less commonly, infection occurs in situations such as:
• Using things that could have gotten the blood of an infected person (razors, manicure accessories, toothbrushes)
• Unprotected sex with a person infected with the hepatitis C virus
• Performing a tattoo or piercing without proper instrument handling.

Hepatitis C is not transmitted by sharing utensils, breastfeeding, hugging, kissing, shaking hands, coughing, sneezing. It is also not spread with food or water.
A person who has recovered from the virus (spontaneously or after using drugs) can become infected again, since the acquired immunity does not protect against other subtypes of the virus (and there are a large number of them).

People at increased risk of contracting hepatitis C include:
• Current or past injecting drug users, including those who used them once and many years ago
• People who received blood clotting factor preparations before the 90s of the 20th century, when less modern methods of their production, control and purification were used
• People who received blood transfusions or organ transplants before the 90s of the 20th century, when the best donor screening became available
• Patients on hemodialysis
• Health care workers after needle sticks from infected patients
People who received blood or an organ from a donor who tested positive for hepatitis C
• Children born to mothers with chronic hepatitis C
• People who have had tattoos or piercings with non-sterile instruments

Given the common modes of transmission, hepatitis C is common among people with HIV infection.That is why all people who have been diagnosed with HIV also need testing for viral hepatitis, including hepatitis C.
If a woman has hepatitis C, she can pass the virus on to her baby during pregnancy. This happens about 6 times out of 100. However, the risk may be increased if the pregnant woman is coinfected with HIV and hepatitis C.
There are several different ways to classify hepatitis C. We have already mentioned one of them – acute hepatitis C (ICD code – B 17.1) and chronic hepatitis C (ICD code – B 18.2).

According to the morphological picture, successive stages are distinguished:
• 0 – no fibrosis
• 1 – mild periportal fibrosis
• 2 – moderate fibrosis with portoportal septa
• 3 – severe fibrosis with portocentral septa
• 4 – cirrhosis of the liver

These stages can be determined using direct (invasive) methods – liver biopsy or using non-invasive diagnostics – fibroscanning (aka elastometry) of the liver or serological panels (based on blood tests) and combined scales and algorithms.

According to the degree of activity of the inflammatory process, there are:
• Minimal (persistent hepatitis)
• Slightly expressed
• Moderately pronounced
• Severe (active hepatitis)

Currently, the most significant (for the selection of therapy and determining the prognosis) is the course of the process (acute or chronic), the degree of fibrosis, the genotype of the virus and the viral load before the start of therapy. As a rule, it is these data that the doctor makes into the final diagnosis.

The manifestations of even acute hepatitis C are usually not severe. Most often, patients note:
• Fever
• Weakness
• Darkening of urine
• Lightening of the stool (clay-colored feces)
• Discomfort in the abdomen
• Loss of appetite
• Nausea, sometimes vomiting
• Joint pain
• Jaundice (yellowness of the sclera and skin)

Most patients with chronic hepatitis C do not have any symptoms.Sometimes this disease can manifest itself only with such general complaints as chronic weakness and depression. That is why hepatitis C often remains unrecognized until a person is examined for one reason or another (for example, before donating blood as a donor or planned surgery).

However, despite such a seemingly mild course of the disease, it is necessary to treat chronic hepatitis C. The fact is that the virus, being present in the body, causes constant chronic inflammation in the liver, it can be expressed in varying degrees, but it always takes place.The result of inflammation is the gradual replacement of healthy liver tissue with fibrous (scar) tissue, which ultimately leads to liver cirrhosis. And cirrhosis of the liver is a serious condition, which is expressed in the fact that the liver does not adequately perform its functions. Cirrhosis can be complicated by fatal bleeding, ascites, dysfunction of the central nervous system, and also significantly increases the risk of developing liver cancer – hepatocellular carcinoma.

Blood tests are used to establish the diagnosis of hepatitis C.As a screening (primary) method of examination, an analysis for antibodies to hepatitis C is used. However, in order to say for sure that a person is currently sick, this analysis is not enough. In patients who have recovered from hepatitis C (spontaneously after suffering an acute form of n or when taking medications), antibodies will also give a positive result. To confirm the presence of the virus in the body, an additional blood test is carried out by the PCR method. This allows you to directly identify the virus itself, or rather, its genetic material – RNA of the hepatitis C virus.
Only in this case, the doctor can establish the diagnosis – chronic hepatitis C (ICD 10 – B.18.2).

Fortunately, nowadays there is a fairly effective and safe treatment of hepatitis C with direct antiviral drugs. The modern course of treatment usually takes 3 months and is carried out only in tablet forms of drugs, without the use of injections. The doctor selects a specific therapy regimen after establishing a complete diagnosis and taking into account concomitant diseases and drugs that the patient may be taking to treat other chronic diseases.Thus, all you need, if during the examination you received a positive test result for antibodies to hepatitis C, is to contact an infectious disease specialist for further examination and selection of therapy if the diagnosis is confirmed.

Author: infectious disease doctor of the University Clinic H-Clinic Degtyareva Svetlana Yurievna .
Medical editor: Head of the University Clinic, Ph.D., infectious disease doctor Konnov Danila Sergeevich .

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90,000 How the world is fighting hepatitis C

On October 5, one of the important events of the scientific world took place – the presentation of the next Nobel Prize in Physiology or Medicine. This year it honored molecular biologists Harvey Olter, Charles Rice and Michael Houghton for the research that led to the discovery of the causative agent of hepatitis C – the “affectionate killer” as doctors call it.

An article about the discovery of the virus was published already in 1989, but scientists, including those in Russia, are still looking for ways to combat the “quiet” but dangerous virus.In our country, within the framework of the national project “Science”, equipment for scientific research and other methods of supporting advanced developments are being updated.

Why the discovery of today’s winners of the award was important for all of humanity, and what still remains to be done in the fight against the insidious virus, from the chronic form of which, according to the World Health Organization, about 71 million people worldwide suffer – in the material of the portal’s correspondent “ The future of Russia. National projects “.

Saving millions of lives

Having freed itself from infections that kill rapidly, mankind in the 20th century turned to the study of diseases that proceed for a long time and secretly. The attention of scientists was attracted by liver lesions, which were conditionally divided into two large groups. According to Vasily Vlasov, Professor of the Department of Health Care Management and Economics of the National Research University Higher School of Economics, the first group included diseases associated with the use of dirty water, designated as hepatitis A, and the second – “blood” hepatitis.

The latter turned out to be heterogeneous, and for quite a long time it was not possible to identify them. “Hepatitis B was discovered first (the names were given in alphabetical order) – this hepatitis was associated with blood transfusions and other close contacts. And, unfortunately, for some time, a large group of liver lesions associated with blood transmission, but not hepatitis B, remained unclear “neither A, nor B” – that’s how they were called “NANBH”, – says the professor.

Associate Professor of the Department of Biophysics and Associate Professor of the Department of Physics of Living Systems at the Moscow Institute of Physics and Technology Oleg Batishchev clarifies that the causative agents of hepatitis A and B were discovered back in the 70s, but doctors understood: there is something else. They saw symptoms similar to hepatitis viral infection in patients, but could not identify the causative agent. “The patient could not be prescribed an effective therapy, could not develop new drugs,” Batishchev emphasized. Scientists came to the discovery of enormous significance only in the late 1980s:

Harvey Olter discovered the viral origin of hepatitis C and its differences from hepatitis A and B viruses, Michael Houghton, using an untested method at that time, isolated the genome of the C virus, and Charles Rice presented “definitive evidence that hepatitis C virus itself can cause hepatitis.”“This study identified the cause of the remaining cases of chronic hepatitis that could not be explained earlier. In addition, thanks to this discovery, it became possible to carry out a blood test for this type of infection. These studies have contributed to the invention of new drugs that have saved millions of lives! ” – emphasized Denis Kuzmin, winner of the Leaders of Russia 2020 competition, candidate of biological sciences, director of the Phystech School of Biological and Medical Physics at MIPT.

“Hepatitis C turned out to be the most dangerous of these viruses in terms of mortality.And it was this study that made it possible to propose effective methods of fighting the virus, which saved millions of lives, ”agrees Oleg Batishchev.

Pharmaceutical Revolution

The practical importance of the discovery for which the authors received the Nobel Prize is that, based on the data of scientific work, the possible pathways of viral infection have been identified, described and systematized, drugs have been developed that are now successfully used in treatment patients.But this did not happen immediately.

Professor of the Department of Management and Health Economics at the Higher School of Economics Vasily Vlasov says that for almost 20 years after the discovery for the treatment of hepatitis C, there was still nothing but interferons. Until recently, the diagnosis of hepatitis C was a death sentence: it gives almost no clinical symptoms until the patient develops viral cirrhosis of the liver, added Oleg Batishchev, associate professor of the Department of Biophysics and Associate Professor of the Department of Physics of Living Systems at MIPT.“Interferon treatment is very expensive, ineffective and very poorly tolerated by patients. Therefore, the fact that we have received an effective remedy for the treatment of hepatitis C in the last 10 years is one of the greatest advances in pharmacy in history. There have not been so many effective drugs of this kind against a deadly disease in the history of mankind, ”noted Vasily Vlasov.

Despite an interval of almost two decades between the discovery and appearance of highly effective therapy, Vasily Vlasov believes that this is a rather short historical perspective.“If science could always do this – having learned to understand, immediately lead to a solution to the problem, we would love science even more,” the scientist jokes. Professor of the Department of Microbiology of the Kabardino-Balkarian State University (KBSU) Zaira Kharaeva also calls the emergence of drugs against hepatitis C a real revolution. “The effective treatment of hepatitis C in Russia began literally in the last decades thanks to the discoveries of scientists and the work of pharmacists. Earlier, in the 1990s and the beginning of the 2000s, if a patient was diagnosed with hepatitis C, B, D, F, then we could practically do nothing to help him, only to alleviate his condition, “she recalls.

According to Chavdar Pavlov, Head of the Department of Therapy of the Institute of Professional Education, Director of the Center for Evidence-Based Medicine at Sechenov University, there are already several generations of antiviral drugs for the treatment of hepatitis C, including combined direct antiviral drugs without side effects, among which there are Russian developments. For example, the domestic drug Narlaprevir is included in the scheme of combined direct antiviral therapy.

Doctors still call hepatitis C “an affectionate killer” for its asymptomatic course for 10-20 years, says Professor of the Department of Infectious Diseases of the KBSU Maryana Nagoeva. “With the isolation of this virus as a separate nosological unit, we have become a screening method to examine patients, which makes it possible to identify patients at an early stage. Before irreversible changes begin, the disease is completely curable: the last groups of antiviral drugs provide 99-100% of hepatitis C cure rate.That is, the virus can be removed even at the stage of cirrhosis or cancer, although the liver damage itself cannot be easily eliminated, ”the doctor emphasizes.

According to her, a lot of work is being done in Russia on the treatment and prevention of hepatitis C, specialized conferences and symposia are regularly held, where pharmacists, doctors and scientists share their developments. Now all inpatients and patients undergoing elective surgery in Russia are examined for hepatitis C. A new protocol for transfusion of blood and its components has also been introduced, which excludes the transmission of the disease from the donor to the recipient.However, despite the fact that an effective treatment for hepatitis C has been found, people continue to become infected with it – 3.5 million people with a chronic form of the disease have now been identified in Russia. It is possible and necessary to reduce this amount, experts say.

Treatment is good, and prevention is better

Although there is no vaccine against the virus yet, its development is underway in Russia, said Maryana Nagoeva, professor of the Department of Infectious Diseases at KBSU. “I think that a vaccine can be invented, but there are a number of difficulties.The structure of the causative agent of the hepatitis C virus is such that it escapes the human immune system, it does not recognize it and, accordingly, does not produce antibodies. The second feature is a very fast mutation, which does not allow creating a vaccine at the same speed. But the goal of developing a vaccine is before Russian scientists, ”she said.

The Moscow Research Institute of Biomedical Chemistry named after V.N. Orekhovich. Professor of the Department of Microbiology of KBSU Zaira Kharaeva noted that the causative agent of hepatitis C mutates even faster than the influenza virus known for its inconstancy.These complexities make it impossible to predict when a vaccine will appear, she said. Meanwhile, the professor noted that the existing vaccine against hepatitis B provides significant relief for infected hepatitis C.

This vaccine has been included in the national immunization schedule and has been administered to newborns since 2002. Revaccination is recommended for risk groups (for example, doctors) every 15 years. Doctors call unprotected sex, intravenous drug use, or poor quality services such as tattoos, piercings, or cosmetic injections as the main routes of transmission of the hepatitis C virus.

According to Chavdar Pavlov, practice shows that the virus often becomes chronic, since the disease at the first stage proceeds without symptoms.
“But in general, things are not so gloomy. The fact that effective therapy has been invented is already a huge step forward! For example, today it is even possible to use an organ infected with hepatitis C for transplantation, and after transplantation, a successful therapy can be carried out. With hepatitis C, thanks to the discoveries of recent decades, everything is not so bad, ”concluded the interlocutor of the portal.

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90,000 Treatment of hepatitis C, treatment of hepatitis B, treatment of chronic hepatitis in Nizhny Novgorod at the clinic Tonus

In the case of acute hepatitis B, treatment for hepatitis is similar to that used for hepatitis A.The patient in this case rarely needs specific antiviral therapy.

Chronic viral hepatitis B and C are a health hazard.

It has been proven that ALL infected persons (regardless of whether there are clinical manifestations of the disease or they are absent) have a very high risk of developing hepatocellular carcinoma – HCC (liver cancer).

At the same time, this risk is the higher, the longer the virus is in the body. The second threat to the patient is a dysfunction of the liver, which also develops imperceptibly, gradually, for many years, but inevitably leads to the development of cirrhosis.Simultaneous exposure to alcohol, drugs, overweight and uncontrolled drug intake quickly and seriously destabilize the situation and accelerate the onset of these formidable outcomes of viral hepatitis B and C. Therefore, all over the world, doctors and scientific experts in this field pay great attention to timely diagnosis of the disease, determination of activity and the stage of the process in the liver with the aim of conducting treatment of hepatitis with antiviral drugs that have a detrimental effect on viruses.

Infectious disease doctors are mainly involved in the treatment of hepatitis in the acute phase, since it is they who can most clearly and competently make a differential diagnosis with other diseases.