Hepatitis C: what it is and how it is transmitted. Side effects of antiviral therapy

Today, hepatitis C is scary incurable disease, which doctors compare to HIV infection. This partly makes sense, since a pathogenic virus, penetrating the blood, gradually spreads throughout the body and ensures the slow death of the patient. It is not possible to eradicate it, vaccination to protect the body is also unknown, and the clinical outcome is the most unpredictable and most often unfavorable. One thing is known: viral hepatitis first progresses in an acute form, but due to the lack of positive dynamics of the disease, doctors make a disappointing diagnosis “ Chronic hepatitis».

Many people think about the question, where did viral hepatitis come from, what preceded such an extensive pathological process? Doctors are relatively familiar with the medical history of this infectious disease, as thousands of scientists around the world race to develop a cure and save patients' lives.

How did hepatitis C appear?

Scientists received the answer to this question not so long ago, and another laboratory study showed that the virus was transmitted to humans from bats. These mysterious mammals have already caused humanity a lot of trouble, remember, for example, the origin of Ebola fever and SARS; but now foreign media are openly stating that viruses that predominate in the body of bats are capable of developing hepatitis C.
To confirm their guesses, scientists used progressive scientific method high-throughput sequencing, which deals with detailed research nucleic acids in the blood. So, the DNA of bats showed that 5% of viruses from the genus pegiviruses and hepatoviruses predominate in the blood, and, as is known, the causative agent of hepatitis C under hire C (HCV) also belongs to hepatoviruses.
This theory is controversial in the scientific world, as there are also ardent defenders of bats who are confident that these mammals have nothing to do with human hepatitis infection. One way or another, according to statistics, about 150 million people around the world are affected by this deadly infection, so modern scientists do not abandon their attempts to find out its origin.

History of the origin and discovery of hepatitis C

Information about the first infected patient was received back in mid-1989, but then doctors had not yet named the progressive pathological process viral hepatitis. In patients whose blood did not contain HBsAg, post-transfusion hepatitis rapidly progressed.

Scheme of the structure of the hepatitis C virus virion

Doctors conducted a series laboratory research and determine that a new agent is present in the blood, differing in content and origin from the hepatitis B and GA viruses. A retrospective analysis helped to discover a new disease, which later received the familiar name “Hepatitis C”. It is frustrating that the years passed, and the medical history was never found, that is, the causes of the virus in the body are so many clinical pictures and remained a mystery.
In the modern world, there is no accurate understanding of the causative agent of hepatitis C, which is associated with the difficulties of accumulation in the right amount viral particles and the lack of adequately living biological material. And, nevertheless, solely thanks to molecular biological research methods, a unique opportunity to control the hepatitis C virus has emerged. And here is what became known about it:

Belongs to the flavivirus family.
It is a weak antigen and a persistent pathogen.
The virus is heterogeneous at the genetic level.
It spreads throughout the body and cannot be treated.
Has a significant number of geno- and phenotypes.
There are 3 known genetic groups and 7 subgroups.
The most common genotypes are lb, la and Za.

In the latter case, it is worth noting that such a conditional classification is determined on a territorial basis, for example, genotype 1a is also known as “American”, lb is considered “Japanese”, and Za is classified as an “Asian” group. The history of the disease also corresponds to territorial divisions, and noticeable outbreaks of the epidemic can be immediately tracked.

The dangers of hepatitis C

Hepatitis C virus

Before the advent of the hepatitis C virus, there were no known modifications A and B. Conditional separation was only required after 1989. Many doctors, constantly engaged in research into this infection, have come to the conclusion that chronic viral hepatitis is not curable, and the acute phase of the disease also does not guarantee positive dynamics with adequate treatment. However, one thing is clear that the hepatitis C virus has increased toxicity, and the pathogenic pathogen contributes to mass mortality healthy cells liver connected by adipose tissue.

The medical history has its own characteristics, which depend on the condition of the liver, the patient’s age and the individual characteristics of the body, but in any case, viral hepatitis C most often leads the patient to a natural death.

It is very important to be vigilant about your health, since chronic hepatitis is not only incurable, but also becomes a death sentence for the patient.

Is it possible to cure hepatitis C without side effects?

Judging by the fact that you are reading these lines now, victory in the fight against liver diseases is not yet on your side... And have you already thought about interferon therapy? This is understandable, because hepatitis C is very serious illness, because proper functioning of the liver is the key to health and well-being. Nausea and vomiting, a yellowish or grayish tint to the skin, bitterness in the mouth, darkening of the color of urine and diarrhea... All these symptoms are familiar to you firsthand. But perhaps it would be more correct to treat not the effect, but the cause?

Today, new generation drugs Sofosbuvir and Daclatasvir are capable of permanently curing hepatitis C with a 97-100% probability. Newest medicines can be purchased in Russia from the official representative of the Indian pharmaceutical giant Zydus Heptiza. Get free consultation on the use of modern drugs, as well as learn about purchasing methods, you can visit the official website of the Zydus supplier in Russia.

Chronic hepatitis B is a serious inflammatory liver disease that lasts more than six months after symptoms first appear. Modern medicine can provide complete cure for this disease only in a very small percentage of all patients. Unlike acute hepatitis, which usually ends with complete recovery, chronic hepatitis most often remains for life.

Treatment of this disease is necessary to curb the process of virus reproduction and recovery.

If you refuse therapy, cirrhosis, malignant tumors or death. Every opportunity should be taken to cleanse the body of the virus and achieve maximum results in healing the liver.

The hepatitis B virus can be acquired through biological fluids (blood, semen, breast milk, etc.) and transmitted from mother to child during childbirth. Due to the enormous stability of the pathogen outside the body, there is a very high probability of infection through domestic means due to the use of other people's personal hygiene items, as well as injections and cuts with unsterile needles or blades. Any contact of an infected instrument with an open wound and even microtrauma can pose a risk of contracting the virus.

Due to its great resistance and activity, the causative agent of hepatitis B is one of the most dangerous. The number of people infected with it has already reached 400 million, and the death rate exceeds 1 million people per year. The number of cases continues to grow, despite measures taken to vaccinate the population.

If a person infected with hepatitis B does not notice in time alarming symptoms and does not receive appropriate treatment, the disease can become chronic. If the patient did not comply with the medical recommendations, violated the diet or consumed alcohol and other toxic substances, the likelihood of such a transition increases significantly.

Symptoms of the disease

After the virus enters the body, it begins to move along with the bloodstream to the liver area, where it begins to invade and multiply. The incubation period usually passes without any alarming symptoms and lasts from several weeks to several months. Depending on the incoming viral load, the general condition of the body and the patient’s immune system, the incubation process may be shortened or increased.

As the disease progresses to the acute stage, various symptoms begin to appear:

general malaise, weakness, loss of strength;
aching joints;
increase in body temperature to subfebrile;
the appearance of discomfort in the area of the right hypochondrium, enlargement of the liver;
nausea, vomiting, refusal to eat, failure of the digestive system;
bitterness in the mouth, unpleasant odor;
darkening and foaming of urine, discoloration of feces;
coloring skin and the whites of the eyes become jaundiced.

If the sick person is provided timely assistance and proper treatment is provided, acute hepatitis B usually results in recovery and recovery period. If all the symptoms persist for more than six months, the disease enters the chronic stage, and then it is necessary to treat the person in more serious ways.

Methods for diagnosing hepatitis B

For the faithful and effective diagnostics For chronic hepatitis B, it is necessary to carefully collect all possible information about the patient's medical history. A person’s lifestyle, bad habits, social conditions and circumstances of infection are of great importance. A physical examination and laboratory tests will give a clearer picture of the condition of the body and the degree of progression of the disease.

To diagnose changes that have occurred in the liver under the influence of the virus, it is necessary to conduct an ultrasound examination. This will allow you to see the degree of transformation of the organ and possible signs the onset of cirrhosis or the appearance of carcinoma.

The most accurate information about the patient’s condition can be provided by a detailed blood test for the presence of specific antigens and antibodies. In this way, the pathogen and the degree of progression of the infection are determined.

There is a set of special markers for diagnosing hepatitis B:

HBsAg - indicates the presence of infection in the body;
HBeAg - indicates that the virus has already begun to multiply in the liver, the blood is infected;
HBcAg - can be detected by biopsy results, indicates the multiplication of the virus in the liver;
anti-HBc - antibodies to HbcAg;
IgM anti-HBc - indicates the presence acute infection or high activity process in chronic form;
anti-HBe - antibodies indicating the recovery stage;
anti-HBs - antibodies indicating a previous infection.

Types of chronic hepatitis B

According to the degree of progression, chronic hepatitis B can be divided into two types: inactive and active.

Symptoms of persistent (low-active) hepatitis are quite mild or may be completely absent. The patient does not make any complaints, his state of health does not change noticeably. There are also no particularly significant abnormalities in the tests; the liver is slightly enlarged. If the patient does not follow the doctor’s recommendations, does not follow the prescribed diet and abuses alcohol and other toxic substances, an exacerbation may occur. But the symptoms quickly pass with a return to the treatment regimen and the elimination of aggressive factors.

With a progressive (active) disease, all the symptoms of liver damage are very well manifested and do not stop as quickly as with persistent hepatitis. In addition to general malaise, digestive disorders and jaundice, bleeding from the nose, accumulation of fluid in the peritoneum, itching and the appearance of vascular dystrophy can be added. There are significant deviations in the analyses, high level bilirubin in the blood, anemia. The liver significantly increases in size and changes color, and the contours of the spleen also transform.

Treatment of chronic hepatitis B involves significant changes in the patient’s life, adjustments to his diet and regimen. If no measures are taken, the disease will progress and destroy liver cells. As a result of necrosis, functioning hepatocytes are replaced by connective tissue, and cirrhosis occurs. In addition, the risk of developing carcinoma (liver cancer) is very high.

Therapy for chronic hepatitis

After detecting a virus in the patient’s body and making a diagnosis, it is necessary to determine a treatment regimen based on the data obtained. Depending on the stage of the disease and the rate of progression of the infection, the doctor decides how to more effectively treat the person. Anyone diagnosed with chronic hepatitis B must be registered at a local dispensary.

In order to successfully and most effectively treat this disease, it is necessary to carry out complex therapy and take all possible measures for the patient’s recovery.

Chronic hepatitis, unlike acute hepatitis, requires not only a general recovery and detoxification course, but also the use of antiviral drugs.

Treatment should pursue several main goals:

reducing the viral load, reducing the amount of pathogen in the body;
liberation of the human body from toxins produced in the process of liver dysfunction;
inhibition of the progression of necrotic processes and reducing the risk of developing cirrhosis or carcinoma;
restoration of liver tissue and maximum normalization of its work;
following a gentle diet to reduce the load on the liver and other digestive organs, as well as to stimulate the outflow of bile.

The result of the therapy should be prolongation and improvement of the patient’s quality of life. It is necessary to achieve stable remission and minimize all risks of developing various complications, liver failure etc. Virus replication must be suppressed, minimized or eliminated completely.

Antiviral treatment

Antiviral therapy is indicated for patients diagnosed with chronic hepatitis B. In the event that the results of all tests confirm the presence of an active inflammatory process or, they are prescribed special drugs. This disease can take a very long time to treat, and antiviral medications are quite expensive, so such therapy is not prescribed without all the necessary data.

Drugs to suppress viral replication fall into two main categories:

alpha interferons are specific regulatory proteins that suppress viral DNA synthesis, have an immunomodulatory effect and stimulate the production of antigens. Treatment with such drugs is very effective because they have great antiviral activity. Interferons also have antitumor and antifibrotic effects. The disadvantages of these drugs are a fairly large number of contraindications and side effects;
Nucleoside analogs are agents that affect the genome. The advantage of these drugs over interferons is a much smaller number of side effects, as well as the ability to be used in patients with progressive liver cirrhosis. Nucleoside analogues are better tolerated and do not require subcutaneous administration. The disadvantages include more long-term use and the formation of body resistance to the drug.

The effectiveness of antiviral therapy is assessed by the degree of suppression of pathogen reproduction. Patients in whom alpha-interferon treatment is indicated should monitor hormonal function thyroid gland. If after 24 weeks of taking these drugs the viral load does not decrease, then treatment with nucleoside analogues is prescribed. A blood test for the necessary indicators should be taken every 6 months.

Restorative therapy for chronic hepatitis B

In order to stop inflammatory and necrotic processes in the liver and restore its functioning cells, patients are prescribed drug treatment. Various hepatoprotectors, as well as immunomodulators, are used to maintain the body’s overall resistance to infection. Taking anabolic and corticosteroid hormones to regulate liver function may be indicated.

The patient must follow all doctor’s prescriptions and additionally take vitamin complexes and comply strict regime nutrition. Typically, patients with liver problems are prescribed diet No. 5, which is aimed at reducing the harmful load on the digestive organs. By maintaining this nutritional pattern, the outflow of bile is stimulated and the body eliminates toxins formed during inflammatory and necrotic processes.

When diagnosing chronic hepatitis B, the patient must completely avoid drinking alcohol, even in diluted form. You should not eat fatty, fried and smoked foods, pickles and spices, as they burden the liver and provoke excessive secretion of gastric juices. It is necessary to increase the proportion of protein and complex carbohydrates in the diet to ensure acceleration of regeneration processes. Animal fat should be replaced with vegetable fat to stimulate the flow of bile.

To avoid infection with the hepatitis B virus and further progression of the disease, mandatory vaccination has been introduced. Young children are vaccinated in the maternity hospital in the absence of contraindications and with the permission of the mother or father. If a person was not vaccinated in childhood, then he needs to go to the clinic and set a date for the first injection.

Chronic hepatitis B in most cases becomes a lifelong diagnosis, and it will take a very long time to treat. Therefore, it is worth getting vaccinated, and if you get an infection, you need to start timely therapy and follow all doctor's instructions. This will help reduce or eliminate the risk of complications.

Hepatitis C (H) is an inflammation of the liver that occurs due to infection of the human body with a virus (hepatitis C virus). In the process of its reproduction, liver tissue is damaged, cirrhosis and oncological pathologies develop.

What is hepatitis C?

Hepatitis C is a viral liver disease. He is also called the “gentle killer.” This disease sneaks up on the sly, proceeds without clear signs and leads to severe consequences: liver cancer or cirrhosis.

Sometimes infection with this virus can occur without any symptoms for several years. But after 15-20 years of inflammatory liver damage, hepatitis C can provoke destructive change liver cancer or .

The virus has an interesting feature. It is constantly changing. Today there are 11 of its variants - genotypes. But after infection with one of them, the virus continues to mutate. As a result, up to 40 varieties of one genotype can be identified in a patient.

Virus resistance

The hepatitis C virus does not reproduce in cell cultures, which makes it impossible to study its stability in the external environment in detail, but it is known that it is slightly more stable than HIV, dies when exposed to ultraviolet rays and can withstand 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.

You can inactivate the infection (HCV) by:

disinfectant solution (detergents containing chlorine, bleach in a ratio of 1:100);
washing at 60°C for 30-40 minutes;
boil the item for 2-3 minutes.

Forms

Hepatitis C can occur in the form of an acute or chronic infectious disease. The acute form can become chronic (this happens more often), and the chronic form, in turn, can have episodes of exacerbation.

Acute viral hepatitis C

Acute hepatitis C is a viral disease caused by HCV infection entering the blood and leading to damage and subsequent destruction of the liver. Infection with this virus occurs not only parenterally, since the pathogen of this disease can be found not only in the blood of a sick person, but also in other liquid media of the body (sperm, urine, etc.).

Chronic form

Chronic hepatitis C is a viral inflammatory disease of the liver that is caused by a blood-borne virus. According to statistics, new hepatitis C becomes chronic in 75-85% of cases, and it is infection with the C virus that takes the leading place in the development of severe complications.

This disease is especially dangerous because it can be completely asymptomatic for six months or several years, and its presence can only be detected by performing comprehensive clinical tests blood.

How is hepatitis C transmitted from person to person?

The main route of infection with hepatitis C is through blood, so donors are always tested for the presence of the virus. A small amount of it may be contained in lymph, saliva, menstrual blood in women and seminal fluid in men. The virus can live from 12 to 96 hours. The likelihood of infection depends on the intensity of the infection and the state of the body’s immunity.

Due to difficulties in accumulating a sufficient amount of study material and the lack of surviving patients, the pathogen has not been fully identified.

After the virus enters the blood, it penetrates with the bloodstream into the liver and thereby infects its cells, then the process of multiplication of infected cells occurs. This virus easily mutates and changes its genetic structure.

It is this ability that leads to his difficult to detect early.

There are three main routes of transmission of the virus:

hemocontact (through blood),
sexual,
vertical (mother to child)

The virus is unstable in the external environment, therefore it is not transmitted through household means using shared household items, clothing and utensils. The pathogen is contained in blood, semen, vaginal secretions and breast milk, but does not multiply on the skin and saliva, and is not excreted in external environment Therefore, it is impossible to become infected with hepatitis C through airborne droplets or touch.

Transmission of hepatitis C through blood

Hepatitis C is primarily transmitted through blood. The serum and blood plasma of carriers of the infection pose a danger even a week before the onset of symptoms of the disease and remain capable of infection for a long time.

For transmission of infection to occur, bloodstream should arrive sufficient quantity contaminated blood, therefore the most frequent way transmission of the pathogen is its introduction through a needle during injection.

The first risk group is drug addicts. Transmission in this way can also occur when:

tattoo,
piercing,
during acupuncture,
in hospitals during blood transfusions or other manipulations,
when performing manicure and pedicure,
using common manicure equipment,
visiting a dental office, if the disinfection measures for instruments are not followed correctly.

Sexual transmission

Factors contributing to hepatitis C infection through sexual contact:

integrity violation inner surface genital tract and oral cavity, their bleeding;
inflammatory diseases genitals;
sexual intercourse during menstruation;
concomitant urinary and reproductive diseases, HIV infection;
promiscuity;
practice of anal sex;
traumatic sex in an aggressive form.

Risk factors

There is a risk of infection when carrying out various medical manipulations, if sterility requirements are not met. You can become infected in the following situations:

various surgical interventions;
injection procedures;
gynecological manipulations, including abortions;
transfusion of blood and its components;
diagnostic manipulations with blood sampling;
dental procedures;
performing manicure, pedicure;
getting tattoos;
unprotected sex with a person with hepatitis;
during childbirth and lactation (vertical route of infection from mother to child).

It is also possible to identify separate groups of people for whom the transfer of this disease is more severe:

people who abuse alcohol;
faces with ;
with chronic liver diseases, as well as with other types;
older people, as well as children - in these cases, among other things, full antiviral treatment measures may often be contraindicated for them.

Hepatitis C cannot be transmitted:

by airborne droplets when sneezing, talking;
when hugging, touching and shaking hands;
With breast milk mothers;
through food and drinks;
while using household items, shared dishes, towels.

In extremely rare cases it is recorded household way transmission, but the condition for the development of the disease is the patient’s blood getting into wounds, abrasions or cuts healthy person.

The first signs in men and women

After infection, hepatitis behaves very secretly. Viruses multiply in the liver, gradually destroying its cells. However, in most cases, a person does not feel any signs of the disease. And if there are no complaints and visits to the doctor, there is no treatment.

As a result, in 75% of cases the disease becomes chronic, and serious consequences. Often, a person feels the first signs of the disease only when cirrhosis of the liver has developed, which cannot be cured.

There is a small list of signs that may indicate the presence of the hepatitis virus:

increasing weakness;
fast fatiguability;
asthenia (general weakness of all organs and systems of the body).

Such manifestations are typical for any colds, chronic diseases or poisonings (intoxications). Later the following may appear:

jaundice;
the abdomen may increase in volume (ascites);
Spider veins may appear;
lack of appetite;
nausea;
joint pain (a rare symptom);
possible enlargement of the spleen and liver.

In general, we can say that the first signs are symptoms of intoxication and liver dysfunction.

Symptoms of hepatitis C

The incubation period of viral hepatitis C ranges from 2 to 23 weeks, sometimes extending 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 severe symptoms, occurring in an anicteric subclinical variant.

Late serological diagnosis of hepatitis C may be associated with the likelihood 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 diagnosed in laboratory 6 or more months after the first clinical symptoms.

Signs of acute hepatitis C

Most infected people do not notice any symptoms of the disease at all, so the acute phase is often not diagnosed. The patient may note:

exanthema - skin rashes (by type);
influenza-like syndrome (fever, short-term increase in temperature, pain in muscles, joints);
general malaise (fatigue, loss of appetite);
dyspeptic syndrome (nausea, vomiting, heaviness in the stomach, pain in the right hypochondrium);
jaundice syndrome (yellow color of the skin or sclera of the eyes, lightening of stool, darkening of urine);
On palpation, a moderate increase in the size of the liver and sometimes the spleen is noted.

Symptoms of chronic hepatitis C

Unfortunately, in 80% of cases, hepatitis C has a primary chronic course. For many years the disease flows hidden, practically without showing itself. The person is unaware of his illness, leads a normal lifestyle, drinks alcohol, aggravating his condition, has unprotected sex and infects others. Liver function in hepatitis C remains compensated for a long time, but often such imaginary well-being ends in acute liver failure.

The chronic stage of the disease is characterized by the following symptoms (clinical manifestations):

general malaise in which sleep patterns are disrupted;
stool becomes light-colored;
you can feel heaviness and mild pain in the right hypochondrium;
a rash appears on the body, which is similar to an allergy;
increased body temperature, which occurs periodically throughout the day;
appetite is disturbed, aversion to food occurs;
Dry and pale skin, hair loss, brittle and flaky nails are the consequences of a lack of vitamins and iron metabolism disorders, for which the liver is responsible. Often in patients with hepatitis there is a severe lack of B vitamins and iron, leading to (anemia).

The hepatitis C virus affects not only the liver, but also other organs. If a person has been sick for a long time (10 years or more), then he may experience so-called extrahepatic symptoms of hepatitis C. More than half of these symptoms are associated with cryoglobulinemia, a disease sometimes caused by the hepatitis C virus, in which special proteins are found in the patient’s blood - cryoglobulins.

Complications

Complications of hepatitis C:

liver fibrosis;
steatohepatitis - fatty degeneration of the liver;
cirrhosis of the liver;
liver cancer (hepatocellular carcinoma);
portal hypertension;
ascites (increase in abdominal volume);
varicose veins (mainly in internal organs);
hidden bleeding;
hepatic encephalopathy;
addition of a secondary infection – hepatitis B virus (HBV).

When consumed alcoholic drinks, symptoms intensify, and pathological lesion liver speeds up to 100 times.

Complications can be recognized by the following signs:

begins severe exacerbation, which is characterized by bloating during general weight loss, as water begins to accumulate in the abdominal cavity;
the liver becomes covered with scars (connective tissue);
so-called stars, venous veins, appear on the body.

The appearance of the above signs and changes in the body is a signal to a person that he needs to check himself and begin timely treatment.

Diagnostics

The diagnosis is made based on:

the availability of data on the possible method of infection - the so-called starting point (it is typical that in approximately half of those infected the cause of the disease cannot be identified);
the presence of specific clinical manifestations (in the icteric form);
determination of IgM and IgG to HCV;
detection of HCV RNA (HCV-RNA) by polymerase chain reaction;
changes in biochemical blood test [increased levels of liver enzymes (ALT, AST), hyperbilirubinemia];
positive thymol test.

Treatment of hepatitis C (C) in adults

Successful therapy includes A complex approach: medications are combined with traditional methods, diet, regular examinations are carried out, patients monitor physical activity and rest regime.

Treatment is aimed at the following actions:

eliminate the virus from the blood;
reduce, eliminate the inflammatory process in the liver;
prevent tumor formation and transformation into cirrhosis.

How to treat hepatitis C should be decided by a specialist. He prescribes medications taking into account the individual characteristics of the body, the genotype of the virus, and the severity of the disease.

Why is it necessary to treat hepatitis C under the supervision of a doctor?

Supervision by a specialist is necessary since there is a risk of disease activation with active damage to the liver tissue and extrahepatic lesions - this threat persists throughout the entire period of carriage of the virus.
Supervision by a specialist includes determination of liver tests and blood serology ( PCR research activity of the infectious process).
If an unfavorable picture of liver tests is detected, or a high viral load (a high level of genetic material of the virus detected in the blood), then antiviral and hepatoprotective therapy is required because the risk of developing liver cirrhosis is high.

Drugs for treatment

The specificity of hcv therapy depends on a number of factors that can influence a positive or negative result:

Patient's gender;
Age;
Duration of the disease;
Virus genotype;
Degree of fibrosis.

The goal of antiviral therapy is full recovery patient and in the prevention of inflammatory and degenerative lesions: fibrosis, cirrhosis and cancer. Most specialists for the treatment of hepatitis C use dual therapy with interferon, aimed at combating hepatitis C, and ribavirin, which accelerates the work of the former.

The patient should receive interferon daily. Another treatment regimen involves administering interferon every three days. short acting and once a week pegelated interferon.

Specific drugs that fight the causative agent of the disease are Ribavirin, Zeffix. The first acts as a means of antiviral therapy, which helps reduce the concentration of the pathogen in the body by affecting its reproduction.

Advantages and disadvantages:

The advantage is worth noting high efficiency in combination with interferon drugs;
The downside is that one of the side effects is dose-dependent.

The choice of treatment regimen and duration is determined by the type of virus, the stage of the disease and the course of the infectious process. The course of combined treatment with interferon + ribavirin lasts on average 12 months.

There is no need to self-medicate or use suspicious drugs and remedies. Before using any medicinal product, be sure to consult your doctor, because self-treatment may harm your body. Please take this disease seriously.

Diet

The general principles of nutrition for patients are:

Providing complete protein (1.0–1.2 g per kg of weight).
An increase in its content at . It has been noted that with viral hepatitis C there is pronounced fatty degeneration of hepatocytes.
Protein restriction in liver failure in the stage of decompensation and threatening coma.
Adequate fat content up to 80 g/day.
Security complex carbohydrates(they must be 50% of energy value) due to the consumption of cereals, grains, vegetables and fruits.
Enrichment of the diet with vitamins (group B, C, folates).
Control of salt content (limit to 8 g, and for edema and ascites - up to 2 g).
Inclusion of specialized products in the diet (protein composite mixtures for protein correction of the diet).

To relieve the load on the liver, a patient with hepatitis C needs to create his menu so that it does not contain foods prohibited for consumption. People with hepatitis are completely prohibited from consuming alcoholic beverages and spicy foods. You also need to stop consuming fats of unnatural origin (compound fat, margarine) and those that are poorly digestible (lard, palm oil, lard).

Authorized Products

meat fish dietary varieties, high-quality boiled sausage;
cereals, pasta;
vegetables, fruits, berries;
butter, vegetable oil;
low fat dairy products;
eggs – no more than 1 per day (hard-boiled, not fried);
sauerkraut (not sour);
soups based on vegetables and cereals;
natural juices (not sour);
rye, wheat bread(yesterday);
weak green or black tea;
compotes, jelly;
marshmallow, jelly, jam, honey, marshmallow.

Prohibited Products

baked goods, freshly baked bread;
meat broths, soups based on them;
canned food,
any smoked, salty foods;
salted fish, caviar;
fried, hard-boiled eggs;
mushrooms;
conservation;
sour berries, fruits;
ice cream;
chocolate;
alcohol;
hot spices, salt in large quantities;
fatty dairy products;
legumes;
sparkling water;
margarine, cooking oil, lard;
onion, sorrel, garlic, radish, spinach, radish.

Patients should follow Diet No. 5 during remission, and during exacerbation - No. 5A. Product range this option corresponds to Diet No. 5, but it involves more thorough culinary processing - boiling and mandatory mashing or pureeing. The diet is applied for 2-4 weeks, and then the patient is transferred to the main table.

Prognosis for humans

Hepatitis C, undoubtedly, can threaten serious complications, however, favorable prognoses for this diagnosis are not excluded; moreover, for many years the disease may not manifest itself at all. During this period it does not require and special treatment– the main thing is to ensure appropriate medical control. It involves regular testing of liver functions, as a result of which, in case of activation of hepatitis, appropriate antiviral therapy is provided.

How long do people live with hepatitis C?

Regarding the general course of hepatitis C, statistics have the following possible outcomes per 100 patients under consideration:

from 55 to 85 patients will experience the transition of hepatitis to a chronic form;
for 70 patients, chronic liver disease may become relevant;
from 5 to 20 patients in the next 20-30 years will face the development of liver cirrhosis due to hepatitis;
from 1 to 5 patients will die as a result of the consequences provoked by chronic hepatitis C (again, this is cirrhosis or liver cancer).

Prevention

Basic preventive measures:

compliance with personal hygiene measures;
hand treatment and use of gloves when working with blood;
refusal of casual unprotected sexual relations;
refusal to take narcotic drugs;
receiving medical and cosmetology services in official licensed institutions;
Carrying out regular preventive examinations in case of possible professional contact with blood.

If there is an HCV-infected person living in the family:

Avoid contact of open cuts and abrasions of an infected person with household items in the house, so that his blood does not have the opportunity to remain on those things that other family members use;
Do not use general subjects personal hygiene;
Do not use this person as a donor.

Hepatitis C is a very dangerous disease because... may not manifest itself for a long time. It is important to undergo diagnosis on time and if a virus is detected in the blood, be sure to begin treatment under the supervision of a specialist. Take care of yourself and your health!

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Hepatitis is the name given to acute and chronic inflammatory diseases of the liver that are not focal, but widespread. U different hepatitis The methods of infection are different; they also differ in the rate of disease progression, clinical manifestations, methods and prognosis of therapy. Even the symptoms of different types of hepatitis are different. Moreover, some symptoms are stronger than others, which is determined by the type of hepatitis.

Main symptoms

Jaundice. The symptom occurs frequently and is due to the fact that bilirubin enters the patient’s blood when the liver is damaged. Blood, circulating throughout the body, carries it to organs and tissues, coloring them yellow.
The appearance of pain in the area of the right hypochondrium. It occurs due to an increase in the size of the liver, leading to pain that can be dull and prolonged or of a paroxysmal nature.
Deterioration in health, accompanied by fever, headaches, dizziness, indigestion, drowsiness and lethargy. All this is a consequence of the effect of bilirubin on the body.

Hepatitis acute and chronic

Hepatitis in patients has acute and chronic forms. In acute form they appear in the case of viral infection liver, and also if there has been poisoning different types poisons In acute forms of the disease, the condition of patients quickly deteriorates, which contributes to the accelerated development of symptoms.

With this form of the disease, favorable prognosis is quite possible. Except for its transformation into chronic. In its acute form, the disease is easily diagnosed and easier to treat. Uncured acute hepatitis easily develops into a chronic form. Sometimes, with severe poisoning (for example, alcohol), the chronic form occurs independently. In the chronic form of hepatitis, the process of replacement of liver cells with connective tissue occurs. It is weakly expressed, progresses slowly, and therefore sometimes remains undiagnosed until cirrhosis of the liver occurs. Chronic hepatitis is less treatable, and the prognosis for its cure is less favorable. In the acute course of the disease, the state of health deteriorates significantly, jaundice develops, intoxication appears, and the functional work liver, the content of bilirubin in the blood increases. With timely detection and effective treatment hepatitis in acute form, the patient most often recovers. When the disease lasts more than six months, hepatitis becomes chronic. The chronic form of the disease leads to serious violations in the body - the spleen and liver enlarge, metabolism is disrupted, complications arise in the form of liver cirrhosis and cancer. If the patient has reduced immunity, the treatment regimen is chosen incorrectly or there is alcohol addiction, then the transition of hepatitis to a chronic form threatens the patient’s life.

Types of hepatitis

Hepatitis has several types: A, B, C, D, E, F, G, they are also called viral hepatitis, since they are caused by a virus.

Hepatitis A

This type of hepatitis is also called Botkin's disease. It has an incubation period lasting from 7 days to 2 months. Its causative agent, an RNA virus, can be transmitted from a sick person to a healthy person through poor-quality food and water, or contact with household items used by the sick person. Hepatitis A is possible in three forms, they are divided according to the severity of the disease:

in the acute form with jaundice, the liver is seriously damaged;
with subacute without jaundice, we can talk about a milder version of the disease;
in the subclinical form, you may not even notice symptoms, although the infected person is the source of the virus and is capable of infecting others.

Hepatitis B

This disease is also called serum hepatitis. Accompanied by an enlarged liver and spleen, joint pain, vomiting, fever, and liver damage. It occurs either in acute or chronic forms, which is determined by the state of the patient’s immunity. Routes of infection: during injections in violation of sanitary rules, sexual contact, during blood transfusions, and the use of poorly disinfected medical instruments. The duration of the incubation period is 50 ÷ 180 days. The incidence of hepatitis B decreases with vaccination.

Hepatitis C

This type of disease is one of the most serious illnesses, as it is often accompanied by cirrhosis or liver cancer, which subsequently leads to death. The disease is difficult to treat, and moreover, having had hepatitis C once, a person can be infected with the same disease again. It is not easy to cure HCV: after contracting hepatitis C in an acute form, 20% of patients recover, but in 70% of patients the body is not able to recover from the virus on its own, and the disease becomes chronic. It has not yet been possible to establish the reason why some heal on their own and others do not. The chronic form of hepatitis C will not disappear on its own and therefore requires therapy. Diagnosis and treatment of the acute form of HCV is carried out by an infectious disease specialist, chronic form diseases - hepatologist or gastroenterologist. You can become infected during a plasma or blood transfusion from an infected donor, through the use of poorly processed medical instruments, through sexual contact, and a sick mother transmits the infection to her child. The hepatitis C virus (HCV) is rapidly spreading throughout the world; the number of patients has long exceeded one and a half hundred million people. Previously, HCV was difficult to treat, but now the disease can be cured using modern antiviral drugs direct action. But this therapy is quite expensive, and therefore not everyone can afford it.

Hepatitis D

This type of hepatitis D is possible only with coinfection with the hepatitis B virus (coinfection is the case of infection of one cell with viruses of different types). He is accompanied by mass destruction liver and acute course of the disease. The route of infection is the entry of the disease virus into the blood of a healthy person from a virus carrier or a sick person. The incubation period lasts 20 ÷ 50 days. Externally, the course of the disease resembles hepatitis B, but its form is more severe. It can become chronic, later turning into cirrhosis. It is possible to carry out vaccination similar to that used for hepatitis B.

Hepatitis E

It is slightly reminiscent of hepatitis A in its course and transmission mechanism, since it is also transmitted through the blood. Its peculiarity is the occurrence of lightning-fast forms that cause death in a period not exceeding 10 days. In other cases, it can be effectively cured, and the prognosis for recovery is most often favorable. An exception may be pregnancy, since the risk of losing a child is close to 100%.

Hepatitis F

This type of hepatitis has not yet been studied enough. It is only known that the disease is caused by two different viruses: one was isolated from the blood of donors, the second was found in the feces of a patient who received hepatitis after a blood transfusion. Signs: the appearance of jaundice, fever, ascites (fluid accumulation in the abdominal cavity), an increase in the size of the liver and spleen, an increase in the levels of bilirubin and liver enzymes, the occurrence of changes in urine and feces, as well as general intoxication of the body. Effective methods of treating hepatitis F have not yet been developed.

Hepatitis G

This type of hepatitis is similar to hepatitis C, but is not as dangerous because it does not contribute to the development of cirrhosis and liver cancer. Cirrhosis can only appear in cases of co-infection with hepatitis G and C.

Diagnostics

Viral hepatitis is similar in its symptoms to one another, just like some others viral infections. For this reason, it can be difficult to accurately diagnose a sick person. Accordingly, to clarify the type of hepatitis and the correct prescription of therapy, laboratory blood tests are required to identify markers - indicators individual for each type of virus. By identifying the presence of such markers and their ratio, it is possible to determine the stage of the disease, its activity and possible outcome. In order to track the dynamics of the process, the examinations are repeated after a period of time.

How is hepatitis C treated?

Modern treatment regimens for chronic forms of HCV are reduced to combination antiviral therapy, including direct-acting antivirals such as sofosbuvir, velpatasvir, daclatasvir, ledipasvir, etc. various combinations. Sometimes ribavirin and interferons are added to enhance effectiveness. This combination of active ingredients stops the replication of viruses, saving the liver from their destructive effects. This type of therapy has a number of disadvantages:

The cost of drugs to combat the hepatitis virus is high; not everyone can buy them.
Reception individual drugs accompanied by unpleasant side effects, including fever, nausea, and diarrhea.

The duration of treatment for chronic forms of hepatitis takes from several months to a year, depending on the genotype of the virus, the degree of damage to the body and the drugs used. Because hepatitis C primarily attacks the liver, patients are required to follow a strict diet.

Features of HCV genotypes

Hepatitis C is one of the most dangerous viral hepatitis. The disease is caused by an RNA virus called Flaviviridae. The hepatitis C virus is also called the “gentle killer.” He received such an unflattering epithet due to the fact that initial stage the disease is not accompanied by any symptoms at all. There are no signs of classic jaundice, and there is no pain in the area of the right hypochondrium. The presence of the virus can be detected no earlier than a couple of months after infection. Before this, the reaction of the immune system is completely absent and markers cannot be detected in the blood, and therefore genotyping is not possible. Another feature of HCV is that after entering the bloodstream during the process of reproduction, the virus begins to rapidly mutate. Such mutations prevent the infected person’s immune system from adapting and fighting the disease. As a result, the disease can proceed for several years without any symptoms, after which cirrhosis or a malignant tumor appears almost immediately. Moreover, in 85% of cases, the disease goes from an acute form to a chronic one. The hepatitis C virus has an important feature - a variety of genetic structure. In fact, hepatitis C is a collection of viruses, classified depending on their structural variants and divided into genotypes and subtypes. Genotype is the sum of genes encoding hereditary traits. So far, medicine knows 11 genotypes of the hepatitis C virus, which have their own subtypes. The genotype is designated by numbers from 1 to 11 (although in clinical studies They mainly use genotypes 1 ÷ 6), and subtypes using letters of the Latin alphabet:

1a, 1b and 1c;
2a, 2b, 2c and 2d;
3a, 3b, 3c, 3d, 3e and 3f;
4a, 4b, 4c, 4d, 4e, 4f, 4h, 4i and 4j;

IN different countries HCV genotypes are distributed in different ways, for example, in Russia the most common ones can be found from the first to the third. The severity of the disease depends on the type of genotype; they determine the treatment regimen, its duration and the result of treatment.

How are HCV strains distributed across the planet?

Hepatitis C genotypes are distributed heterogeneously across the globe, and genotypes 1, 2, 3 can most often be found, and in certain areas it looks like this:

V Western Europe and in its eastern regions genotypes 1 and 2 are most common;
in the USA - subtypes 1a and 1b;
in northern Africa, genotype 4 is the most common.

People with blood diseases (tumors of the hematopoietic system, hemophilia, etc.), as well as patients undergoing treatment in dialysis units, are at risk of possible HCV infection. Genotype 1 is considered the most common across the world - it accounts for ~50% of the total number of cases. In second place in prevalence is genotype 3 with an indicator of slightly more than 30%. The spread of HCV throughout Russia has significant differences from the global or European variants:

genotype 1b accounts for ~50% of cases;
for genotype 3a ~20%,
~10% of patients are infected with hepatitis 1a;
hepatitis with genotype 2 was found in ~5% of infected people.

But the difficulties of HCV therapy depend not only on the genotype. The effectiveness of treatment is also influenced by the following factors:

age of patients. The chance of cure is much higher in young people;
It is easier for women to recover than for men;
the degree of liver damage is important - the favorable outcome is higher with less damage;
the magnitude of the viral load - the fewer viruses in the body at the time of treatment, the more effective the therapy;
the patient’s weight: the higher it is, the more complicated the treatment becomes.

Therefore, the treatment regimen is chosen by the attending physician, based on the above factors, genotyping and recommendations of the EASL (European Association for Liver Diseases). EASL constantly supports its recommendations in current state and as new effective drugs for the treatment of hepatitis C become available, it adjusts the recommended treatment regimens.

Who is at risk for HCV infection?

As you know, the hepatitis C virus is transmitted through blood, and therefore the following are most likely to become infected:

patients receiving blood transfusions;
patients and clients in dental offices and medical institutions where medical instruments are improperly sterilized;
due to unsterile instruments, there may be dangerous visit manicure and beauty salons;
piercing and tattoo enthusiasts can also suffer from poorly processed tools,
there is a high risk of infection for those who use drugs due to repeated use of unsterile needles;
the fetus can become infected from a mother infected with hepatitis C;
During sexual intercourse, the infection can also enter the body of a healthy person.

How is hepatitis C treated?

It was not for nothing that the hepatitis C virus was considered a “gentle” killer virus. It can remain silent for years, and then suddenly appear in the form of complications accompanied by cirrhosis or liver cancer. But more than 177 million people in the world have been diagnosed with HCV. The treatment that was used until 2013, combining injections of interferon and ribavirin, gave patients a chance of healing that did not exceed 40-50%. Moreover, it was accompanied by serious and painful side effects. The situation changed in the summer of 2013 after the US pharmaceutical giant Gilead Sciences patented the substance sofosbuvir, produced in the form of a drug under the Sovaldi brand, which included 400 mg of the drug. It was the first direct-acting antiviral drug (DAA) to combat HCV. The results of clinical trials of sofosbuvir pleased doctors with the effectiveness, which reached 85 ÷ 95% depending on the genotype, while the duration of the course of therapy was more than halved compared to treatment with interferons and ribavirin. And, although the pharmaceutical company Gilead patented sofosbuvir, it was synthesized in 2007 by Michael Sophia, an employee of Pharmasett, which was later acquired by Gilead Sciences. From Michael’s last name, the substance he synthesized was named sofosbuvir. Michael Sofia himself, together with a group of scientists who made a number of discoveries that revealed the nature of HCV, which made it possible to create effective drug for his treatment, received the Lasker-DeBakey Award for Clinical medical research. Well, almost all of the profit from the sale of the new effective product went to Gilead, which set monopoly high prices for Sovaldi. Moreover, the company protected its development with a special patent, according to which Gilead and some of its partner companies became the owners of the exclusive right to manufacture the original DPP. As a result, Gilead's profits in just the first two years of sales of the drug many times covered all the costs that the company incurred to acquire Pharmasett, obtain a patent and subsequent clinical trials.

What is Sofosbuvir?

The effectiveness of this drug in the fight against HCV has proven to be so high that now almost no treatment regimen can do without its use. Sofosbuvir is not recommended for use as monotherapy, but integrated use he shows exceptionally good results. Initially, the drug was used in combination with ribavirin and interferon, which made it possible to achieve a cure in just 12 weeks in uncomplicated cases. And this despite the fact that therapy with interferon and ribavirin alone was half as effective, and its duration sometimes exceeded 40 weeks. After 2013, each subsequent year brought news of the emergence of more and more new drugs that successfully fight the hepatitis C virus:

daclatasvir appeared in 2014;
2015 was the year of birth of ledipasvir;
2016 pleased with the creation of velpatasvir.

Daclatasvir was released by Bristol-Myers Squibb in the form of Daklinza, containing 60 mg active substance. The next two substances were created by Gilead scientists, and since neither of them was suitable for monotherapy, they used medicines only in combination with sofosbuvir. To facilitate therapy, Gilead prudently released the newly created drugs immediately in combination with sofosbuvir. This is how the drugs appeared:

Harvoni, combining sofosbuvir 400 mg and ledipasvir 90 mg;
Epclusa, which included sofosbuvir 400 mg and velpatasvir 100 mg.

During therapy with daclatasvir, two different drugs, Sovaldi and Daklinza, had to be taken. Each paired combination of active ingredients was used to treat specific HCV genotypes according to treatment regimens recommended by EASL. And only the combination of sofosbuvir with velpatasvir turned out to be a pangenotypic (universal) drug. Epclusa cured all genotypes of hepatitis C with almost equally high effectiveness of approximately 97 ÷ 100%.

The emergence of generics

Clinical trials confirmed the effectiveness of the treatment, but all these highly effective drugs had one significant drawback - too high prices, which prevented the majority of patients from purchasing them. Monopoly high prices for products set by Gilead caused outrage and scandals, which forced patent holders to make certain concessions, granting some companies from India, Egypt and Pakistan licenses to produce analogues (generics) of such effective and popular drugs. Moreover, the fight against patent holders offering drugs for treatment at biasedly inflated prices was led by India, as a country where millions of chronic hepatitis C patients live. As a result of this struggle, Gilead issued licenses and patent developments to 11 Indian companies to independently produce first sofosbuvir, and then its other new drugs. Having received licenses, Indian manufacturers quickly began producing generics, assigning their own names to the drugs they produced. trade names. This is how generics Sovaldi first appeared, then Daklinza, Harvoni, Epclusa, and India became the world leader in their production. Indian manufacturers, under a licensing agreement, pay 7% of earnings to patent holders. But even with these payments, the cost of generics produced in India turned out to be tens of times less than the originals.

Mechanisms of action

As already reported above, the new HCV therapy products that have emerged are classified as DAAs and act directly on the virus. While interferon with ribavirin, previously used for treatment, increased immune system human, helping the body resist the disease. Each substance acts on the virus in its own way:

Sofosbuvir blocks RNA polymerase, thereby inhibiting viral replication.

Daclatasvir, ledipasvir and velpatasvir are NS5A inhibitors that interfere with the spread of viruses and their entry into healthy cells.

This targeted effect makes it possible to successfully combat HCV using sofosbuvir for therapy in combination with daklatasvir, ledipasvir, velpatasvir. Sometimes, to enhance the effect on the virus, a third component is added to the pair, which most often is ribavirin.

Manufacturers of generics from India

Pharmaceutical companies in the country have taken advantage of the licenses granted to them, and now India produces the following generic Sovaldi:

Hepcvir - manufactured by Cipla Ltd.;
Hepcinat - Natco Pharma Ltd.;
Cimivir - Biocon ltd. & Hetero Drugs Ltd.;
MyHep is manufactured by Mylan Pharmaceuticals Private Ltd.;
SoviHep - Zydus Heptiza Ltd.;
Sofovir - manufactured by Hetero Drugs Ltd.;
Resof - produced by Dr Reddy's Laboratories;
Virso - produced by Strides Arcolab.

Analogs of Daklinza are also made in India:

Natdac from Natco Pharma;
Dacihep by Zydus Heptiza;
Daclahep from Hetero Drugs;
Dactovin by Strides Arcolab;
Daclawin from Biocon ltd. & Hetero Drugs Ltd.;
Mydacla from Mylan Pharmaceuticals.

Following Gilead, Indian drug manufacturers also mastered the production of Harvoni, resulting in the following generics:

Ledifos - released by Hetero;
Hepcinat LP - Natco;
Myhep LVIR - Mylan;
Hepcvir L - Cipla Ltd.;
Cimivir L - Biocon ltd. & Hetero Drugs Ltd.;
LadyHep - Zydus.

And already in 2017, the production of the following Indian generics of Epclusa was mastered:

Velpanat was released by the pharmaceutical company Natco Pharma;
the release of Velasof was mastered by Hetero Drugs;
SoviHep V was launched by Zydus Heptiza.

As you can see, Indian pharmaceutical companies do not lag behind American manufacturers, quickly mastering their newly developed drugs, while observing all qualitative, quantitative and medicinal characteristics. Maintaining, among other things, pharmacokinetic bioequivalence in relation to the originals.

Requirements for generics

A generic is a drug that is capable of pharmacological properties replace treatment with expensive original medicines with a patent. They can be produced either with or without a license; only its presence makes the produced analogue licensed. In case of issuing a license to Indian pharmaceutical companies, Gilead also provided the production technology for them, giving the license holders the right to independently pricing policy. In order for a drug analogue to be considered a generic, it must meet a number of parameters:

It is necessary to observe the ratio of the most important pharmaceutical components in the drug according to qualitative as well as quantitative standards.

Compliance with relevant international standards should be adhered to.

Proper production conditions are required.

The preparations should maintain the appropriate equivalent absorption parameters.

It is worth noting that the WHO is guarding the availability of medicines, seeking to replace expensive branded medicines with the help of budget generics.

Egyptian generics of sofosbuvir

Unlike India, Egyptian pharmaceutical companies have not become world leaders in the production of generic drugs for hepatitis C, although they have also mastered the production of sofosbuvir analogues. True, the bulk of the analogues they produce are unlicensed:

MPI Viropack, produces the drug Marcyrl Pharmaceutical Industries - one of the very first Egyptian generics;

Heterosofir, produced by Pharmed Healthcare. Is the only licensed generic in Egypt. There is a code hidden on the packaging under the hologram that allows you to check the originality of the drug on the manufacturer’s website, thereby eliminating its counterfeit;

Grateziano, manufactured by Pharco Pharmaceuticals;

Sofolanork produced by Vimeo;

Sofocivir, manufactured by ZetaPhar.

Generics to fight hepatitis from Bangladesh

Another country producing large volumes of generic anti-HCV drugs is Bangladesh. Moreover, this country does not even require licenses for the production of analogues of branded medicines, since until 2030 its pharmaceutical companies are allowed to produce such medications without having the appropriate licensing documents. The most famous and equipped last word technology is the pharmaceutical company Beacon Pharmaceuticals Ltd. The design of its production capacity was created by European specialists and meets international standards. Beacon produces the following generics for the treatment of hepatitis C virus:

Soforal is a generic version of sofosbuvir, containing 400 mg of active substance. Unlike traditional packaging in bottles of 28 pieces, Soforal is produced in the form of blisters of 8 tablets in one plate;
Daclavir is a generic version of daclatasvir, one tablet of the drug contains 60 mg of the active substance. It is also produced in the form of blisters, but each plate contains 10 tablets;
Sofosvel is a generic version of Epclusa, containing sofosbuvir 400 mg and velpatasvir 100 mg. A pangenotypic (universal) drug, effective in the treatment of HCV genotypes 1 ÷ 6. And in this case, there is no usual packaging in bottles, the tablets are packaged in blisters of 6 pieces in each plate.
Darvoni- complex drug, combining sofosbuvir 400 mg and daclatasvir 60 mg. If it is necessary to combine sofosbuvir therapy with daklatasvir, using drugs from other manufacturers, you must take a tablet of each type. And Beacon combined them into one pill. Darvoni is packaged in blisters of 6 tablets in one plate and sent for export only.

When purchasing medications from Beacon for a course of therapy, you should take into account the originality of their packaging in order to purchase the quantity required for treatment. The most famous Indian pharmaceutical companies As mentioned above, after the country's pharmaceutical companies received licenses to produce generics for HCV therapy, India has become a world leader in their production. But among the many companies, it is worth noting a few whose products are the most famous in Russia.

Natco Pharma Ltd.

The most popular pharmaceutical company is Natco Pharma Ltd., whose drugs have saved the lives of several tens of thousands of people with chronic hepatitis C. It has mastered the production of almost the entire line of direct-acting antiviral drugs, including sofosbuvir with daclatasvir and ledipasvir with velpatasvir. Natco Pharma appeared in 1981 in Hyderabad with an initial capital of 3.3 million rupees, then the number of employees was 20 people. Now in India, 3.5 thousand people work at five Natco enterprises, and there are also branches in other countries. In addition to production units, the company has well-equipped laboratories that allow it to develop modern medications. Among her own developments, it is worth noting drugs to combat cancer. One of the most known drugs in this area, Veenat, produced since 2003 and used for leukemia, is considered. And the production of generics for the treatment of hepatitis C virus is a priority area of activity for Natco.

Hetero Drugs Ltd.

This company has set its goal to produce generics, subordinating its own network of production facilities, including factories with branches and offices with laboratories. Hetero's production network is designed to produce medicines under licenses received by the company. One of its areas of activity is medications that help combat serious viral diseases, the treatment of which has become impossible for many patients due to the high cost of original drugs. The acquired license allows Hetero to quickly begin producing generics, which are then sold at a price affordable for patients. The creation of Hetero Drugs dates back to 1993. Over the past 24 years, a dozen factories and several dozen production units have appeared in India. The presence of its own laboratories allows the company to carry out experimental work on the synthesis of substances, which contributed to the expansion of the production base and the active export of drugs to foreign countries.

Zydus Heptiza

Zydus is an Indian company whose goal is to create a healthy society, which, according to its owners, will be followed by a change in better side quality of people's lives. The goal is noble, and therefore, to achieve it, the company conducts active educational activities that affect the poorest segments of the country's population. Including through free vaccination of the population against hepatitis B. Zidus is in fourth place in terms of production volumes on the Indian pharmaceutical market. In addition, 16 of its drugs were included in the list of 300 most important drugs of the Indian pharmaceutical industry. Zydus products are in demand not only on the domestic market; they can be found in pharmacies in 43 countries on our planet. And the range of drugs produced at 7 enterprises exceeds 850 drugs. One of its most powerful production facilities is located in the state of Gujarat and is one of the largest not only in India, but also in Asia.

HCV therapy 2017

Hepatitis C treatment regimens for each patient are selected by the doctor individually. To correctly, effectively and safely select a regimen, the doctor needs to know:

virus genotype;
duration of illness;
degree of liver damage;
presence/absence of cirrhosis, concomitant infection (for example, HIV or other hepatitis), negative experience of previous treatment.

Having received this data after a series of tests, the doctor, based on EASL recommendations, selects the optimal treatment option. EASL recommendations are adjusted from year to year, with newly introduced drugs being added to them. Before new treatment options are recommended, they are submitted to Congress or a special session. In 2017, a special EASL meeting in Paris considered updates to the recommended schemes. The decision was made to completely stop using interferon therapy in the treatment of HCV in Europe. In addition, there is not a single recommended regimen left that uses one single direct-acting drug. Here are several recommended treatment options. All of them are given for informational purposes only and cannot become a guide to action, since the prescription of therapy can only be given by a doctor, under whose supervision it will then be carried out.

Possible treatment regimens proposed by EASL in case of hepatitis C monoinfection or concomitant HIV+HCV infection in patients who do not have cirrhosis and have not previously been treated:

for treatment genotypes 1a and 1b can be used:

— sofosbuvir + ledipasvir, without ribavirin, duration 12 weeks; — sofosbuvir + daclatasvir, also without ribavirin, treatment period 12 weeks; - or sofosbuvir + velpatasvir without ribavirin, course duration 12 weeks.

during therapy genotype 2 used without ribavirin for 12 weeks:

- sofosbuvir + dklatasvir; - or sofosbuvir + velpatasvir.

during treatment genotype 3 without the use of ribavirin for a period of therapy of 12 weeks, use:

— sofosbuvir + daclatasvir; - or sofosbuvir + velpatasvir.

during therapy genotype 4 You can use without ribavirin for 12 weeks:

- sofosbuvir + ledipasvir; — sofosbuvir + daclatasvir; - or sofosbuvir + velpatasvir.

EASL recommended treatment regimens for hepatitis C monoinfection or concomitant HIV/HCV infection in patients with compensated cirrhosis who have not previously been treated:

for treatment genotypes 1a and 1b can be used:

— sofosbuvir + ledipasvir with ribavirin, duration 12 weeks; - or 24 weeks without ribavirin; - and another option - 24 weeks with ribavirin if the response prognosis is unfavorable; — sofosbuvir + daclatasvir, if without ribavirin, then 24 weeks, and with ribavirin, the treatment period is 12 weeks; - or sofosbuvir + velpatasvir without ribavirin, 12 weeks.

during therapy genotype 2 apply:

— sofosbuvir + dklatasvir without ribavirin the duration is 12 weeks, and with ribavirin in case of poor prognosis - 24 weeks; - or sofosbuvir + velpatasvir without combination with ribavirin for 12 weeks.

during treatment genotype 3 use:

- sofosbuvir + daclatasvir for 24 weeks with ribavirin; - or sofosbuvir + velpatasvir, again with ribavirin, treatment period is 12 weeks; — as an option, sofosbuvir + velpatasvir is possible for 24 weeks, but without ribavirin.

during therapy genotype 4 apply the same schemes as for genotypes 1a and 1b.

As you can see, the result of therapy is influenced, in addition to the patient’s condition and the characteristics of his body, by the combination of prescribed medications chosen by the doctor. In addition, the duration of treatment depends on the combination chosen by the physician.

Treatment with modern drugs for HCV

Take tablets of direct antiviral drugs as prescribed by a doctor orally once a day. They are not divided into parts, not chewed, but washed down with plain water. It is best to do this at the same time, this way a constant concentration of active substances in the body is maintained. There is no need to be tied to the timing of meals, the main thing is not to do it on an empty stomach. When you start taking medications, pay attention to how you feel, since during this period it is easiest to notice possible side effects. DAAs themselves do not have very many of them, but drugs prescribed in combination have much less. Most often, side effects appear as:

headaches;
vomiting and dizziness;
general weakness;
loss of appetite;
joint pain;
changes in biochemical blood parameters, expressed in low hemoglobin levels, a decrease in platelets and lymphocytes.

Side effects are possible in a small number of patients. But all the same, all noticed ailments should be reported to the attending physician for treatment. necessary measures. To avoid increased side effects, alcohol and nicotine should be avoided, as they have a harmful effect on the liver.

Contraindications

In some cases, taking DAAs is excluded, this applies to:

individual hypersensitivity of patients to certain drug ingredients;

patients under 18 years of age, since there is no accurate data on their effect on the body;

women carrying a fetus and breastfeeding babies;

Women should use reliable methods of contraception to avoid conception during therapy. Moreover, this requirement also applies to women whose partners are also undergoing DAA therapy.

Storage

Store direct-acting antiviral drugs in places inaccessible to children and out of direct sunlight. Storage temperature should be in the range of 15 ÷ 30ºС. When starting to take medications, check their production and storage dates indicated on the packaging. Expired medications should not be taken. How to purchase DAAs for residents of Russia Unfortunately, it will not be possible to find Indian generics in Russian pharmacies. The pharmaceutical company Gilead, having granted licenses to produce drugs, prudently banned their export to many countries. Including all European countries. Those wishing to purchase budget Indian generics to combat hepatitis C can use several options:

order them through Russian online pharmacies and receive the goods in a few hours (or days) depending on the delivery location. Moreover, in most cases, even an advance payment is not required;
order them through Indian online stores with home delivery. Here you will need an advance payment in foreign currency, and the waiting time will last from three weeks to a month. Plus there will be the need to communicate with the seller on English language;
go to India and bring the drug yourself. This will also take time, plus the language barrier, plus the difficulty of checking the originality of the product purchased at the pharmacy. Added to this is the problem of self-export, which requires a thermal container, a doctor’s report and a prescription in English, as well as a copy of the receipt.

People interested in purchasing medicines decide for themselves which one possible options delivery choose. Just don’t forget that in the case of HCV favorable outcome therapy depends on the speed of its initiation. Here, in the literal sense, delay is like death, and therefore you should not delay the start of the procedure.

Hepatitis B is a systemic viral disease characterized by liver damage and all sorts of extrahepatic manifestations. You can become infected with it in different ways:

through blood and blood products;

sexual contact;

transmission from mother to child.

drug addicts

persons practicing promiscuous intimate life

medical workers

patients who require blood transfusion or hemodialysis

prison inmates

family members of a patient with hepatitis B.

Much depends on the age of the person and the method of transmission of the virus; in young people, the disease often develops into a chronic form, moreover younger man, the greater the likelihood, which is why doctors insist on meeting vaccination deadlines.

Symptoms

Hepatitis B does not manifest itself immediately; it has a period of hidden incubation, which lasts from 2 months to six months. Later illness manifests itself with a number of symptoms:

headache appears.

there is an increased body temperature.

weakness and body aches are observed.

characterized by general malaise.

Many people confuse hepatitis B with acute respiratory infections, and it is not surprising, because the symptoms are very similar at first, but after a while jaundice appears, appetite worsens, nausea and vomiting are noted, pain is observed in the right hypochondrium, urine darkens over time, and the count becomes discolored. It is interesting that when jaundice appears, a person’s condition improves.

Most often, if there is an adequate immune response to the disease, the disease recedes, but if its course is anicteric, hepatitis becomes chronic, which is characterized by a number of the following symptoms:

The liver enlarges.

There is pain or a feeling of heaviness in the right hypochondrium.

Dyspeptic symptoms are noted.

Observed itchy skin, sometimes jaundice, low-grade fever.

Appetite worsens.

Belching, nausea, flatulence and unstable stool appear.

Patients complain of weakness and sweating, and their ability to work decreases.

If the disease progresses, liver cells gradually die and liver cells form in the place of connective tissue. scar tissue, the organ eventually ceases to perform its functions that are vital for the body. With this course of the disease, liver cancer may develop, and if a person also abuses alcohol, the risk of an unfavorable outcome increases significantly.

Diagnostics

To diagnose hepatitis B, the doctor usually conducts a thorough examination of the patient and prescribes biochemical analysis blood and its examination for markers of hepatitis B, the patient is sent for ultrasound of the abdominal strip and other studies.

Treatment

If a diagnosis of hepatitis B is made, the patient is required to strictly follow the doctor’s instructions; treatment is carried out taking into account the severity and stage of the disease. Most often used antiviral drugs alpha interferons and nucleoside analogues, with their help it is possible to reduce the rate of reproduction of viruses and their accumulation in the liver. Hepatoprotectors (Bicyclol, Urosan, etc.) and agents that support the immune system are also prescribed. All detailed information about the drug Bicyclol is available. The daily routine is of great importance, as well as diet, it is based on complete refusal from fatty and salty, spicy, fatty foods, preservatives, as well as alcoholic beverages.

Typically the treatment process lasts from 6 months to several years. If the form of the disease is acute, drugs are used for maintenance and detoxification therapy, which makes it possible to remove poisons and restore organ tissue; antiviral drugs are not required. It is very rare to get rid of the chronic form of hepatitis B; today it is 10-15% of cases.