HCV – viral time bomb

Wake up while the HCV virus is dozing – this is the slogan of an educational campaign dedicated to building public awareness of hepatitis C.

The campaign is run by the Urszula Jaworska Foundation, and it is substantively supported by the Polish Group of HCV Experts and the Hepatological Coalition, associating patient organizations related to liver diseases. The honorary patronage over the campaign was assumed by the Spouse of the President of the Republic of Poland, Ms. Anna Komorowska, and media support was provided by: Medonet Portal, Termedia Medical Publishing House and the Journalistic Club of Health Promotion. The strategic partner is Janssen. Katarzyna Dowbor became the ambassador of the campaign.

The project is supported by Agnieszka Kowalska – the wife of the famous actor Maciej Kozłowski, who died in 2010 due to hepatitis C, and his friends: Dariusz Dziekanowski, Zbigniew Hołdys, Arkadiusz Janiczek, Irena Karel, Małgorzata Kożuchowska and Dorota Landowska. Maciej Kozłowski was infected with HCV in the army 30 years ago. However, he only found out about it in 2005, donating blood as part of the Krewniacy campaign. By then, the virus had already wreaked havoc on his liver. Only a transplant could save him. He died without this surgery.

In order for others not to share the fate of Maciej Kozłowski, it is necessary to disseminate knowledge about the risks of HCV. Sociological research shows an alarmingly low level of knowledge on this subject in Polish society.

HCV epidemic

HCV (Hepatitis C Virus) is the most dangerous of all viruses that cause viral hepatitis. The WHO has recognized Viral Hepatitis C (hepatitis C) as one of the world’s greatest epidemiological threats. The number of people infected with this virus in the world ranges from 170 to 300 million. In Europe alone, HCV infection causes 86 deaths annually, which is twice as much as AIDS. This means that a city the size of Jelenia Góra dies in Europe every year due to hepatitis C. Polish epidemiological data show that anti-HCV antibodies are detected in 000% of the population, which means that the estimated number of infected people in Poland may be as high as 1,9 people. However, according to the data of the National Institute of Hygiene, only about 730 cases of hepatitis C have been diagnosed so far, i.e. about 000 people are not aware of their disease. This will probably result in an increase in the late sequelae of hepatitis C, including cirrhosis and hepatocellular carcinoma, over the next 55 years. Experts calculated that the Polish government’s expenditure on the treatment of people with HCV should amount to EUR 000 billion. However, if effective screening and treatment programs come into force, this amount could save EUR 700 billion.

Asymptomatic course of hepatitis C infection

Hepatitis C was identified by researchers in 1989. It is a chronic disease that destroys the liver, and yet it can be asymptomatic for many years. Due to the secretive course of the disease and its extent, hepatitis C is often called a silent epidemic.

Timely diagnosis and treatment of hepatitis C can significantly reduce or prevent liver damage. However, failure to start therapy at the right time may cause cirrhosis of the liver, and in extreme cases also cancer of this organ.

We can become infected with the virus through contact with infected blood in the following situations:

— hemodialysis,

— acupuncture,

– tattooing or body piercing,

– shaving,

– dental visits,

– cosmetic and hairdressing treatments,

– use of common cosmetic accessories by family members of the sick person,

– providing first aid to accident victims without adequate protection, if the victim is infected with HCV,

– through sexual contact (very unlikely to become infected).

However, we will not become infected with the virus during:

— Chinese,

– coughs,

– holding hands,

– kissing,

– cuddling,

– using the same toilet, bathtub, shower,

– eating food prepared by an HCV infected person (if the food has not been in contact with the blood of that person),

– swimming in the same water body.

Hepatitis C diagnosis

If we suspect an infection, we should see a doctor and ask for a blood test for antibodies against the hepatitis C virus. It is a simple and quick test. Privately, it costs from 30 to 40 PLN.

Antibodies are proteins of the immune system and are made by the body to defend it against infection. Their task is to destroy foreign particles, such as the hepatitis C virus. If antibodies are found in the patient’s blood, it means that he has been in contact with the hepatitis C virus. However, the mere presence of the antibodies does not mean that the virus is still in the blood. and it actively multiplies, because in about 20% of people the virus is eliminated spontaneously from the body.

To confirm an active infection, an additional test is required that measures the actual amount of hepatitis C virus genetic material (RNA). This test is usually done using a technique called polymerase chain reaction (PCR) or variants of it.

In addition to confirming the presence of antibodies and genetic material (RNA) of the virus, your doctor may also order blood transaminases (ALT, AST). These are enzymes released by liver cells, and their elevated levels suggest that this organ is inflamed.

Liver biopsy, elastography, determination of fibrosis markers

To accurately determine the degree of liver damage, a biopsy is performed. A piece of liver tissue is removed with a needle and examined under a microscope. The results are given on a multi-grade scale, depending on the severity of the inflammation and scarring of the organ. Biopsies are also useful for monitoring liver injury during progress. Follow-up biopsies may be recommended every 3-5 years. In assessing the degree of liver damage, non-invasive methods are also increasingly used, such as the determination of liver fibrosis markers or elastography – measuring the elasticity of liver tissue using ultrasound with a device called a fibroscan. The results of all of these tests help your doctor choose a treatment regimen.

Testing for hepatitis C is recommended primarily for people from risk groups. They are:

* people who have injected themselves with drugs, including those who have only had one injection in their lifetime

* people infected with HIV,

* people with haemophilia who received clotting factors from concentrates before 1987,

* people who have undergone hemodialysis in the past,

* people with abnormal transaminase levels, if the cause of the abnormality is not established

* people who have had blood transfusions or organ transplants in the past, especially if the blood transfusion or administration of blood products and the organ transplant took place before 1992,

* children of HCV-infected mothers,

* health care workers, including ambulance and public safety services, who are exceptionally exposed to accidental needle stick injuries or mucosal contact with blood infected with hepatitis C

* current sexual partners of people with hepatitis C.

How to avoid hepatitis C infection?

Hepatitis C infection occurs through contact with infected blood. Therefore, in order to reduce the risk of infection with hepatitis C, hygiene should be followed, especially in situations where the skin is damaged, e.g. during piercing or tattooing. We do not decide on the procedure if the needle or the piercing machine have already been used. In addition, open wounds must always be protected to reduce the risk of contracting the virus.

If there is a need to come into contact with blood or blood products of foreign people, wear gloves and be careful with sharp objects (such as needles and syringes), as there is a risk of small, invisible cuts or scratches on the skin.

Blood products and blood products used in the treatment process are now routinely screened for hepatitis C virus in most countries and undergo a virus inactivation process when necessary. The blood of potential blood donors is also tested in this regard. In Poland, this is in force in 1992.

Infection of the child with hepatitis C by the mother

Your baby is infected with hepatitis C probably during childbirth. The risk of transmitting the virus to a child is approximately 5%. The risk is greater if the mother is infected with HIV. There is no evidence that hepatitis C is transmitted during breastfeeding, so the infant can be fed naturally by an HCV infected mother. Avoid breastfeeding when the skin of the mother’s nipple is damaged. For HCV infected women, drinking alcohol while pregnant may further increase the virus multiplication and accelerate liver damage.

Chronic hepatitis C infection

It usually takes 50 to 150 days from infection to full development of acute hepatitis C. Most infected with hepatitis C is asymptomatic. On the other hand, about 20% develop flu-like symptoms, usually of short duration. Acute hepatitis C can cause: tiredness, nausea, jaundice (yellowing of the skin and eyes), dark urine, fever.

In 70–90% of cases, the virus remains in the patient’s body after the acute phase of infection. Then it is said to be a chronic infection.

It is still unknown why some patients are effective against the virus, while in most patients the infection turns into a chronic, generally asymptomatic phase.

If untreated, the risk of significant liver damage increases over time. First, there is scarring or fibrosis of the liver tissue. In approximately 20% of patients, chronic hepatitis leads to cirrhosis and liver failure. Cirrhosis develops for about 20-30 years. In patients with advanced cirrhosis, symptoms such as jaundice, muscle wasting, skin damage, increased abdominal circumference or swelling of the feet may appear.

The emotions of hepatitis C go through many phases during which sufferers can experience extremely extreme feelings. During this time, both the infected person and their relatives may need psychological support. In such situations, local patient associations and their support groups are extremely helpful.

Treatment of hepatitis C – interferons, ribavirin

After diagnosis of hepatitis C, the attending physician decides whether the patient is eligible for treatment at a given stage of the disease. The genotype of the virus may determine the prompt initiation of treatment. The main goal of hepatitis C treatment is to obtain a sustained virological response, that is, to eliminate the virus from the body. This occurs when the genetic material (RNA) of the virus is not detectable in the patient’s blood immediately after stopping treatment and six months later. However, some patients do not respond to treatment (no response). Others, on the other hand, will have undetectable levels of the virus in their blood during treatment and yet will develop the virus after treatment ends. If the patient has not responded to treatment, or the virus has returned, discuss with your doctor whether or not to start treatment again.

Early diagnosis is essential in combating the effects of HCV infection, as early diagnosis of HCV infection not only reduces the risk of passing the virus on to another person, but also increases the chances of a permanent cure. Until now, the standard treatment of hepatitis C was dual therapy, consisting of pegylated interferon alpha and ribavirin. Interferony is a group of proteins found in the body that make up an essential part of the immune system and are involved in fighting many infections in the body. Interferons used in the treatment of hepatitis C have been subjected to the so-called pegylation, which causes pegylated interferon alpha to break down slowly and maintains a constant amount of the drug in the patient’s body for a longer period of time. In this way, the effectiveness of interferons has been improved and it is possible to take the drug only once a week. Ribavirin is a synthetic antiviral analogue nucleoside that enhances the efficacy of interferon therapy. The success rate of combination therapy with pegylated interferon and ribavirin will vary with viral genotype. People infected with genotype 1 virus are much less likely (less than 50%) of treatment success than those infected with genotype 2 and 3 viruses. increase in temperature and other flu-like symptoms (fatigue, bone and joint pain), as well as anemia, thrombocytopenia and depression. It is worth emphasizing, however, that these are temporary ailments.

Triple drug therapy

The two-drug combination therapy described above is the standard treatment of chronic hepatitis in Poland and is carried out under drug programs financed by the National Health Fund. In recent years, studies of new drugs have been completed, which exceed the effectiveness of drugs previously used in the treatment of hepatitis C. Therefore, the Polish Group of HCV Experts currently recommends a triple therapy consisting of a protease inhibitor, pegylated interferon alpha and ribavirin. This therapy uses NS3 protease inhibitors, which include boceprevir and telaprevir registered in the European Union in 2011. They act by inhibiting virus replication in host cells infected with HCV.

The introduction of new drugs to the standard of care will significantly benefit patients infected with genotype 1, increasing the proportion of patients with SVR to approximately 65-84%. In the group of the most difficult to treat patients, who showed no virological response during the previous two-drug therapy, the effectiveness of treatment improves from the current 5% to about 30% with the use of new drugs.

In the European Union countries, triple drug therapy is now becoming the new standard of treatment for hepatitis C. In Poland, this modern form of therapy is currently unavailable, but the process of introducing new drugs to the market is underway. Expert consultations are ongoing on the content of the new drug program with protease inhibitors. If new drugs and a new standard of hepatitis C treatment are approved by the Ministry of Health, the drug program will be financed by the National Health Fund.

It would be a great success for the Polish Group of HCV Experts and the Hepatological Coalition, which represents patients in contacts with public institutions and makes sure that patients have the opportunity to be treated with the most effective therapies and have access to comprehensive medical care. The coalition was established on May 13, 2012 in Częstochowa during the XNUMXth National Congress of non-governmental organizations working for people with liver diseases. More info on page: www. star nadziei.pl