HCV virus – virus infection, diagnosis, treatment

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HCV is a very dangerous virus that causes hepatitis C. It is dangerous because its carriers in Poland are almost 700. people, most of which are unaware, as being a carrier of this virus does not give you any symptoms. By the time HCV becomes active, causing hepatitis C, it is usually too late for adequate treatment.

HCV virus – structure

HCV virus causes hepatitis C. It is an enveloped, spherical virus, classified on the basis of the molecular organization of the genome. According to one classification, HCV has 6 genotypes with subtypes – in Western Europe and the USA, genotypes 1a, 1b, 2a, 2b, 3a are the most common. In Poland, genotype 1b is most often detected – these studies were carried out on a group of adult patients and asymptomatic carriers.

The virus mutates strongly. The result is the occurrence of pseudo-forms, considered to be mutants of the primary virus responsible for the infection. Its characteristic feature is the diversity of the genome, which is exceptionally strong – it is expressed by the presence of a heterogeneous population of quasi-species of the mutating virus. Infection with HCV is a serious problem on a global scale.

HCV virus – infection statistics

The largest number of HCV infections is recorded in Eastern Europe – mostly in health centers and other medical entities. Recipients of blood, organs, medical workers, hospitalized persons, and people who inject drugs are often infected. In Poland, the prevalence of the virus remains at an average level – approximately 1,9% of Poles had HCV.

In Poland, infection with the virus was recorded for the first time in 1997 – in the years 1997-2010, mortality due to hepatitis C remained at a high level. According to estimates, the number of infected increases by about 3000 people each year. In addition, it turns out that as many as 95% of infected Poles are not aware of being carriers.

HCV virus – cause of infection

Infection with HCV occurs through contact with the blood of the host. This can happen during blood transfusions, tattooing, acupuncture, intravenous drug use, and even surgery at the hairdresser. Long-term dialysis, organ transplantation from an infected donor and the use of infected medical equipment also contribute to infection.

Injecting drug users are particularly susceptible to infection. They often use the used equipment or, for example, use the same syringe. The virus is transmitted through needles and syringes, but it can also be found in the preparation tools of the drug, i.e. in a pot, filter and in water. Contrary to appearances, the possibility of sexual infection is negligible, but it increases when it is accompanied by inflammation of the skin, mucous membranes around the genital area, anus and mouth.

In Poland, the risk groups are:

1. people with blood transfused,
2. people hospitalized many times,
3. frequently operated persons,
4. people undergoing mole removal, tooth extraction and endoscopic examination,
5. people using beauty salons,
6. people using tattoo parlors,
7. people using common cosmetic tools,
8. people having casual sex,
9. doctors and nurses.

HCV virus – symptoms

Conditions for which HCV infection may be suspected include:

1. chronic fatigue,
2. depression,
3. muscle aches,
4. arthralgia,
5. low-grade fever,
6. loss of appetite
7. nausea,
8. vomiting,
9. itchy skin
10. enlarged liver
11. enlargement of the spleen,
12. yellowing of the skin
13. yellowing of proteins,
14. weight loss
15. flatulence.

HCV virus – diagnosis

To detect the presence of HCV, an anti-HCV antibody test should be performed. Diagnostics also includes performing a test to quantify or characterize the components of the virus particles, i.e. HCB RNA and the core antigen. Virological tests are crucial in further treatment – based on the result, the doctor makes a therapeutic decision. The study is not complicated or lengthy.

A person is HCV carrier is indicated by a reactive (positive) result, but always requires confirmation that HCV RNA is present in the blood. A non-active (negative) test result indicates that the patient is healthy and has not been in contact with the virus carrier. It is worth knowing that there is no vaccine for HCV. That is why it is so important to perform these tests regularly, so that you can start treatment quickly.

First of all, people with elevated levels of the enzymes alanine aminotransferase and aspartate aminotransferase from the blood should take part in the study. Moreover, it should be used by people who undergo chronic dialysis, injecting drugs, and children of mothers with HCV detected during pregnancy. The indication is also HIV infection and suffering from hemophilia when born before 1991.

HCV test may be ordered by the primary care physician and it is reimbursed by the National Health Fund. A privately performed test costs about PLN 40.

Liver package – you can buy diagnostic tests at Medonet Market. You will use it to test albumin, liver tests, HBs antibodies and HCV antibodies.

HCV virus – treatment

Hepatitis C is treated pharmacologically. The medications used for this fall into two groups – drugs that block the viral key enzyme proteins (DAA) directly and the combination of pegylated interferon alpha with ribavirin (PegINF). However, taking both drugs can have side effects. The most common side effects caused by the use of both drugs mentioned include:

1. tiredness,
2. itching
3. Headache,
4. rash,
5. nausea,
6. anemia,
7. insomnia,
8. diarrhea,
9. asthenia,
10. anorexia,
11. depression,
12. alopecia
13. viral infections,
14. tachycardia.

Another way to treat the disease is targeted therapy, which has made a significant breakthrough in the treatment of viral hepatitis. During the treatment, drugs are used that directly block the functions of the key proteins in the replication apparatus of the virus – as a result, the process that destroys the liver parenchyma is inhibited. Targeted therapy has already found application in curative therapy for HIV-infected patients.

A breakthrough event was the introduction in 2013 of Sofosbuvir, a compound that is an incompetent inhibitor of NS5B polymerase. Its advantage is the ability to administer the drug to patients with any virus genotype, as it inhibits the critical moment of pathogen proliferation. The use of new anti-HCV therapies has resulted in a significant increase in treatment efficacy.

Unfortunately, a therapeutic treatment involving new drugs can be a large expense for many patients – for example, a daily treatment with the SOF / LDV combination, converted into PLN, amounts to about PLN 4800. On the other hand, a standard 48-week treatment, converted into PLN, costs about PLN 112 thousand. The patient will have to pay about PLN 400 for the full beinterferon treatment.

HCV virus and pregnancy

It is difficult to estimate the incidence of one of the diseases caused by HCV in pregnant women – the reason is the insufficient number of screening tests carried out among them. Nevertheless, it can be concluded that much more infections occur in some endemic regions of the world – e.g. in Egypt, the incidence rate was as high as 15%. In Poland, a program of testing pregnant women in terms of HCV infection has been conducted since 2011, co-financed by the Ministry of Health.

A woman can become infected with HCV even before or during pregnancy – but a greater risk of infection is among women who have not yet become pregnant. Moreover, many infected women are unaware of this fact. Hepatitis C appears in a chronic form. Acute hepatitis C is a rare disease, but it is a threat to the life of a child – most often it affects mothers who take drugs by injection during pregnancy.

Hepatitis C does not pose a great risk to pregnant women, except in late-stage disease, where liver disease may occur. The risk of mother-to-child transmission is low, estimated at 1,8% to 5%.

HCV virus and pregnancy – the risk of endangering the child

Mother-to-child transmission of the virus is an issue that is still under investigation – the mechanism is still waiting to be described in more detail. The presence of viral RNA in the mother’s blood is a factor contributing to the risk to the baby’s health. The greater the amount of HCV RNA, the greater the risk of endangering the baby. Nevertheless, there have been reports among infected children where there was no viral load during pregnancy.

A factor that increases the risk of virus infection is the prolonged time from the recovery of amniotic fluid to delivery. It turns out that the time longer than 6 hours from the time the amniotic fluid drains to delivery makes the risk of infecting the baby with the virus greater. Another factor that increases the risk of passing the virus to your baby is the increase in ALT levels before pregnancy.

HCV virus and pregnancy – treatment

Virus infection in Poland is treated with pegylated interferon and ribavirin. So far, no therapeutic and protective vaccines against HCV have been developed. The treatment process takes between 24 and 48 weeks. The best solution, however, is to treat the infection even before pregnancy – when fertilization occurs, the use of medical treatment is not recommended due to the possibility of side effects.

HCV virus – reactive and non-reactive

If in the test for the presence of HCV virus we will get a positive result, it means that antibodies are detected in the blood HCV, that is, the patient had contact with this virus and it is reactive. This does not mean the patient is infected HCVand only that he had contact with it – the body could fight the virus itself and it is no longer dangerous. However, it is necessary to carry out an extended presence test in such a case HCV, i.e. the so-called molecular test for the presence of genetic material HCV virus. If the test is positive, the patient is infected HCV.

HCV non-reactive as a test result it means we are not infected HCV and that we never came into contact with him. However, this does not mean that we are immune to HCV infection, So the test should be repeated from time to time to detect a possible threat in time.

The virus is transmitted through blood, so we should avoid any contact with the blood of potential virus carriers, and in situations where it is necessary, for example, to collect blood, pay particular attention to the hygienic conditions in the facility. When giving first aid, disposable gloves should be used, and condoms should be used during casual sexual contact. If you visit a beautician or hairdresser, make sure that the equipment they use is properly sterilized.