Hepatitis C
The content of the article:
- Causes and risk factors
- Forms of the disease
- Disease stages
- Symptoms
- Diagnostics
- Treatment
- Possible complications and consequences
- Forecast
- Prevention
Hepatitis C is an acute or chronic anthroponous liver infection caused by the hepatitis C virus.
According to the World Health Organization, there are currently 130-150 million people (according to other sources - up to 200 million) infected with the hepatitis C virus (HCV, HCV, Hepatitis C Virus). The annual mortality rate for this disease and associated pathologies is approximately 700,000 cases.
Consequences of hepatitis C
After the determination of the viral nature of hepatitis in the 70s of the XX century and the isolation of pathogens of types A and B, the question arose about the classification of other hepatitis, the presence of which was confirmed, but it was not possible to identify the type of virus. For such diseases, the name “non-A, non-B hepatitis” (non-A, non-B hepatitis, or NANBH) has been proposed. Only in 1994 was it reliably confirmed the presence of the hepatitis C virus, which provokes the corresponding disease (hereinafter also referred to as D and E hepatitis). At the same time, mandatory screening of donated blood for the presence of antibodies to HCV was introduced.
Often, acute illness is asymptomatic and in 15–35% of infected persons spontaneously resolves within 3–6 months, even in the absence of specific treatment. The remaining 45–85% of patients with acute hepatitis C have chronic inflammation, which in about a third of cases is complicated by cirrhosis or liver cancer.
The main features of this type of hepatitis, which determine its severity, are:
- a high percentage of chronicity of the disease;
- life-threatening long-term consequences (cirrhosis and liver cancer);
- lack of effective etiotropic (aimed at destroying the pathogen) treatment;
- impossibility of effective immunization due to the high mutability of the virus.
Synonyms: viral hepatitis C.
Causes and risk factors
The causative agent of hepatitis C is an RNA virus of the Flaviviridae family, which has at least 6 genetic types and about 90 subtypes that have spread in different regions and determine the severity of the disease.
Subtype 1a prevails in North Europe and America, 1b - in Japan, South and Eastern Europe, Asia; subtypes 2a and 2b are most widespread in Europe, North America, Japan; type 3 is widely represented in Southeast Asia, Indo-Pakistani region. Subtype 3a is the second most common in developed countries; as a rule, persons under the age of 20 who use injecting drugs are infected with it. Genotypes 4 and 5 are most common in African countries.
In Russia, genotype 1 and subtypes 2a and 3a are more common.
The only source of infection is a sick person. The main route of transmission of the virus is parenteral:
- transfusion of infected blood and blood products;
- medical, diagnostic and cosmetic (aesthetic) manipulations in conditions of non-compliance with sterility (with contamination of the instruments with infected blood);
- joint injection of drugs with one needle with a carrier of the hepatitis C virus (according to statistics, every second injection drug user is infected with HCV).
In addition to the parenteral route of infection, the vertical route of transmission of HCV from a sick mother to a child during pregnancy and infection during unprotected sexual contact are possible. These methods of infection account for no more than 10-14% of cases in total.
Ways of transmission of hepatitis C
You cannot get hepatitis C:
- when using some household appliances (with the exception of shaving, manicure and other accessories, which may have traces of blood);
- when shaking hands, hugging;
- when kissing;
- with a joint meal.
Main risk factors:
- donor blood transfusion;
- performing tattooing, manicure, injection manipulations, dental procedures in unreliable institutions;
- unprotected sex with a casual partner;
- joint injection drug use;
- professional contact with blood (we are talking about medical workers, military, emergency workers).
Forms of the disease
The main forms of viral hepatitis C:
- acute (manifest icteric, manifest anicteric, subclinical);
- HCV paste infection (acute outcome, recovery);
- chronic HCV [latent (inapparent or subclinical), manifest].
Outcomes of chronic hepatitis C:
- HCV cirrhosis of the liver (compensated or decompensated);
- hepatocellular carcinoma.
Chronic hepatitis C leads to liver cirrhosis and hepatocellular carcinoma
According to the severity, hepatitis C is:
- easy;
- moderate severity;
- heavy;
- fulminant (severe malignant).
Disease stages
The following stages of hepatitis C are distinguished:
- Incubation period.
- Preicteric stage.
- Icteric stage.
- Reconvalescence (recovery) or transition to a chronic form.
Symptoms
The incubation period of the disease lasts from 1.5 to 6 months (on average, 2-3).
Acute hepatitis C is characterized by a benign course, the condition quickly normalizes, the manifestations of the disease are mild or moderate:
- unexpressed dyspeptic symptoms (1-2 times vomiting, heaviness or dull bursting pain in the right hypochondrium, unstable stools, nausea, decreased appetite, bitterness in the mouth);
- rise in body temperature to subfebrile numbers (noted by about a third of patients), high fever is uncharacteristic;
- enlarged liver;
- icteric staining of the skin and visible mucous membranes, icterus of the sclera;
- dark staining of urine, discoloration of feces.
It is characteristic that the severity of the disease in acute hepatitis C is less pronounced than in other forms of viral hepatitis.
Jaundice of the sclera in a patient with hepatitis C
Recovery against the background of an acute process occurs in 15–35% of infected persons, in other cases the disease becomes chronic and lasts for many years and even decades.
Most often (in about 70% of cases), any symptoms of both acute and (subsequently) chronic hepatitis are absent for many years, an infected person is worried about increased fatigue, recurrent severity in the right hypochondrium, intolerance to intense physical activity. In this case, the carrier of the virus is determined by chance during preventive examinations, during hospitalization or when trying to donate blood as a donor.
Diagnostics
Diagnosis is based on:
- the presence of epidemiological data on the possible method of infection - the so-called starting point (it is characteristic that in about half of the infected, the cause of the disease cannot be identified);
- the presence of specific clinical manifestations (with an icteric form of the disease);
- determination of IgM and IgG to HCV;
- detection of HCV RNA (HCV-RNA) by polymerase chain reaction;
- changes in the biochemical blood test [increased levels of liver enzymes (ALT, AST), hyperbilirubinemia];
- positive thymol test.
To detect the hepatitis C virus, you need to donate blood for analysis
Treatment
The main goals of treatment are to prevent the development of complications and slow or stop progression. To do this, appoint:
- direct-acting antiviral drugs (DAAs);
- interferons (including PEG-interferon);
- immunomodulators;
- hepatoprotectors;
- detoxification therapy;
- desensitizing agents;
- vitamin therapy;
- enzyme preparations.
Complex treatment of hepatitis C with the use of immunomodulators and interferons
According to some reports, complex pharmacotherapy of acute hepatitis C using DAA and PEG-interferon for 6 months in 98% of cases led to the cure of patients and excluded the transformation of the disease into a chronic form.
Possible complications and consequences
Complications of hepatitis C can be:
- chronization of the process (in approximately 80% of cases);
- cirrhosis of the liver;
- hepatocellular carcinoma.
Forecast
In 25–35% of patients diagnosed with chronic hepatitis C, connective tissue degeneration of liver tissue (cirrhosis) with a possible fatal outcome occurs within 10 to 40 years. In 30-40% of patients with a chronic form of the disease, liver cirrhosis will undergo malignant transformation in the future.
If HCV RNA remains in the blood of an infected person for more than 6 months, HCV infection is unlikely to resolve spontaneously.
Prevention
There is no specific immunization (vaccination) for hepatitis C due to the high variability of the virus.
Main preventive measures:
- compliance with personal hygiene measures;
- handling hands and using gloves when handling blood;
- rejection of casual, unprotected sexual relationships;
- refusal to take narcotic drugs;
- obtaining medical, cosmetic services in officially licensed institutions;
- carrying out regular preventive examinations with possible professional contact with blood.
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Olesya Smolnyakova Therapy, clinical pharmacology and pharmacotherapy About the author
Education: higher, 2004 (GOU VPO "Kursk State Medical University"), specialty "General Medicine", qualification "Doctor". 2008-2012 - Postgraduate student of the Department of Clinical Pharmacology, KSMU, Candidate of Medical Sciences (2013, specialty "Pharmacology, Clinical Pharmacology"). 2014-2015 - professional retraining, specialty "Management in education", FSBEI HPE "KSU".
The information is generalized and provided for informational purposes only. At the first sign of illness, see your doctor. Self-medication is hazardous to health!
