Hepatitis C diagnosis and new techniques , Hepatitis treatment

Diagnosis of hepatitis C

hepatitis c diagnosis

diagnosis of hepatitis C Install using only classical methods of laboratory diagnosis is not possible. This is due to HCV infection flow, which is characterized by: asymptomatic during the initial stages of the disease is low, normal ALT levels are often late appearance of antibodies (up to 2 years the onset of illness) leading role in the laboratory diagnosis of HCV infection occupy methods allow: directly detect the genetic material of the virus in the blood and tissues of the human body (mononuclear cells, hepatocytes, bone marrow tissue, etc.) to evaluate the replicative activity of the virus in tissues quantify concentration of virus in the blood serum to establish the genotype and to monitor the variability of HCV Biochemical analysis of blood biochemical blood analysis criteria: not specific do not characterize the etiology of viral hepatitis are essential for the assessment of the functional state of the liver bilirubin metabolism Performance Indicators exchange bilirubin (the basis of biochemical analysis of blood, urine and feces) for the diagnosis of viral hepatitis only play a role in the development of jaundice. anicteric form of viral hepatitis in the majority remain unrecognized. Antibody (anti-HCV) found in 70% of cases when the first symptoms of the disease, and in 90% of cases - within three months. But the fact that the symptoms often can not be.HCV RNA in the blood (more detailed analysis of the PCR method) is detected within 1-2 weeks after infection. Acute hepatitis C is rarely diagnosed and often by chance. Characterized by a rather high activity of transaminase liver (often an increase in ALT 10 times or more) in the absence of clinical manifestations (patient complaints, no outward signs of illness). The symptoms of acute hepatitis C include intoxication, lack of appetite, weakness, nausea, and sometimes - joint pain. Then may develop jaundice, which with the advent of transaminase activity is reduced. Possible enlargement of the liver and spleen (hepatosplenomegaly). Overall, intoxication and elevated transaminases are less pronounced than in hepatitis A and B. The presence of antibodies to hepatitis C virus (anti-HCV) and HCV-RNA. Positive results of both tests confirm the presence of infection.Antibodies class IgM (anti-HCV IgM) to distinguish from active hepatitis carriers (when no IgM antibodies and normal ALT).

To which the doctor you need to go?

Chronic hepatitis C should be treated by an experienced specialist hepatologist.
This will ensure maximum effectiveness of the treatment, its good tolerability and avoid additional costs.
Many doctors are taken for treatment of hepatitis, given the high demand for it today. However, not many have the proper training and, most importantly - the clinical experience of modern therapy for chronic hepatitis C.
Modern drugs and schemes effective combination therapy for chronic hepatitis C appeared not so long ago and the experience of their use in our country has been concentrated in a few specialized centers. The greatest experience in the treatment of hepatitis C have doctors hepatologists involved in international clinical trials of those drugs that are taken in treatment now or go on a wide appeal in the near future.

Determination of hepatitis C virus RNA

Definition of HCV-RNA by PCR:

the main method of diagnosis, allowing directly detect the genetic material of hepatitis C virus in the blood and tissues of the human body. This study helps to confirm the infection and gives information about the activity and the rate of viral replication in the body. Detection of HCV RNA in the blood for positive ELISA results (determination of antibodies to HCV) confirms the presence of hepatitis C in a patient. PCR - diagnosis - the main method for the diagnosis of early (acute) forms of hepatitis C, in which the blood has not yet been determined by the antibody.

Genotyping of hepatitis C virus RNA:

an analysis to determine the genetic variation of hepatitis C virus genotypes There are more than 10 hepatitis C virus, but enough for clinical practice to identify 5, the most common in Belarus types: 1a, 1b, 2, 3 a/3b. Identification of genotype (genotype) is important in determining the duration of treatment, which is very important given the wide range of side effects of interferon and low tolerability of the drug patients.

Tests:

Qualitative detection of HCV-RNA

The direct detection of HCV-specific RNA in the serum can be achieved only when using very sensitive techniques, since the number of viruses is usually negligible. To detect HCV RNA is used for hepatitis analysis by PCR. However, this method is not reliable. Studies conducted in the framework of the European Hepatology Group (Eurohep) for qualitative evaluation of this test showed complete absence of errors in the analysis of serum samples, only 16% of all laboratories involved in this work. Errors in taking and storing blood and analysis significantly reduce the reliability of the results. However, only the analysis for hepatitis PCR method allows detection of active viral replication. PCR remains a decisive criterion in determining the indications for antiviral therapy.

Quantitative determination of HCV-RNA

Quantity of virus circulating in the blood is dependent on the activity of viruses and their replication clearance. To determine the quantitative PCR used viremia. Recently it was shown that the amount of virus in untreated patients with chronic HCV infection is relatively stable. We can not exclude that the quantification of HCV in the future may become an additional criterion for the indications for therapy, especially in difficult situations (in the long course of the disease, are coming histological changes, the elderly, etc.). In practice , however, the application of expensive method to quantify HCV RNA are currently not worth it, because it is not a decisive indication for interferon. In future quantitative determination of HCV-RNA could play a role if monotherapy will shift antiviral combination treatment comprising the specificeffect on virus replication. However, the excess of the quantitative threshold of virus can not in practice be regarded as a lack of evidence to interferon. It is also important to point out that the effectiveness of treatment is monitored for activity and GPT (in those cases when this is necessary), a qualitative determination of RNA by PCR. For a simple statement of chronic HCV infection liver biopsy is not necessary. This does not apply to cases when a patient with chronic HCV infection is planned to antiviral treatment. The purpose of such treatment is primarily to prevent the formation of cirrhosis of the liver. The question of whether there is cirrhosis of the liver at the time of the planned treatment can be solved only by histologic examination. Since recently began to carry out research in the form of laparoscopic "mini-laparoscopy." Strong optics (1.9 mm) is inserted through the same trocar through which the needle was inserted before Veres (Veres) insufflation of nitrous oxide. In the German study on the application of this method is extremely gentle 200 patients diagnosed with cirrhosis macroscopically was established in 74 of them. However, the histological study, which was conducted without the knowledge of the data pathologist laparoscopy, an accurate diagnosis was confirmed only in 35 of 74 patients. Possible (but notfinal) the diagnosis of cirrhosis was suspected in 20 of 74 patients. In 12 of 74 patients with histological evidence of cirrhosis were absent. Conflicting results were observed primarily in patients with cirrhosis, which is known (with a hook called dysplastic nodes) is considered a precancerous condition. Histological confirmation of the macroscopic picture SKD cirrhosis was only possible in 14% of cases. Thus, the data obtained using the "mini-laparoscopy", indicate a high sensitivity of the method in the diagnosis of liver cirrhosis. Laparoscopy is undoubtedly reached peak capacity in the form of a "mini-laparoscopy" superior method of percutaneous liver biopsy, especially in an uncertain interpretation of the nature of dysplastic nodes within cirrhosis. The old rule that the pathologist should be as fully informed about available patient baseline liver changes, applies in cases of chronic HCV infection.

Markers of hepatitis C

Antibodies (markers) of hepatitis C virus (anti-HCV)

the first analysis that needs to be done in cases of suspected infection with hepatitis C. This is not the virus itself, and the proteins produced by the immune system in response to the virus from entering the body. Antibodies are different classes and can be detected for a long time, sometimes for life, even in the absence of the virus. If this analysis is negative, hepatitis never hurt you. The only exceptions are cases of recent infection (less than 6 months). During this time, the antibody may not yet appear in the blood. Positive same test to determine antibody means that the body had contact with the virus. For various reasons (for pregnant women, patients with certain infections, the presence of some features of the immune system), this analysis may give false-positive (positive analysis, but infections are actually not) and false-negative results (negative analysis, but the infection actually there). That's why for more accurate diagnosis of hepatitis C, other studies performed.

Antibodies to individual proteins of hepatitis C virus (range)

this specific antibodies to individual structural and nonstructural proteins of hepatitis C virus to determine their judgments about the viral load, the activity of infection, the risk of chronicity, the delimitation of acute and chronic hepatitis, liver damage.

Confirmation of the presence of antibodies to hepatitis C virus

the method of infection with hepatitis C by detecting specific antibodies in the blood, resulting in proteins of hepatitis C virus (CORE, NS1 NS2, NS3, NS4, NS5) to confirm the preliminary studies for hepatitis C upon receipt of positive or questionable results in the study to identify antibodies to viral hepatitis C. The study is considered positive if detected antibodies to 2 or more proteins of the hepatitis C virus.
  Detection of antibodies to hepatitis C virus can not determine the difference between a current infection and infection. To confirm the diagnosis of active hepatitis C infection and need to be tested for the presence of RNA by polymerase chain reaction.