Viral hepatitis: diagnosis and treatment abroad

Viral hepatitis is an inflammatory disease of the liver of infectious nature. In most cases, the cause of the disease are viruses: A, B, C, E and D.

Viral hepatitis: the prevalence of the disease

The most common are considered viral hepatitis B, C and A. According to data provided by the World Health Organization (WHO), viral hepatitis B and C affect about 500 million people around the globe. Unfortunately, at present, there is no downward trend in the incidence of viral hepatitis, rather on the contrary, the number of detected cases of viral hepatitis is increasing.

What is the danger of the disease?

Viral hepatitis leads to impaired liver function - an organ that takes part in many vital functions of the body. In particular, in the processes of detoxification, blood circulation, digestion, etc. The degree of liver dysfunction depends on the aggressiveness of the virus and the course of the disease. Some types of chronic viral hepatitis in a certain number of cases end in cirrhosis or primary liver cancer.

Viral hepatitis: features of diagnosis

The diagnosis of viral hepatitis relies on clinical data (complaints and examination of the patient) and laboratory criteria. The most common complaints of a patient carrying hepatitis are weakness, rapid fatigue, drowsiness, periodic nausea, soreness in the right subcostal area. Violation of pigment metabolism (hyperbilirubinemia) leads to the appearance of jaundice - jaundiced coloring of the skin and mucous membranes. It should be said that complaints and jaundice are not permanent symptoms. In some cases, the disease can be asymptomatic, in particular - acute hepatitis C. Because of the lack of symptoms in the acute period and severe consequences in the future, viral hepatitis C has been nicknamed “tender killer”.

Among the laboratory criteria in the first place are general clinical studies (general blood count), biochemical blood tests (increased ALT, AST, bilirubin levels), as well as serologic markers of hepatitis (virus antigens, antibodies to the virus or virus fragments, DNA or RNA of the virus).

Viral hepatitis: peculiarities of treatment

The most common drugs intended for the treatment of viral hepatitis are antiviral agents: interferon alpha, pegylated interferon, ribavirin. It should be said that antiviral drugs of direct action are not always prescribed. The specialist makes a decision depending on the type of hepatitis, the patient's condition, laboratory data and concomitant diseases. In treatment, diet, restriction of physical activity, hepatoprotective drugs, in some cases - choleretic agents are important.

Viral hepatitis A

The cause of the disease is the hepatitis A virus. In most cases, this disease has a benign course. The source of infection is a sick person. The virus is excreted with feces and is transmitted from person to person with contaminated water and food, as well as through household contacts. Parenteral (through blood) and transplacental (from mother to fetus) routes of transmission are not given practical importance.

What is the danger of infection?

Viral hepatitis A, although rare, but still can have a severe or lightning course, in which a life-threatening condition develops - liver failure. Hepatitis A is accompanied by intoxication and short-term liver dysfunction. The chronic form of the disease is not formed.

Hepatitis A: diagnosis

Diagnostically important tests are the determination of:

• IgM anti-HAV - class M antibodies to the hepatitis A virus.
• IgG anti-HAV - class G antibodies to the hepatitis A virus (immunological memory, the indicator remains positive for life after the infection).

Hepatitis A: treatment

There is no special treatment. Supportive therapy, diet and observance of the daily regimen are important. For prevention, vaccination against viral hepatitis A, observance of hygiene and sanitation measures are used.

Viral hepatitis B

The cause of the disease is the hepatitis B virus. The source of infection is a person: a virus carrier or a sick person. Hepatitis B virus is found in all human biological fluids, but in the transmission of infection is important blood, semen and saliva.

Distinguish acute and chronic course of viral hepatitis B. According to the degree of severity, a mild, moderate and severe course is distinguished.

Infection with hepatitis B is possible:

• When transfusing blood from an infected donor
• Unprotected sexual contact (including oral-genital)
• Using contaminated syringes, injection needles, and acupuncture needles.
• Accidental injury from needles and medical instruments (including dental instruments)
• Transplacental (from mother to fetus)
• During breastfeeding if there is a nipple injury (but not through milk!)
• During piercing, manicure, tattooing - provided that non-sterile instruments are used.

What are the dangers of the infection?

In the chronic course of hepatitis B (5-10% of all cases), there is a risk of liver cirrhosis and primary liver cancer. The lightning form of acute hepatitis B (0.1-0.5%) has a severe course and in some cases is accompanied by fatal complications. A woman who has hepatitis B during pregnancy has a risk of miscarriage and premature labor.

Hepatitis B: diagnosis

Diagnostic tests are:

• determination of virus antigens in the blood (HBsAg, HBeAg)
• antibodies to virus antigens (anti-HBc IgM, anti-HBc total)
• Determination of hepatitis B virus DNA (PCR to HBV-DNA).

HBsAg - surface antigen of hepatitis B virus.
HBeAg - nuclear antigen of the virus.
Anti-HBc IgM - antibodies to nuclear antigens of hepatitis B virus, class M.
Anti-HBc total - total antibodies to hepatitis B virus nuclear antigen.

Hepatitis B: treatment

Self-cure in acute hepatitis B occurs in 95-99% of cases. Treatment of patients with chronic hepatitis B depends on the functional state of the liver, concomitant diseases, including co-infections such as HIV, hepatitis C, etc.
Patients are monitored by a hepatologist or infectious disease specialist. In uncomplicated course of viral hepatitis B, antiviral therapy is not prescribed. Antiviral therapy is recommended for people with weakened immunity and concomitant severe chronic diseases. From antiviral drugs prescribe Lamivudine, alpha-interferon, in some cases consider the appointment of pegylated interferons.

Prophylaxis

The most effective way of prevention is vaccination. Currently, there are several varieties of hepatitis B vaccines. According to studies, they do not have significant differences in efficacy and safety. Vaccination leads to the formation of protective titers of antibodies to the surface antigen of hepatitis B virus (HBsAg) in 95% of vaccinated children and 90% of adults.

According to WHO recommendations, if the biological fluids of a hepatitis B patient come into contact with another person (on mucous membranes, in the eye, sexual contact), it is necessary to inject hepatitis B immunoglobulin (HBIG) as soon as possible and conduct hepatitis B vaccination according to the accelerated scheme.

Hepatitis C

The disease is caused by the hepatitis C virus. This infection often has a chronic course (60-85%).

In most cases, the hepatitis C virus is transmitted through blood. Extremely rare through sexual contact (0.2-2%), also rare from mother to fetus (up to 5%).

Infection with hepatitis C is possible:

• During transfusion of blood and its components
• When reusing syringes from an infected person
• Accidental injection with a medical needle used by an infected patient
• Shaving (using a razor from an infected person)
• During hemodialysis procedures
• During tattooing, medical manipulations (endoscopy), piercing.

Distinguish acute and chronic course of hepatitis C. Extremely rare is observed lightning form. Often the infection is asymptomatic, which does not allow adequate treatment in the acute phase of the disease and contributes to the transformation of hepatitis into a chronic form.

Hepatitis C: Diagnosis

The diagnostic tests are:

• Detection by PCR of hepatitis C virus RNA. Viral RNA can be detected 1-3 weeks after the onset of the disease.
• HCVcoreAg is the nuclear antigen of the hepatitis C virus
• Antibodies to hepatitis C virus (anti-HCV IgG, anti-HCV core IgM, anti-HCV core IgG). Antibodies are not always detected (50-70% of cases), usually not earlier than 3 months after infection.

Hepatitis C: treatment

The need for active treatment of the acute form of hepatitis C is a controversial issue. A number of foreign and domestic experts recommend the prescription of alpha-interferon preparations, noting that treatment of hepatitis C in the acute phase is primarily aimed at preventing chronicization of the process. There is evidence of self-healing from the acute form of hepatitis C. The criterion of cure is the disappearance of viral RNA during the first month of the disease. If the PCR analysis with detection of viral RNA remains positive after one month from probable infection, then start therapy of the disease.

Treatment of chronic hepatitis C consists in the prescription of pegylated interferon alpha and ribavirin. The duration of treatment is 12, 24 or 48 weeks, depending on the genotype of the hepatitis C virus that caused the disease.
Side effects of antiviral therapy force an average of 10% of patients to stop treatment early.

In the last few years, there have been some changes in the treatment regimens for viral hepatitis C. In particular, drugs that inhibit viral replication have appeared: Horvani and Sovaldi.