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A new hope has emerged for patients with chronic hepatitis C (hepatitis C): two drugs that, according to research, increase the effectiveness of treatment for hepatitis C. They work by inhibiting the enzyme protease virus, without which HCV virus cannot multiply in cells.

HCVand hepatitis B virus (HBV) account for 70-8% of cases of cirrhosis of the liver and for 80 percent. cases of primary liver cancer.Hepatitis C( Hepatitis C ) is the leading cause of hepatitis transplantation in Europe.

Hepatitis C (hepatitis C): research

Basic HCV hepatitis diagnosis costs PLN 30. It is a serological test that detects the presence of anti-HCV antibodies that appear 8-10 weeks after infection. A positive result (the presence of anti-HCV antibodies) should be confirmed by a test detecting the genetic material of the virus in blood (it appears as early as 1-2 weeks after infection). PCR tests (cost about PLN 300) are used for this, which determine the presence of viral nucleic acid and its concentration in the blood serum. Another test is to determine the HCV genotype, because it allows to determine the duration of treatment. People infected with genotype 1, 4, 5 and 6 HCV are treated twice as long as those infected with genotype 2 and 3. A positive test for anti-HCV antibodies in the blood may mean that we have hepatitis C or that we have contact with the virus, but the body he fought it himself. Additional HCV RNA testing is necessary to confirm or rule out infection. A positive result confirms the infection. Before treatment is started, ultrasound and liver biopsy are usually performed, and markers of liver fibrosis are determined. A liver biopsy assesses the degree of liver fibrosis and damage. The doctor always decides whether it is necessary. For diagnostic purposes, a small fragment of the liver is removed under local anesthesia or after sedation. After the procedure, a few hours' rest is necessary to make sure that there are no complications.


Groups at high risk of HCV infection

  • people who were transfused with blood or blood products before 1993
  • people hospitalized several times, undergoing treatmentssurgical and frequent blood tests
  • vulnerable he alth, fire and police workers
  • injecting or intranasal drug users
  • people using tattoo parlors, pierced ones

Current therapeutic methods make it possible to cure more than half of the patients who undergo treatment. The treatment plan is determined individually for each patient, based on the genotype of the virus. The standard treatment for chronic hepatitis is subcutaneous injection of pegylated interferon alpha - they help fight a variety of pathogens in the body, including viruses - in combination with the administration of an oral antiviral drug called ribavirin. The dose of this medication is adjusted, inter alia, to the patient's weight. Different types of hepatitis C respond differently to treatment. With genotype 1, 4, 5, 6 of the virus, standard therapy lasts 48 weeks. Treatment may be shortened to 24 weeks in the case of low baseline viraemia (the amount of virus in the blood) and rapidly responding genotypes. With genotypes 2 and 3 of the virus, standard therapy lasts 24 weeks. If the side effects of interferon and ribavirin are severe, the doses of both drugs may be reduced or the treatment stopped. Six months after the end of therapy, you must undergo tests that will ultimately assess the effectiveness of the treatment. If the treatment has not eliminated the infection, the doctor may consider whether it is worth repeating the treatment for a specific patient, changing the type of interferon. However, in such situations the chances of success of the next therapy are much smaller.

Treatment for hepatitis C: there will be new drugs

A new hope has emerged for patients with chronic hepatitis C: two drugs which - according to the studies conducted so far - significantly increase the effectiveness of treatment. The new antiviral drugs are telaprevir and boceprevir. While the standard treatment is effective in approx. 50 percent. cases of infections with the most popular HCV genotype 1 in Poland, new drugs can increase this effectiveness to over 70 percent. They work by inhibiting an enzyme in the virus called protease, without which HCV cannot multiply in cells. The new drugs will not replace the current treatment, but will be added (one each) to the standard therapy. Triple drug therapy increases the chances of successful treatment of patients, i.e. achieving a state of recovery, which should be understood as situations when no virus particles are detected in the patient's blood six months after the end of treatment. Previous studies show that the new drugs are equally effective in patients in whom standard therapy has not been successfuleffects or who have come back. It is also important that thanks to the new drugs it will be possible to shorten the therapy in a significant proportion of patients. This is especially true in patients infected with genotype 1, in whom treatment with alpha interferon (lasting almost a year) is often not well tolerated by the body. With the registration of telaprevir and boceprevir by the European Medical Agency (EMA), the drugs will theoretically also be available in Poland. Unfortunately, they will be expensive, so patients who have not responded to standard therapy will receive them first.


Low risk for mothers-to-be

The risk of transmission of HCV from mother to child is approx. 6%. It grows with the increase in the concentration of the virus in a woman's blood and her additional infections, such as HIV. For the infection of the fetus in 30-50 percent. cases occur during pregnancy, the rest are perinatal infections. A caesarean section does not reduce the risk, but a thorough washing of the baby's postpartum blood probably does. The time between water breakdown and delivery affects the risk of infection. If it exceeds 6 hours, the risk increases. An infected woman should breastfeed. The concentration of the virus in breast milk is much lower than in her blood. And in the digestive tract of the child, the virus is deactivated.

Viral hepatitis: interferon treatment

High hopes are also placed on lambda interferon (IFN-lambda), which - if future research confirms its effectiveness - may become a safer alternative to the currently administered pegylated interferon alpha. Interferons are natural proteins in the body that are actively involved in fighting viral infections. INF-alpha receptors are found on cells in various organs and tissues, including the brain, blood cells and others. This explains the side effects of therapy, such as depression, flu-like symptoms (generalized pain, fever, chills), muscle and bone pain, and haematological complications, e.g. anemia. Because of them, about 20 percent. patients either discontinue standard therapy or require reducing the dose of IFN-alpha. The receptors for the INF-lambda under test are found almost exclusively in the liver, so theoretically it should have fewer side effects. However, scientists are wondering if it will be as effective as interferon alpha, since it only works in liver cells and viral particles circulate throughout the body.

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