Hepatitis C is a viral infectious liver disease transmitted by transfusion, characterized by a mild, often subclinical, rarely moderate course in the phase of primary infection and a tendency to chronization, cirrhosis and malignancy. In most cases, hepatitis C has an inanimate, low-symptom onset. In this regard, it may remain undiagnosed for several years and is detected when cirrhosis is already developing in the liver tissues or a malignant transformation into hepatocellular cancer occurs. The diagnosis of hepatitis C is considered sufficiently justified when viral RNA and antibodies to it are detected in the blood as a result of repeated studies by PCR and various types of serological reactions.
General information
Hepatitis C is a viral infectious liver disease transmitted by transfusion, characterized by a mild, often subclinical, rarely moderate course in the phase of primary infection and a tendency to chronization, cirrhosis and malignancy. Viral hepatitis C is caused by an RNA-containing virus of the Flaviviridae family. The tendency of this infection to chronicity is caused by the ability of the pathogen to stay in the body for a long time without causing intense manifestations of infection. Like other flaviviruses, the hepatitis C virus is able, multiplying, to form quasi-strains with a variety of serological variants, which prevents the body from forming an adequate immune response and does not allow the development of an effective vaccine.
The hepatitis C virus does not reproduce in cell cultures, which makes it impossible to study its resistance in detail in the external environment, however, it is known that it is slightly more resistant than HIV, dies when exposed to ultraviolet rays and withstands heating up to 50 ° C. The reservoir and source of infection are sick people. The virus is contained in the blood plasma of patients. Both those suffering from acute or chronic hepatitis C and those with asymptomatic infection are contagious.
The mechanism of transmission of the hepatitis C virus is parenteral, mainly transmitted through blood, but sometimes infection can also occur through contact with other biological fluids: saliva, urine, semen. A prerequisite for infection is the direct ingestion of a sufficient amount of the virus into the blood of a healthy person.
In the vast majority of cases, infection currently occurs with the joint use of intravenous drugs. The spread of infection among drug addicts reaches 70-90%. People who use drugs are the most dangerous source of viral hepatitis C in epidemic terms. In addition, the risk of infection increases in patients who have received medical care in the form of multiple blood transfusions, surgical procedures, parenteral injections and punctures using non-sterile instruments of repeated use. The transfer can be carried out during tattooing, piercing, cuts during manicure and pedicure, manipulations in dentistry.
In 40-50% of cases, it is not possible to track the method of infection. In medical professional groups, the incidence of hepatitis C does not exceed that among the population. Mother-to-child transmission occurs when a high concentration of the virus accumulates in the mother’s blood, or when the hepatitis C virus is combined with the human immunodeficiency virus.
The possibility of developing hepatitis C with a single ingestion of a small amount of the pathogen into the bloodstream of a healthy person is small. Sexual transmission of infection is rarely realized, primarily in people with concomitant HIV infection, prone to frequent changes of sexual partners. The natural susceptibility of a person to the hepatitis C virus largely depends on the dose of the pathogen received. Postinfectious immunity is insufficiently studied.
Hepatitis c symptoms
The incubation period of viral hepatitis C ranges from 2 to 23 weeks, sometimes lasting up to 26 weeks (due to one way or another of transmission). The acute phase of infection in the vast majority of cases (95%) does not manifest itself with pronounced symptoms, proceeding in an analgesic subclinical variant. Later serological diagnosis of hepatitis C may be associated with the probability of an “immunological window” – a period when, despite the existing infection, there are no antibodies to the pathogen, or their titer is immeasurably small. In 61% of cases, viral hepatitis is diagnosed in the laboratory 6 months or more after the first clinical symptoms.
Clinically, the manifestation of viral hepatitis C can manifest itself in the form of general symptoms: weakness, apathy, decreased appetite, rapid satiety. There may be local signs: severity and discomfort in the right hypochondrium, dyspepsia. Fever and intoxication with viral hepatitis C are quite rare symptoms. If the body temperature rises, it rises to subfebrile values. The intensity of the manifestation of certain symptoms often depends on the concentration of the virus in the blood, the general state of immunity. Usually the symptoms are insignificant and patients are not inclined to attach importance to it.
In the blood test in the acute period of hepatitis C, a reduced content of leukocytes and platelets is often noted. In a quarter of cases, short-term moderate jaundice is noted (often limited to icteric sclera and biochemical manifestations). In the future, with the chronization of infection, episodes of jaundice and an increase in the activity of liver transferases accompany exacerbations of the disease.
Severe course of viral hepatitis C is observed in no more than 1% of cases. In this case, autoimmune disorders may develop: agranulocytosis, aplastic anemia, neuritis of peripheral nerves. With this course, a fatal outcome is likely in the pre-inflammatory period. In normal cases, viral hepatitis C proceeds slowly, without pronounced symptoms, remaining undiagnosed for years and manifesting itself already with significant destruction of liver tissue. Often, patients are diagnosed with hepatitis C for the first time when there are already signs of cirrhosis or hepatocellular liver cancer.
Complications of viral hepatitis C are cirrhosis and primary liver cancer (hepatocellular carcinoma).
Diagnostics
Unlike hepatitis B, where viral antigen isolation is possible, clinical diagnosis of viral hepatitis C is performed using serological techniques (IgM antibodies to the virus are determined using ELISA and RIBA), as well as the determination of viral RNA in the blood using PCR. In this case, PCR is performed twice, since there is a possibility of a false positive reaction.
When detecting antibodies and RNA, it can be said that the diagnosis is sufficiently reliable. Determination of IgG in the blood can mean both the presence of a virus in the body and a previously transmitted infection. Patients with hepatitis C are prescribed biochemical liver tests, coagulograms, liver ultrasound, and in some complex diagnostic cases, liver biopsy.
Hepatitis c treatment
Therapeutic tactics for hepatitis are the same as for viral hepatitis B: diet No. 5 is prescribed (restriction of fats, especially refractory fats, with a normal ratio of proteins and carbohydrates), exclusion of products that stimulate the secretion of bile and liver enzymes (salted, fried, canned food), saturation of the diet with lipolytically active substances (fiber, pectins), a large amount of liquid. Alcohol is completely excluded.
Specific therapy for viral hepatitis is the appointment of interferon in combination with ribavirin. The duration of the therapeutic course is 25 days (with a virus variant resistant to antiviral therapy, it is possible to extend the course to 48 days). As a prevention of cholestasis, ursodeoxycholic acid preparations are included in the complex of therapeutic measures, and ademetionine is used as an antidepressant (since the psychological state of patients often affects the effectiveness of treatment). The effect of antiviral therapy directly depends on the quality of interferons (degree of purification), the intensity of therapy and the general condition of the patient.
According to indications, basic therapy can be supplemented with oral detoxification, antispasmodics, enzymes (mezim), antihistamines and vitamins. In severe hepatitis C, intravenous detoxification with solutions of electrolytes, glucose, dextran is indicated, if necessary, therapy is supplemented with prednisone. In case of complications, the course of treatment is supplemented with appropriate measures (treatment of cirrhosis and liver cancer). If necessary, plasmapheresis is performed.
Forecast
With proper treatment, 15-25% of cases of the disease end in recovery. Most often, hepatitis C turns into a chronic form, contributing to the development of complications. Death in hepatitis C, as a rule, occurs due to cirrhosis or liver cancer, the mortality rate is 1-5% of the case. The prognosis of combined infection with hepatitis B and C viruses is less favorable .
Prevention
General measures for the prevention of hepatitis C include careful observance of the sanitary regime in medical institutions, control over the quality and sterility of transfused blood, as well as sanitary supervision of institutions providing services to the population using traumatic techniques (tattooing, piercing).
Among other things, explanatory and educational activities are carried out among young people, individual prevention is advertised: safe sex and drug withdrawal, the implementation of medical and other traumatic procedures in certified institutions. Disposable syringes are distributed among drug addicts.
