Hepatitis C treatment and prophylaxis , how to get it

Hepatitis C treatment

Hepatitis C treatment and prophylaxis , Hepatitis treatment

complex and largely similar to the treatment of hepatitis B. Risk of hepatitis C in the fact that an effective vaccine capable of protecting against infection with hepatitis C does not exist.

The goals of hepatitis C treatment:

• Reduce or eliminate inflammation of liver, to prevent passage of hepatitis to cirrhosis.
•     Reduce the amount or eliminate the virus from the body, particularly of the liver.

    European Association for the Study of the Liver, including Russia, has developed basic principles of treatment of hepatitis C patients and monitor them. The basis for all regimens is interferon-alpha. mechanism of action of this preparation is to prevent the infection of new liver cells (hepatocytes). Under the influence of interferon in the body, symptoms resembling flu infection: fever, weakness. Side effects of the drug last about 12 hours after administration, and then tested. Most strongly expressed in the first two weeks of treatment. When receiving interferon need monthly blood tests to evaluate the effectiveness of treatment. Interferon can not guarantee full recovery, but to prevent the development of cirrhosis and liver cancer. The effectiveness of treatment is significantly improved if interferon is used in combination with ribavirin. A positive effect is achieved in 40-60% of cases. After hepatitis C treatment, it is important to continue to monitor blood tests over the next few months, as some patients may reappear signs of inflammation of the liver.
    Hepatitis C treatment was marked by significant advances in connection with the introduction into clinical practice of pegylated (long-acting) interferon and inhibitors of virus replication that today not only helps prevent the development of serious complications such as cirrhosis and liver cancer, but also many patients completely eliminate (remove) the pathogen, leading to recovery.

How can hepatitis C treatment be done ?

In order to stop or slow the progress of the disease with a sense of responsibility can carry out a course of treatment with interferon-alpha, possibly in combination with the drug ribavirin. Ribavirin - a substance that overwhelming virus hepatitis C, the mechanism of this effect has not yet been able to find out all the details. This material has a particularly good effect in combination with the drug interferon alpha, it takes in the form of tablets or capsules. Interferon - is an autologous protein, which is produced, including white blood cells, particularly in those cases where the body is necessary to fight against viral pathogens. Alpha-interferon is used to treat hepatitis B virus, are prepared using biotechnology. As well as, for example, insulin treatment of patients suffering from diabetes, interferon alpha drug must be injected into the subcutaneous adipose tissue. In order to improve the frequency of positive responses to treatment with interferon alpha and tolerability of this treatment, the interferons can be combined with polyethylene glycol (PEG) (pegylated interferon-alpha, pegylated interferon alpha). Changed such manner interferons longer retain its action in the body and must therefore be injected only once a week. Polyethylene glycol coats alpha interferon and creates a kind of "protective cover", preventing thus premature decomposition of the medicament. However, those portions of interferon, which are responsible for its antiviral effect, remain blocked. Thus able to maintain a more uniform level of drug exposure and over a longer period of time constantly suppress virus replication process. Another technique for prolonging the duration of action of interferon-alpha is its combination with human serum albumin. Albumin - a natural substance with long half-life, performing a variety of tasks in the body. Alpha interferon combined with albumin (albumin-interferon) retains antiviral effects of interferon, however, due to the long half life of albumin, the drug must be injected only once every two to four weeks. Clinical studies have shown that patients with chronic hepatitis C receiving interferon preparations long-acting frequency index positive virological response is much better than the indicator in patients taking standard drugs interferon short-term action. Through a combination of long acting interferons with drug ribavirin can even further enhance the frequency of cures. Standard dosages of interferon also, and with the point of view of the combination treatment tolerance in quality is much better than a combination of standard interferon with ribavirin.Also ribavirin dose Your doctor should help you to choose individually tailored to your pictures blood (especially the content of red blood pigment [hemoglobin), the weight of your body, as well as the genotype of the hepatitis C virus dose is generally from 800 to 1200 mg per day, it is administered in two portions - morning and evening. In particularly serious cases, you can think about the introduction of a higher dose. Given the body weight after infection with hepatitis C virus 1st and 4th genotype ribavirin dose should be about 15 mg per 1 kg body weight, and in the case of the 2nd and 3rd genotype - about 13 mg per 1 kg body weight body. The main goal of treatment is to stop connective tissue growth [cirrhosis] in the liver and related complications). This goal can be achieved best if the hepatitis C virus will be completely removed from the body, ie if on over a long period of time, the hepatitis C virus RNA can not detect even using the most sensitive methods. Frequency of positive responses (the number of patients at the time of treatment in blood longer not possible to identify hepatitis C) at prolonged treatment with interferon action and ribavirin is about 60-90%. Unfortunately, some patients who initially had a good response to treatment, even during treatment (rarely), or after the termination of taking medication again detected hepatitis C. Therefore, the long-term success of the treatment with combination therapy long-acting interferon and ribavirin 50-60% of the total. Especially important is the regular intake of medicines. If treatment with alpha interferon / ribavirin originated chickpeas severe side-effects (eg, depression), then, if necessary, such phenomena should be treated with medication, but all the same (if possible) need to continue treatment with antiviral drugs. Since the side effects of treatment with interferon alpha / ribavirin after treatment very quickly pass, the concomitant therapy can be undone. Particularly good results of treatment can be achieved if treatment is started as soon as possible. Daylight acute forms of the disease hepatitis C in chronic form may be prevented by the 24-week monotherapy using (PEG) interferon-alpha. Treatment for this severe form of hepatitis C should begin not later than three to four months after infection.
 Treatment of chronic hepatitis C in younger patients with a short-lived occurrence of the disease is far more successful than the treatment of elderly patients who have already reached the stage of cirrhosis. The probability of a positive long-term virological response (cure) to combination therapy in patients infected with the 2nd or 3rd genotype, much better than in patients infected with hepatitis C virus 1 or 4 genotype. And duration of therapy also has a great influence on the success of the treatment of chronic hepatitis C.The current provisions on the treatment of hepatitis C (as amended in 2009) is recommended for patients with hepatitis C virus 2nd or 3rd genotype carrying 24 - week standard therapy, which in the best case can be reduced to 16 weeks (if the patient has a normal weight, have a no cirrhosis of the liver, before treatment it has a low viral load and rapid virological response differs with the proviso that in the beginning of the 4 th week of treatment, the patient no longer be detected HCV RNA). Patients infected with hepatitis C virus 2nd or 3rd genotype in the blood which in the beginning of the 4th week of treatment still manages to identify  RNA virus of hepatitis C may benefit from therapy, which lasts a little longer than 24 weeks (36 -48 weeks ). Standard duration of therapy in patients infected with hepatitis C virus with 1 or 4 genotype is 48 weeks, but in patients (without cirrhosis), which before the start of therapy had a lower viral load in the blood which through four weeks treatment is not possible to identify the viruses hepatitis C, duration of therapy may be reduced to 24 weeks. In this case the chances of long-term virological response to such therapy does not decrease. It seems that patients infected with hepatitis C 1 or 4 genotype with slow response to antiviral therapy (at the beginning of the 12th week of treatment, blood is still possible to identify hepatitis C virus RNA, but by the 24th week of their already no longer detected) receive much benefit from an extended period of up to 72 weeks of treatment. On the basis of such indicators as the initial viral load and an initial reduction in viral load in the blood in patients undergoing treatment, and after four through twelve weeks can make a conclusion about how high the odds are good for long-term removal of viruses . Chances of a cure, the higher the faster and clearer flows initial decrease in viral load. Chances that in the first 12 weeks of treatment did not reach at least 99% reduction of the initial viral load. Various studies have shown that in the successful combined treatment of interferon and ribavirin is the proportion of connective tissue fibers in the liver decreases and the incidence of liver cancer development is reduced. However, even after complete removal of the hepatitis C virus risk of liver cancer for many years there is still high, so after successful therapy still has a sense of place regular monitoring of liver ultrasound. For all patients with chronic hepatitis C and with increased inflammatory activity in the liver Treatment with the proviso that the patient does not suffer additional diseases and that does not exist other circumstances which have served as the basis to prohibit the course of therapy. The decision on the preparations used, the dose and duration of treatment must individually check your attending physician.

Toxic hepatitis C treatment

Called toxic hepatitis liver damage caused by a toxic agent: drugs, pesticides, household cleaning products, and other occupational hazards. Currently two types secrete toxic hepatitis. The first type is predictable liver, which is associated with the occasional use of toxic substances of any origin. The second type are unpredictable liver, which include destruction of medical origin. Treatment of toxic hepatitis are carried out according to the general principles of treatment of liver failure, and only under medical supervision. In order to suppress the formation and removal of toxic substances in the body is assigned a protein restricted diet in daily diet to 50 g and the intestine is washed regularly. With a view to carry out detoxification treatments aimed at restoring and maintaining acid-base balance, electrolyte balance and other metabolic disorders. Data entry procedures include intravenous glucose solution, ascorbic acid, potassium chloride, and other solutions. Treatment of toxic hepatitis assigned individually depending on the degree of intoxication and liver damage. Criterion of effective treatment is to normalize the patient's general condition, including biochemical parameters of the functional state of the liver. Duration of treatment ranged from 2 weeks to several months depending on the severity of the disease.

Chronic hepatitis C treatment

Infection with hepatitis C leads to chronic liver disease and can cause cirrhosis or liver cancer, if time does not start the treatment of chronic hepatitis. For the purpose of selecting the optimal course of treatment for chronic hepatitis C requires an individual approach based on a clear understanding:

•     history and course of the disease;
•     factors influencing the progression of the disease;
•     results of continuous monitoring of the treatment;
•     monitoring for side effects for their correction and prevention.

Currently, treatment of patients with chronic hepatitis C is based on interferon or combination therapy. The duration of treatment depends on the course and stage of hepatitis and can last up to 12 months. EMC experts Hepatology center treats hepatitis C, developing a method of therapy, depending on many factors. In  the case of the presence of comorbidities and side-effects during therapy, treatment for hepatitis C is carried out in conjunction with experts according to the profile of the patient and the nature of established adverse effects (endocrinologist, neurologist, therapist, cardiologist, etc .). In most cases, treatment of hepatitis Gastroenterological Center performed in outpatient conditions, whichever combination therapy using drugs interferon and nucleoside analogues.

Modern treatment strategies for chronic hepatitis C

The mainstay of treatment for hepatitis C - combined antiviral therapy. International research and clinical practice have shown that currently the most proven itself a combination of two drugs - interferon-alpha and ribavirin. Individually they are less effective. However, in special cases (eg, contraindications to one of the drugs) can be assigned to one drug monotherapy. Doses and duration of treatment are selected by the doctor individually, taking into account many factors. Any other treatments with proven efficacy that can ensure the elimination of hepatitis C virus does not exist today. About all the new methods with proven efficacy in the treatment of chronic hepatitis C, we will write in this section, as soon as they appear. General recommendations of all physicians - not self-medicate. Beware the suggestions of other treatments, always discuss this with your doctor. Today you can find a lot of publicity and allegations of effective treatments for hepatitis C and new media - whether it be drugs acting on the immune system, "strengthen" the liver, vitamins, supplements or methods physiotherapy. Ignore the loud-sounding names and solid recommendations. In the best case - these methods do not bring harm, but their benefits have never been proven in practice.The main thing - "do not overlook" dangerous scenario of infection just assign really effective treatment for hepatitis C. When hepatitis C is more difficult to treat? According to statistics, more difficult to treat hepatitis C in men, people older than 40 years, in patients with normal transaminase activity, with a high viral load, we have b 1 genotype. Of course, the presence of cirrhosis at the time of initiation of treatment worsens the prognosis. Effectiveness of antiviral treatment depends on many factors. Prolonged course of hepatitis C is not easy to achieve complete eradication of the virus. The main task - to slow down the process of active viral replication. This is possible in most cases using modern schemes of antiviral therapy. When there is no active virus replication in the liver was significantly reduced the severity of inflammation, fibrosis does not progress. What happens if after the course of treatment, the patient "does not fall" in the percentage of cured? There are courses and special schemes for re-treatment of people whose treatment outcome was not achieved or proved incomplete (a relapse of infection immediately after treatment). Drugs and hepatitis C therapy protocols are constantly being improved, increasing their efficiency and may be higher than the previous treatment regimen, which did not give the desired result.

Hepatitis C prophylaxis

With the advent of mandatory preventive measures, such as testing for the virus With blood and the use of disposable syringes and surgical instruments virus infection during medical procedures has decreased, the main route of infection is the use of non-sterile needles when injecting drugs, as well as piercing and tattooing. Effective vaccine to prevent hepatitis C does not exist yet, but the infection can be avoided by following these rules:

•     You can not use injection drugs. If a person can not abandon them, you can not share with anyone needles, syringes, solutions and any similar devices (tubes for inhaling cocaine) and you can not use someone else's. Necessarily need to be vaccinated against hepatitis A and B, that will keep the liver at risk of co-infection;
•     you can not divide and use other people's razors and appliances, toothbrushes and any article which may be infected blood;
•     HCP should be immutable observe safety, especially when working with sharp objects and, of course, be vaccinated against hepatitis B.
•     in a medical facility, including dental surgery, the patient needs to ensure that all potentially dangerous manipulations performed only disposable instruments;
•     if you want to spoil your skin, making a tattoo or piercing, well laid out, where do you go for it. Master shall wash their hands before touching you, and then work in disposable gloves. But, unfortunately, you can not check the needle, which will prick you, and can easily get infected if the needle contains infected blood.
•     final rule, it must also be the first - can not drink alcohol, which is the main enemy of the liver.

Passive or active immunization against HCV infection has not yet been developed. Immunization of chimpanzees using glycoprotein E1 and E2 results in some animals with experimental HCV infection to the development of specific immunity. However, considerable variability of the HCV genome and the existence of many genotypes represent a significant obstacle to the creation of a protective vaccine. Normal serum immunoglobulin does not prevent hepatitis C. spend even late 70s study includes intravenous administration of high doses of immunoglobulin for the prevention of post-transfusion hepatitis (then called hepatitis non-A or-B), only allowed to reduce the incidence of icteric disease (which is only hampered his diagnosis), but have not reduced the total number of cases of hepatitis. Three different gene region encoding the HCV non-structural proteins NS3, NS4 and NS5. In an experimental model in mice after DNA immunization against the nonstructural proteins able to obtain distinct cell (but not humoral) immune response. Using the nonstructural proteins NS3 and NS5 is promising, at least in mice, in terms of generating a subsequent immunity.