Hepatitis C, or hepatitis C for short, is a viral hepatitis caused by hepatitis C virus (HCV) infection and is mainly transmitted through blood transfusions, needle sticks, and drug use. According to the World Health Organization, the global HCV infection rate is about 2.8%, with about 185 million infected people worldwide and about 35,000 new cases of hepatitis C each year. More than 50 of infected individuals convert to chronicity, also known as chronic hepatitis C (HCH), which can lead to chronic inflammatory necrosis and fibrosis of the liver, and some patients can develop cirrhosis or even hepatocellular carcinoma (HCC). Mortality associated with HCV infection (death due to liver failure and hepatocellular carcinoma) will continue to increase in the next 20 years, posing a great risk to the health and lives of patients, and has become a serious social and public health problem.
The following is based on the characteristics of the virus and and current treatment options, and we hope to bring some help to sufferers in understanding the hepatitis C virus and the treatment of hepatitis C virus.
A proper view of hepatitis C
Hepatitis C, in the current treatment environment, is not terrible, as long as it is treated correctly and seriously, with regular and positive treatment, maintain a good optimistic attitude, the possibility of cure is very large, the current cure rate of the Chinese population using standard treatment is as high as 85%, and there are some new antiviral drugs listed in the international hepatitis C, so the treatment of hepatitis C, as long as it is treated actively and seriously, there is a There is a good chance that hepatitis C can be cured if treated aggressively.
Hepatitis C virus (HCV).
HCV belongs to the Flaviviridae family and is spherical, less than 80 nm in diameter (36-40 nm in hepatocytes and 36-62 nm in blood), has an envelope, a lipid-containing capsid wrapped around the nucleocapsid, spines on the capsid, single-stranded positive-stranded RNA (9.6 kb), a polyprotein composed of 3000 amino acids, and 10 trillion (1012) viral particles per day of replication. HCV is sensitive to general chemical disinfectants and can be killed by treatment at 100°C for 5 minutes or 60°C for 10 hours, and the virus can be killed rapidly by high-pressure steam or formaldehyde fumigation. HCV, like most hepatitis viruses, has no direct damaging effect on hepatocytes itself and is parasitic in hepatocytes, but it causes autoimmune It attacks liver cells, which leads to liver damage, and with the development of time, followed by liver fibrosis, cirrhosis, and even liver cancer, which is the danger of HCV to the organism.
Clinical manifestations of hepatitis C
There are two main clinical manifestations of hepatitis C, namely the acute infection phase, chronicity, followed by the possible development of fibrosis and cirrhosis and liver cancer.
1. Acute viral hepatitis C
The condition of acute hepatitis C in adults is relatively mild, most of them are acute non-jaundiced hepatitis, usually with elevated ALT, and a few appear to be acute jaundiced hepatitis with mild or moderate elevation of jaundice. Nausea, loss of appetite, generalized weakness, yellow urine and yellow eyes may be seen. Hepatitis C virus infection alone rarely causes liver failure. In the natural state, only 15% of these patients can spontaneously clear HCV to achieve healing, and 85% of them develop chronic hepatitis C without antiviral treatment intervention; 50% of children with acute hepatitis C virus infection can spontaneously clear HCV.
2.Chronic viral hepatitis C
After six months of acute infection, the infection becomes chronic. Generally, the symptoms are mild and manifest as common symptoms of hepatitis, such as easy fatigue, poor appetite and abdominal distension. It can also be without any conscious symptoms. Laboratory tests for ALT fluctuate repeatedly and HCV-RNA is consistently positive. One third of chronic HCV-infected patients have normal liver function all the time, with persistent positive anti-HCV and HCV-RNA. Liver biopsy can reveal the manifestation of chronic hepatitis, and even liver fibrosis and cirrhosis can be found.
3.Cirrhosis
In 20-30 years of HCV infection, 10%-20% of patients may develop cirrhosis, and 1%-5% of patients may develop hepatocellular carcinoma (HCC), leading to death. To a certain extent, cirrhosis may lead to loss of compensation, such as jaundice, peritoneal effusion, ruptured varices and bleeding, hepatic encephalopathy, etc. The survival rate decreases sharply.
Clinical examination
1.Biochemistry (liver function)
Including serum ALT, AST, total bilirubin, direct bilirubin, indirect bilirubin, albumin, globulin, cholinesterase, alkaline phosphatase, transpeptidase, etc.
2.Serology
Anti-HCV.
3.Virological examination
HCV-RNA quantification, to understand the active degree of hepatitis C virus replication.
4.Imaging
Ultrasound examination of the abdomen, liver, gallbladder and spleen to understand whether there is chronic damage to the liver. If necessary, CT or MRI will be performed to understand the degree of damage.
5.Liver transient elastic wave scan
This is a non-invasive test that can be used to assess the degree of liver fibrosis in patients with chronic hepatitis C. Assessment of the degree of liver fibrosis in patients with hepatitis C is important to determine treatment options.
6. Liver tissue biopsy
is the gold standard for assessing the grade of inflammation and the stage of fibrosis in the patient’s liver.
Diagnosis of hepatitis C
1, HCV-RNA, the ribonucleic acid of hepatitis C virus, is the genetic material of HCV and a direct indicator of HCV virus infection in the body. At present, HCV-RNA can be directly detected in blood by PCR method, which is the most direct indicator of early diagnosis of HCV infection because it appears earlier than hepatitis C antibody.
2, anti-HCV (i.e. hepatitis C antibody) is also the main indicator for the diagnosis of viral hepatitis C at present, but it cannot be used as a method of early diagnosis because of the slow appearance of HCV infection, which usually turns positive only 2-6 months or even 1 year after the onset of the disease.
The main differential diagnosis includes: other types of viral hepatitis: hepatitis B, D, E, EBV hepatitis, CMV hepatitis. The differential diagnosis is mainly based on specific blood
Treatment of chronic hepatitis C
Currently, there are several international antiviral treatment regimens for hepatitis C as follows.
1, long-acting interferon + ribavirin (PEG-INF + RBV, referred to as PR therapy) Gold standard
2.General interferon + ribavirin (INF + RBV)
3, direct antiviral drugs/direct antiviral drugs + PR/direct antiviral drugs + PEG-INF
(DAA/DAA + PR/DAA + PEG-INF) is not available in China
All the above treatment regimens consider patient genotype, viral genotype, cirrhosis, hepatocellular carcinoma, other systemic diseases, etc.
In mainland China, long-acting interferon + ribavirin (PR therapy) is still the main treatment regimen because the Chinese genotype is relatively well treated. In the Chinese population, the cure rate (also known as SVR rate) is up to 85% or more with PR standard treatment and adherence to a standardized treatment regimen, which is also the gold standard for antiviral treatment of hepatitis C. It is the best choice for those who need treatment and have no contraindications to PEG-INF.
The DAA drug is a newly developed antiviral drug for hepatitis C for more than 1 year, which has not been officially marketed in China. From the international data, the treatment prospect for hepatitis C is better, and the international research data suggest that the overall population cure rate is up to 90% or more (different genotypes and other different factors affect the cure rate), but there is a lack of long-term follow-up data, and there may be unknown risks, and the international formal The original drugs are also more expensive. Nevertheless, it offers great hope for patients who currently have contraindications to long-acting interferon or cirrhosis, etc.
The following is a brief description of the standard treatment regimen for PR therapy.
Viral genotype 1/4/5/6: The standard course of treatment is 48 weeks, with extension to 72 weeks for patients who require it, adjusted for response to each viral therapy, with a minimum reduction to 24 weeks.
Viral genotype 2/3: The standard course of treatment is 24 weeks, with an extension to 48 weeks for those patients who require it, adjusted for response to each viral therapy.
The standard treatment dose (full dose) should be adhered to, with dose adjustments based on the patient’s actual condition.
Prognosis of treatment for chronic hepatitis C
Compared with hepatitis B, hepatitis C is relatively well treated, and its prognosis is also more optimistic. Patients who have obtained viral clearance (undetectable) with regular treatment and whose virus is still undetectable at 24 weeks of follow-up after discontinuation of the drug (i.e., SVR) have a 5-year follow-up non-relapse rate of 95-99%, which is basically equivalent to a cure. This means that patients who obtain SVR are clinically equivalent to a cure, and the risk of just cirrhosis and liver cancer is greatly reduced by antiviral therapy.