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Hepatitis C is often asymptomatic, and people usually find out about it when they are being tested for other diseases. One of the manifestations of this disease is swelling of the legs and scrotum area. However, patients are not aware of problems with the liver and do not rush to the doctor with this symptom, trying in every possible way to cope with the swelling on their own. More severe symptoms appear when hepatitis progresses to cirrhosis.
In medicine, edema is defined as an increase in volume of any part of the body as a result of fluid accumulation. The causes of edema are as follows:
The specific cause of swelling can only be determined by a specialized physician by referring the patient for a diagnostic examination. Treatment of edema occurs by eliminating the root cause of its occurrence. To alleviate the condition, the patient may be prescribed decongestants.
Liver diseases often provoke fluid retention in the body, and the affected organ responsible for the production of bile ceases to produce the required amount of protein and, as a result, the oncotic pressure of the blood plasma drops, the retention of fluid in the circulatory system ceases and edema develops. With liver pathologies, edema affects the lower extremities, moving towards the abdominal cavity.
In the early stages of hepatitis C development, the patient may not observe any signs of liver disease. As the disease progresses, disruptions in the functioning of this vital organ occur and the patient begins to observe the following symptoms of hepatitis C:
Increased fatigue and weakness are one of the symptoms of chronic hepatitis.
Above are the symptoms of hepatitis occurring in the acute phase. The chronic course of liver disease is characterized by prolonged fatigue and weakness, as well as intolerance to loud sounds, bright colors and strong aromas. Often people pay attention to these signs when irreversible outcomes have already developed. A serious consequence of untreated hepatitis C is cirrhosis of the liver, which manifests itself in the deterioration of the victim’s condition, icteric discoloration of the skin and an enlarged abdomen.
In order to eliminate swelling of the extremities in case of hepatitis, first of all, you should get rid of the root cause, i.e. you should start treating the liver. Therapy for kidney diseases is carried out in a complex manner - the patient is prescribed medication and a special diet. To prevent hepatitis from enlarging a body part due to accumulated fluid, you should reduce your salt intake, avoid alcoholic beverages, and enrich your diet with minerals and proteins. If the liver is inflamed, accompanied by edema, you should reduce the amount of liquid you drink before bed. You need to give up frying in oil, giving preference to steaming food.
To remove excess fluid from the body, the patient is prescribed diuretic drugs, for example:
Pharmaceuticals should be taken according to the recommendations of a specialized physician, strictly adhering to the indicated dosages and duration of the therapeutic course. To eliminate swelling, which is a sign of hepatitis C, representatives of alternative medicine recommend using a decoction of flaxseed. To prepare it, take 4 tablespoons of seeds, pour them with a liter of water and set to boil for 15 minutes. Then put the container with the broth in a warm place to infuse. After an hour, the folk decongestant medicine is filtered and a little lemon juice is added to taste. Take throughout the day every 2 hours.
Dizelvet Pupil (102), closed 6 years ago
doctors are talking from one to another, I don’t know what to do anymore, but I really want to live without pain, it’s impossible to sleep at night, especially to turn over, I’ve been suffering for a year and a half now, during treatment they found hepatitis C, but it’s not progressive, and now everyone is biting at him , they say, identify the hypatitis and everything will go away, as it may be true, I made an appointment with a hypatologist, I’ll wait for the appointment, maybe someone will help me in my trouble!
Piskovatsky Pavel Enlightened (28061) 6 years ago
I agree with Andrei Enyutin, it is necessary first of all to look for infection: gonococcus, chlamydia, yersinia, tuberculosis, streptococcus. Hepatitis C is probably not a problem here.
Did a rheumatologist look at it? And the orthopedist.
Vitaly Ogay Profi (744) 6 years ago
I advise you to contact a chiropractor.
DOKTOPWA Sage (19731) 6 years ago
Well, let's start with the fact that hepatitis does not cause joint pain))) If you have it, then you need to go to an infectious disease specialist first, and not to a hepatologist.
As for joints, see an orthopedist or rheumatologist
Alexander Shapovalov Guru (2863) 6 years ago
You can read on my website about the treatment of the musculoskeletal system, write me the address.
Andrey Enyutin Artificial Intelligence (144296) 6 years ago
if hepatitis is found. Apparently C, I think it’s worth looking for gonococcus, sometimes it slips into the blood and attacks the joints. By the way, there should be deviations in the analyzes in any case.
anna antonenko Artificial Intelligence (117749) 6 years ago
Hepatitis C can actually cause muscle and joint pain.
So go to a hepatologist, if possible, and not just to a gastrointestinal specialist or an infectious disease specialist, although a competent infectious disease specialist can refer you to the necessary tests and prescribe treatment. At the same time, you can and should, just in case, get tested for sexually transmitted infections and rheumatic tests. Joints can hurt from both. Just be sure to tell these doctors (rheumatologist, gynecologist, urologist). that you have been diagnosed with hepatitis C, otherwise they may prescribe medications that will make you worse or will not help.
Reviews posted on the official website are considered to be the personal health of the persons who wrote them. Near the consequences of additional ailments, they can be withstood by blood group diseases, boils, bruises, ruptures and development of ligaments, as well as with hernias of various origins.
Effective states in the blood plasma deteriorate in puerperal 2 times after administration, the droplet level in intoxication will remain for a period of 8 hours.
This concerns, first of all, people over 40 years of age, although the pulps of their tolerance are not yet visible. The selective hypothesis is the presence of oncological risk factors for the progression of the process and the creation of venous thrombosis (diabetes mellitus, obesity, connective tissue lipoma, smoking, as well as blood vessels for blood clots, changes in the hemostatic system, which do the legs hurt with hepatitis with thrombosis).
Let the orbital results of narrowing need to take into account the location of more detailed information about the carriers, in particular, about the limitations of the convenience of thrombotic complications in their place. It is also worth following the convention of dividing areas of relative thrombosis into refined and stopudous. Therefore, it is surprising to continue studying compensated separation, as well as antihistamines with it in the treatment of patients who have suffered a pulmonary embolism or a preventive examination.
TOUR TO PRAGUE DRESDEN VIENNA
Inflammation of the veins in the anus photo
How to respond to I'm falling at my feet
Japanese ointment for varicose veins
To remove the scaffold from the platform, paved the day before yesterday 6 m from the woman’s varicose veins, the trousers are installed on hard-to-reach supports.
Preference is given to alternating and previous rectal fields, Bernard currents, and laser therapy. Lunar therapeutic sollux can leg pain with hepatitis C be selected when carrying out special bandages that the cosmetologist implements natural compression of the lower extremities with special thin cuffs, gradually identified from the scurvy to the upper third of the thigh.
In patenting, we need to popularize that varicose lavage of CVI is possible only with a table approach to each individual conductor, rational use of the successful issue of lateral infectious technologies, and a clear attraction with vitamins of the need to bow to girlfriends. Institute of Gerontology of the Academy of Medical Sciences of Ukraine Popova venous insufficiency CVI is one of the most ancient evils.
Savior for newspaper pain, tested.
Swelling of the legs is a sign of the later stages of cirrhosis, when the process becomes decompensated.
They can develop in both the upper and lower extremities, but swelling of the legs is still more typical.
The lower limbs increase in size, and the usual shoes no longer fit. The legs are dense and warm to the touch. When pressed with a finger, a mark remains for a long time. This swelling is permanent.
Swelling of the legs in heart failure of the right ventricle can be combined with cirrhosis of the liver. They are characterized by their appearance in the evening, initially affecting only the feet and ankles.
Thrombophlebitis is the cause of edema of the lower extremities. In addition to them, this disease is characterized by pain, numbness, tingling in the legs, fever, and poor health.
For differential diagnosis of a symptom such as edema of the lower extremities, it is necessary to take into account the presence of other signs, as well as data from the medical history and disease.
The next stage of treatment is the prescription of diuretics: as a rule, a combination of furosemide and spironolactone is used.
Diuretics are used under the control of body weight, and the content of electrolytes in the blood (sodium, potassium, chlorine, etc.) is also regularly checked.
Remember! Self-medication can cause irreparable consequences for your health! At the first symptoms of the disease, we recommend immediately contacting a specialist!
Edema of the lower extremities is one of the many symptoms of liver cirrhosis.
Why they arise and how they manifest themselves will be discussed in this article.
Their appearance is due to several reasons:
Swelling of the legs with cirrhosis of the liver is most often combined with another similar condition - ascites. With ascites, fluid accumulates in the abdominal cavity.
In addition, hepatic hydrothorax may be observed - accumulation of fluid in the pleural cavity.
In addition to the above symptoms, swelling of the legs with cirrhosis of the liver is distinguished by the presence of all the signs of decompensation of cirrhosis:
Laboratory studies show an increase in the activity of specific and nonspecific liver enzymes, bilirubin, and globulins.
The content of albumin and potassium is reduced. Instrumental studies (ultrasound, FGDS, biopsy) confirm the diagnosis of liver cirrhosis.
Edema of the lower extremities can develop not only with cirrhosis of the liver. There are many reasons why they occur.
During the night the swelling disappears. Other signs of right ventricular heart failure are also observed: shortness of breath during exercise or at rest, high blood pressure, severe fatigue.
Varicose veins are also accompanied by swelling of the legs. Liver cirrhosis may affect the development of this disease.
In addition to swelling, varicose veins are accompanied by heaviness and pain in the lower extremities; in the later stages, the pain can be severe. Varicose nodes and dilated vessels are visible on the skin of the legs.
At the last stage, trophic ulcers may develop.
Swelling of the legs is also accompanied by allergic reactions. Typically, there is a previous factor that caused the swelling. After prescribing treatment, as well as eliminating the provoking factor, the swelling disappears.
First of all, it is necessary to prescribe a diet with limited salt. If you have ascites and swelling of the legs, it is better not to use salt at all, at least until symptoms improve.
Swelling that appears with cirrhosis of the liver is the most common symptom. First you need to figure out what this terrible pathology called cirrhosis of the liver is. With such a diagnosis, you need to understand that the disease kills liver cells, and the organ ceases to function normally, which ultimately leads to death. And the first alarming notes are swelling.
The main cause of this disease is most often heavy metal poisoning, they predominate in:
There is an accumulation of toxins in the liver cells, which leads to poisoning and scarring of the entire tissue. Treatment in this case is carried out only after consultation with a doctor.
Edema of the extremities is one of the latest symptoms of cirrhosis. Such manifestations can occur on both the lower and upper extremities, as well as the lungs, but most often occur on the legs. Why do swelling of the legs appear?
There are several causes for cirrhosis:
Impaired liver function leads to a decrease in the production of albumin, which is responsible for retaining the liquid part in the vessels. Due to this, more and more fluid gets into the tissues and this further increases the swelling of the legs. Treatment of the condition is carried out only in conjunction with therapy of the pathology itself.
Edema of the legs may develop earlier in the case of cardiac cirrhosis, as it is a symptom of heart failure. The heart does not cope sufficiently with its functions, and this leads to blood retention in the legs.
It is also worth noting that with such a phenomenon as swelling of the legs with cirrhosis, the following signs appear:
All these manifestations of cirrhosis are usually taken into account when making a diagnosis and direct treatment. The liver is one of the main human organs, without which the body cannot exist. It is responsible for removing all toxins from the body and producing a lot of useful substances.
Why do complications of varying degrees occur with cirrhosis? Since the liver produces certain groups of substances and functions as a filter for the body, when its functioning is disrupted, various diseases begin to occur.
Let's look at specific examples:
Let's look at the most common causes of the disease:
to contents ^
Treatment involves targeted elimination of liver cell destruction, emerging complications and avoidance of the appearance of cancer cells. Liver transplantation (in difficult cases) has also been practiced for a long time. Many people prefer treatment from their grandmothers, the so-called folk one. Milgamma is one of the most popular medications for the treatment of this disease.
To prevent damage, the following actions can be distinguished:
For people at high risk of liver cancer (patients with cirrhosis and hepatitis), it is recommended to undergo a routine ultrasound every six months. This is done in order to identify and exclude the appearance of tumors in time. This procedure should not be neglected, since hepatitis is still curable, but cancer is not.
One of the most effective, but also the most dangerous procedures is transplantation. It is resorted to only in case of complete failure of therapy. About 84% of liver transplant patients live another 6-10 happy years. This is a very good indicator and confirms the fact of the targeted use of transplantation. Unfortunately, not every person who needs a transplant receives their organ, since the liver is one of the most scarce organs in medical practice. The ideal option for a transplant is a paid operation.
Hepatitis C (“C”) is an infectious disease. It is caused by the hepatitis C virus, which lives and multiplies in human liver cells. Reproduction of the virus in cells leads to their death and the occurrence of inflammation of the liver - viral hepatitis C. In the vast majority of cases (70-90%), hepatitis C does not go away on its own, the virus remains in the body for life and causes chronic inflammation of the liver - chronic hepatitis C.
hepatitis C virus only from person to person in three ways.
Bloodborne infection can occur when using:
- foreign, used syringes, needles, spoons, cotton wool, filters, etc.;
- other people's razors, toothbrushes, scissors, manicure tools;
-unprocessed instruments for piercing, tattoos;
-unprocessed medical instruments;
-as well as through direct contact with someone else’s blood.
There is still no consensus on how high the risk of transmitting hepatitis C through sexual contact is, but in any case, this risk exists, especially if there is contact with blood during sexual intercourse.
3. From mother to child - during pregnancy and childbirth
The risk of hepatitis C transmission during pregnancy and childbirth is low - up to 5%. Moreover, about half of children who received the hepatitis C virus from their mother recover from it on their own. Breastfeeding itself does not carry a risk of transmitting the virus, since breast milk does not contain the virus. However, when breastfeeding, a woman must ensure that there are no cracks in the nipples or damage to the baby’s oral mucosa to prevent contact with infected blood.
The hepatitis C virus is highly infectious. Infection is possible through contact even with an amount of blood invisible to the eye. There is no vaccine against hepatitis C, so you can protect yourself from infection only if you follow these simple rules.
When performing injections, always use sterile instruments: dishes, samples, syringes and needles, filters, a spoon (or other containers for water, preparation and distribution of drugs), a tie, water for washing syringes. Injections should be carried out only on a clean surface, avoiding contact with objects that may have traces of someone else's blood (even if these traces are not visible). It must be remembered that even the slightest contact with someone else's blood can lead to transmission of the virus. There are no sterilization methods that completely protect against transmission of the hepatitis C virus, since the virus is very tenacious. Therefore, in any situation it is better to use only sterile or your own injection equipment! However, if you are in an extreme situation when your instruments are absolutely inaccessible, you must take all possible measures to sterilize the equipment: thoroughly rinse the syringe with bleach or cold running water. Do not rinse the syringe with boiling water, as the blood may clot and harden. Therefore, even if you decide to boil the syringe, you must first rinse it thoroughly with cold water, remembering that the rinsing water should only be used once.
It is necessary to carefully handle all objects on which tiny particles of blood may remain. You should only use your own personal hygiene items: toothbrush, washcloth, manicure tools, razor - store them separately, since the virus can remain viable in the environment for up to several days (16 hours - 4 days).
Piercing and tattooing equipment should ideally be disposable or properly sterilized (including not only needles, but also accessories such as ink containers or piercing machines). The tattoo or piercer must wear disposable gloves throughout the entire procedure. This will protect both him and you. When piercing, use only your own accessories. You should not use other people's accessories - they can also retain tiny particles of blood.
When having sex, you must use condoms. In addition, ensure that the mucous membranes are intact and that there are no cracks or microtraumas. Remember that with inflammatory diseases of the genital organs, the mucous membrane is damaged, bleeding increases, which increases the risk of transmission of hepatitis C. It is not recommended to practice unprotected sex during menstruation, regardless of who is infected with hepatitis C: a man or a woman.
A feature of hepatitis C is its latent course. For a long period after infection (months or years), no clear signs (symptoms) may appear indicating that a person has hepatitis C. The presence or absence of hepatitis C can only be clearly determined by testing the blood. Think about whether there have been any episodes in your life when hepatitis C infection could have occurred. A state of persistent fatigue, a periodic feeling of heaviness in the right 1st hypochondrium, and decreased appetite may also serve as a reason for examination for viral hepatitis, including hepatitis C. However, these symptoms not everyone experiences them.
To detect hepatitis C, blood tests are used to look for antibodies or the virus itself. In widespread practice, the first method is most often used - the determination of antibodies.
With hepatitis C, it is believed that if there are antibodies, then there is a virus. In the vast majority of people, hepatitis C does not go away on its own, but remains for life.
However, it is important to remember that antibodies to the virus do not appear immediately after infection - their appearance to the level detected by test systems can take up to 6 months, although most often they can be detected after 2-3 months. The period of time between infection and detection of antibodies is called the incubation period.
Thus, you can finally make sure that you do not have the virus if you do an antibody test 6 months after the risky contact. If you receive a positive result during the examination, you should conduct a confirmatory test. A confirmatory test will show whether you have had hepatitis C or are currently ill, because it is aimed at directly identifying the virus. In order to determine whether the virus is currently present, a special test is used - polymerase chain reaction (PCR). This test is more expensive. If the test result is negative, this means that either you had hepatitis C and recovered, or the virus disappeared from the body as a result of treatment, or the virus reproduction activity has become so low that PCR is not able to detect it. It should be remembered that the viral load is not as informative in indicating disease progression as with other chronic viral infections (for example, HIV infection).
The liver is the second largest organ in your body (after the skin) and is located on the right side of your torso. An important function of the liver is to provide a person with energy. It breaks down food and processes it into carbohydrates, which are stored and later used as needed. Carbohydrates are converted into glucose and then stored (mainly in the liver and muscles) in the form of a special substance - glycogen. If the body urgently needs energy, a certain amount of glycogen is converted back into glucose.
Damage to the liver can reduce its ability to convert carbohydrates into glucose: it may begin to produce either too much glucose or too little. The liver also produces bile: a greenish-yellow fluid that helps break down food. Bile is stored in the gallbladder. After eating, the gallbladder contracts and releases bile into the intestines. Blood passing through the liver is filtered and purified. The liver helps the body get rid of various processed foods. The liver also produces substances that affect blood clotting (they are involved in stopping bleeding).
Persistent, long-term damage to liver tissue can lead to the formation of scars called fibrosis. The formation of scars leads to changes in the normal structure of the organ.
Scars compress the liver tissue itself, blood vessels and, as a result, the liver stops working normally. This condition is called cirrhosis. One of the common causes of cirrhosis is chronic hepatitis C.
The more severely damaged the liver, the greater the likelihood of severe signs of this damage. As the liver becomes damaged, its ability to neutralize poisons and process substances decreases, which can lead to chronic fatigue, weakness, loss of appetite, nausea, and weight loss. Other symptoms that indicate liver problems may include: jaundice, dark urine and light-colored stool, spider veins (when capillaries become visible), ascites (when fluid accumulates in the abdominal cavity), umbilical varices, and bleeding from the esophageal veins.
The news that you have been diagnosed with hepatitis. S, - the news is not pleasant. There is no doubt that the disease will require you to pay more attention to your own health and certain lifestyle adaptations. It is important to remember that even if you have the virus, if you follow certain rules, you can live a long and fulfilling life. In most cases, the period of development of the disease to the stage when it begins to cause significant damage to the liver with the development of fibrosis ranges from 12 to 20 years.
With hepatitis C, the liver works in “emergency conditions.” Any additional stress can lead to serious consequences for your health. Try to stop or significantly reduce your alcohol consumption. Street injection drugs, as a rule, contain a small amount (from 5 to 15%) of the “active substance”, the rest is what they are diluted with. All this “ballast” settles in the liver, which, naturally, is not indifferent to it. The conclusion is the same - it is better to stop or reduce drug use as much as possible.
If you are taking any medications, be sure to check with your doctor to see if you can take them if you have hepatitis. You may need to change your medication regimen or replace one medication with another.
If a woman takes oral contraceptives, it is necessary to consult a gynecologist, because they also affect the condition of the liver.
Heavy physical work, work with various toxic substances (varnishes, paints, household chemicals, etc. production of chemical products) also negatively affect the liver. During periods of exacerbation of hepatitis C, it is recommended to limit physical activity.
The liver plays an important role in processing food, so many people living with hepatitis can benefit from changing their diet to feel better. Following a strict diet is mainly necessary for acute hepatitis and exacerbations of chronic hepatitis. If there is no exacerbation, it is enough to simply adhere to certain rules and avoid excesses. It is important for each person to be attentive to his body, to monitor what he takes or does not take, since everyone’s characteristics may be different. A few general guidelines will help you understand the principles of the hepatitis diet. The general idea of the diet comes down to limiting or stopping the consumption of those foods that create additional stress on the liver. It is important to completely eliminate or reduce alcohol consumption as much as possible.
Eliminate from the menu or reduce your consumption:
-saturated fats. Try to reduce the amount of fatty foods you eat. These products include animal fats and everything prepared with them (fried, broths), as well as smoked meats. Replace foods high in fat (eg sour cream, yogurt) with foods lower in fat. If you eat meat and fish, then eat lean parts of meat and lean fish. Avoid excessive amounts of fried foods and sugar. Avoid excessive consumption of sugar, especially that added to food, drinks, etc. The sugar contained in fruits is not so harmful. Eliminate or reduce the consumption of sugary carbonated drinks from your menu, replacing them with plain water. It is better to use honey to sweeten foods.
×artificial colors and preservatives
Tea and coffee. These foods may increase nausea, heartburn, and insomnia.
×salt. With hepatitis, water exchange processes in your body are disrupted. Characteristic is the accumulation of water in the body and swelling. One way to deal with swelling is to regulate your salt intake. Salt works like a sponge: when the body absorbs it, it absorbs moisture. Therefore, by reducing the amount of salt, you can influence the retention of water.
Include in the menu or increase your consumption:
-fresh vegetables and fruits
-whole grains and legumes
-antioxidants. Foods rich in antioxidants help protect cells from oxidative damage. Antioxidants include beta-carotene (carrots, pumpkin, dark green leafy vegetables, spinach, beets, apricots), vitamin C (citrus fruits, kiwi, berries, plums, dark green vegetables. Long cooking destroys vitamin C).
-zinc (raw nuts and seeds, almonds, walnuts, whole grains, lentils, fish, lean meats).
-milk protein. Methionine contained in cottage cheese is a good hepa-
- bitter products. Promotes digestion. Eat bitter salads and greens, as well as grapefruits and lemons.
-drinks (water, fresh fruit or vegetable juices, herbal teas: chamomile,
Many of us do not like to go to doctors and often turn to them only when obvious manifestations of the disease arise. The peculiarity of hepatitis C is that it is a rather “silent” disease. Inflammation in the liver occurs despite the absence of obvious manifestations of the disease. Significant health problems may appear in the later stages, for example, with severe exacerbation of chronic hepatitis and with the formation of cirrhosis of the liver. In order to monitor the condition of the liver and the behavior of the virus, it is necessary to regularly see a doctor and undergo examinations.
ALT (AlAT, transaminase) and bilirubin
These tests make it possible to determine the presence and severity of inflammation in the liver, as well as the severity of disturbances in the functioning of the organ. ALT (transaminase) is a substance found in liver cells.
Normally, cells are periodically renewed. In this regard, a small amount of transaminase from old dead cells is constantly present in the blood. Inflammation of the liver, including hepatitis C, causes more cells than normal to die. As a result, the amount of ALT in the blood increases. The stronger the inflammation, the more cells die, and the higher the level of ALT in the blood. Bilirubin is a substance formed during the breakdown of hemoglobin. Normally, it is captured by the liver from the blood, processed in it and excreted with bile into the intestines. If the liver is malfunctioning, its cells are unable to capture all the bilirubin from the blood. It accumulates in the blood and penetrates the skin - jaundice appears. The body tries to get rid of excess bilirubin and removes it with urine - as a result, it darkens. Since the processing of bilirubin by the liver is impaired, it stops entering the intestines - the stool becomes lighter. It is recommended to take transaminase and bilirubin for chronic hepatitis C 3-4 times a year.
This is the standard way to determine if there is damage to the liver. The biopsy procedure can be uncomfortable and sometimes painful. When performing a biopsy, a hollow needle is inserted into the surface of the liver through the skin in the hypochondrium. A small piece (several millimeters) is taken from the liver, which is pulled out at the end of the needle. This piece is then examined to determine the level of liver damage, if such damage is present. The biopsy examination usually takes at least 2 weeks.
Liver biopsy is the only, most informative way to determine indications for starting treatment for hepatitis C.
Ultrasound examination of the liver (ultrasound) provides specialists with valuable information about what is happening to the liver at the moment. For example, ultrasound can identify the initial signs of liver cirrhosis. This allows you and your doctor to start treatment in a timely manner. It is advisable to undergo an ultrasound 1-2 times a year.
An important point in assessing the condition of the body with hepatitis C is the examination of the condition of the gallbladder. This organ is located directly below the liver, its work is closely related to the work of the liver. With hepatitis C, health problems are often associated not so much with the liver, but with the gallbladder (for example, pain in the right side after severe dietary violations is most often caused not by inflammation in the liver, but by disruption of the gallbladder). The presence of hepatitis C can contribute to the development of inflammation in the gallbladder - cholecystitis, which will require separate treatment.
It is customary to talk about hepatitis C as one virus. In fact, this is a fairly large group of viruses that are very similar to each other. The varieties of hepatitis C virus are called genotypes. The presence of one type of virus in the body does not protect against infection by the remaining five.
So, if you do not protect yourself from re-infection, you can eventually collect a whole “collection” of hepatitis C viruses. The entry of new varieties of the virus into the body naturally leads to a worsening prognosis of the disease and increases the risk of liver cirrhosis.
When deciding on the treatment of hepatitis C, the presence of a “mixture” of several varieties of the virus will reduce the likelihood of a successful outcome of therapy. At the moment, it is not entirely clear how virus genotypes affect the length of time before the onset of cirrhosis, but a relationship has been established between genotypes and the effectiveness of treatment. It is widely accepted that, in general, genotypes 2 and 3 respond better to interferon-based antiviral treatment than other genotypes. It is possible to determine what genotype you have only by passing a special genotype test. This study is strongly recommended before starting interferon therapy, because allows the doctor to assess the possible effectiveness of treatment. Thus, when treated with the standard regimen of peginterferon + ribavirin, the effectiveness of treatment reaches 50% for genotypes of group 1 (a and b) and up to 80% for genotypes 2 and 3.
What to consider when deciding to start treatment
To make a decision about starting treatment, you must consult a specialist and undergo an in-depth examination. The best treatment result is the complete destruction of the hepatitis C virus. Unfortunately, it is unlikely to achieve such a result even with the help of modern methods. A more realistic goal is to suppress the replication of the hepatitis C virus over the long term. Achieving this goal allows, in particular, to reduce the risk of developing cirrhosis and improves a person’s quality of life.
Before starting treatment, the following issues need to be resolved:
— What is the prognosis for the effectiveness of treatment in your case?
— When to start treatment?
— Which treatment will be more effective?
- How long should it last?
The following factors play an important role in resolving these issues:
- degree of liver damage - symptoms of fibrosis, cirrhosis;
— genotype (subtype) of the virus;
- your ability to adhere to your treatment regimen.
Interferon is a protein produced naturally by the body in response to infection. It is because of the production of interferon that you feel unwell.
Interferon blocks viruses from entering healthy cells (thus preventing them from multiplying) and stimulates the immune system to fight them. Interferon has been used to treat hepatitis for many years. Currently, the international standard for hepatitis treatment is a combination of pegylated interferon and ribavirin. The process of so-called pegylation - the addition of non-toxic inert polyethylene glycol to the interferon molecule - enhances the activity of biologically active proteins. Pegylated interferon (peginterferon alfa) differs from the standard one in the duration of action: peginterferon is enough to be administered once a week to maintain the required therapeutic concentration in the blood, and standard interferon - 3 times a week. Interferon is used in the form of intramuscular injections. According to the standard international treatment regimen, interferon is used in combination with ribavirin. Ribavirin is a drug that slows the replication of the hepatitis C virus and modifies the immune system's response to the virus. Ribavirin is used only in combination with interferon, since by itself it has no effect on the virus. Ribavirin is used in capsule form. Some patients (a small number) do not tolerate ribavirin, and only in this case interferon monotherapy is prescribed.
Under the influence of interferon (in any form), the same phenomena occur in the human body as with any viral infection: increased body temperature, weakness, sweating, nausea, muscle and headaches, depression. Side effects of the drug begin soon after the injection of the drug and can last about 12 hours. The severity of side effects varies depending on the individual's body. They are most pronounced in the first few weeks of treatment. After this, the body gradually adapts, and the side effects become less noticeable. To overcome the side effects, some people find paracetamol helpful if taken an hour before the interferon injection (some take the injection right before bed to sleep through the most unpleasant sensations). It is useful to drink plenty of fluids - about 10 glasses of water per day are recommended (water can be replaced with juices, but not caffeinated drugs or alcoholic beverages).
It is extremely important to avoid skipping medications: adherence to the regimen significantly affects the effectiveness of the course of treatment.
During treatment, monthly blood tests should be done to determine whether liver inflammation is decreasing. After completing the course of treatment, you need to continue to do tests for several more months, since after stopping interferon injections, signs of liver inflammation may reappear.
If a woman is undergoing interferon treatment, pregnancy can be planned no earlier than 1 year after the end of therapy.
In Russia, standards for the treatment of hepatitis C have not yet been developed, and the availability of effective treatment depends on the region in which you live. Compulsory health insurance (CHI) includes interferon therapy as permitted, but the compulsory medical insurance standards proposed in most regions do not include interferon as a mandatory component paid for by the insurance company. Therefore, depending on the region, you will be offered either completely free therapy, or fully or partially paid for by the patient. Today, the state, as mandatory assistance, undertakes only to provide advice on the regimen, diet and the need for inpatient treatment: IVs in combination with enzymes (see below).
When deciding whether to take one type of therapy or another, remember: monotherapy with any form of interferon is not recommended by international standards. Therefore, when deciding on it, you should carefully weigh and discuss all the pros and cons with your doctor. The only recommended standard of care today is the combination of peginterferon and ribavirin (except for patients who cannot take ribavirin).
Before starting treatment, it is important to discuss with your doctor the issue of the stability of the supply of drugs, since treatment must be carried out for 24–48 weeks (depending on the genotype), without interruptions. If you purchase drugs with your own money, this factor should also be kept in mind.
In Russia, some drugs are popular, which are usually classified as hepatoprotectors. These medications, unlike interferon with ribavirin, do not act on the virus, but are designed to support the functioning of the liver. The most common drugs in this group are Karsil, Essentiale, Legalon, LIV-52.
Do not use these medications under any circumstances without careful consultation with your doctor and prior examination. It has been established that during exacerbation of hepatitis C, some of them can increase inflammation in the liver. The effectiveness of hepatoprotectors in treatment has not been established, and for some there are negative data. Thus, “LIV-52” has long been discontinued and banned in Western Europe due to carcinogenicity. In relation to Essentiale, the only condition for which its effectiveness has been scientifically proven is alcoholic liver disease (namely steatosis). Its effectiveness has not been proven for viral hepatitis, and it is contraindicated for acute viral hepatitis.
For example, “Festal”, “Creon”, “Mezim_forte”, etc.) help the body digest food faster and thereby reduce the load on the liver. There is an opinion that with chronic hepatitis C it is necessary to periodically “cleanse the blood.” In fact, the liver perfectly cleanses the blood without IVs. It is important to create favorable conditions for her to do this with the help of a regimen and diet.
It is possible to receive monetary compensation for purchased medications. New legislation, namely Chapter 23 of the Tax Code of the Russian Federation, provides for tax deductions of four types in the taxation of individuals: standard, social, property, professional. Social tax deductions (Article 219 of the Tax Code) allow you to reduce taxable income by amounts allocated by the taxpayer from personal funds for his treatment and/or for the treatment of his spouse, his parents and/or children under the age of 18, as well as for the purchase medicines prescribed by the attending physician, in the amount of actual expenses, but not more than 38,000 rubles. To take advantage of the right to social deductions, you must:
• be a payer of income tax;
• stock up on the necessary documents proving the right to the deduction;
• contact the tax office on time with an application and declaration.
Before making a decision to purchase medicines and receive paid medical services with the expectation of further compensation, you should carefully consult with a lawyer or the tax office. Currently, the list of medicines for which compensation is provided includes only Interferon alfa; Ribavirin is not there.
Pregnancy and hepatitis C
Two scientifically proven facts:
1. The risk of transmitting hepatitis C from mother to child during pregnancy and childbirth is small - up to 5%.
2. Pregnancy does not affect the course of hepatitis C.
The risk of a child becoming infected with hepatitis C during pregnancy and childbirth is higher if:
• hepatitis C occurred during pregnancy, especially after the 23–24th week;
• there was inflammation of the placenta (placentitis) or severe changes in the placenta.
When planning a pregnancy, it is advisable to undergo an in-depth examination, in particular to determine the amount of hepatitis C virus in the blood - the viral load. It is extremely important to exclude the presence of liver cirrhosis, because in this condition, pregnancy is not recommended, and in some cases even contraindicated.
Today it is generally accepted that a caesarean section does not reduce the risk of transmission of the hepatitis C virus during childbirth, and therefore delivery is carried out “in the usual way”. If you have hepatitis C, breastfeeding is allowed, because It is believed that the virus does not pass into breast milk, but when breastfeeding, it is strongly recommended to monitor the condition of the mother's nipples and the baby's oral mucosa to avoid the mother's blood entering the baby's body.
It is possible to speak reliably about the presence or absence of hepatitis C in a child no earlier than a year after birth.
Until this time, the child may retain antibodies received from the mother. If you test your baby for hepatitis C soon after birth, the test may be positive (as if the virus is present). A woman's immune system decreases its activity during pregnancy. After childbirth, its activation occurs, which can lead to an exacerbation of hepatitis C.
Hepatitis C and cirrhosis of the liver
Some patients with viral hepatitis C (about 20–40% of cases) develop a severe irreversible condition - cirrhosis of the liver. Cirrhosis is the replacement of normal liver tissue with scars. Scars tighten the liver tissue, deform it, compress the blood vessels passing through the liver, and as a result, it ceases to perform most of its functions normally. Regular observation and examination make it possible to timely identify cirrhosis of the liver and begin its treatment. In some cases, the changes that have begun may disappear, in most cases the process will be greatly “slowed down.”
The most serious health problems with cirrhosis are:
1. The liver ceases to adequately cleanse the blood.
Harmful substances that are formed in the intestines are not destroyed by the liver, they bypass and negatively affect the body as a whole. The nervous system suffers first. In the most severe cases, the development of so-called hepatic encephalopathy, associated with severe disorders of the brain, is possible. Most of the harmful substances that affect the nervous system come from proteins. Therefore, it is necessary to minimize the consumption of products containing animal proteins. They can be replaced with soy products.
2. Water-salt metabolism is disrupted.
The liver is an organ that maintains and regulates the ratio of water and various salts (potassium, sodium, etc.) in our body. Violation of water-salt metabolism and compression of the blood vessels of the liver by scars that form during cirrhosis leads to the development of swelling of the legs. In severe cases, fluid begins to accumulate in the abdomen (ascites). If edema occurs, it is strongly recommended to limit the consumption of salt and water. Salt “holds” water on itself: the more salt in the blood, the more water it “holds”, and the stronger the swelling. Reducing salt consumption will lead to the fact that water will begin to “leave” from the body, swelling will decrease or disappear altogether.
3. Blood clotting decreases.
There is an increased risk of hemorrhage, bleeding (such as from the nose) and bruising. In this case, be sure to consult your doctor. You may need to take special medications that increase blood clotting. Following a proper diet helps solve a number of problems with cirrhosis.
Cirrhosis often reduces appetite: taste sensations are distorted, smells change, and an aversion to certain types of food appears. Try to choose the food that suits you best, taking into account its protein and salt content. If your appetite is “zero,” you can switch to fractional meals: small portions, but often (5–7 times a day).
In Russia, many people infected with HIV are also infected with hepatitis C. Hepatitis C is one of the most common causes of chronic liver disease, causing severe damage to the health of people with HIV. The presence of hepatitis C in a person may require changes in HIV treatment. Since 1999, hepatitis C has been considered an opportunistic infection for people with HIV. Timely diagnosis and treatment of hepatitis C in people with HIV allows:
-reduce the risk of transmission of the virus from mother to child;
- slow down the development of liver disease.
Every year more and more information appears about the co-infection of HIV and hepatitis C, but today more is known about how HIV affects hepatitis C; The impact of hepatitis C on HIV has been less studied.
Impact of HIV on hepatitis C
HIV-positive people tested for hepatitis C antibodies may receive a false negative result, especially if they have a low CD4 count (indicative of a poor immune response to hepatitis C). In this regard, a PCR test can be used to diagnose hepatitis C in HIV-positive people. The risk of transmission of both HIV and hepatitis C from mother to child during pregnancy, childbirth and breastfeeding increases if the mother is coinfected. The level of risk is also related to the viral load of both viruses.
HIV infection disrupts the functioning of the human immune system and, thereby, accelerates the development of hepatitis C: it increases the possibility of transition from acute to chronic form of hepatitis C, the development of fibrosis and, subsequently, cirrhosis.
The effect of hepatitis C on HIV
The effect of hepatitis C on the progression of HIV infection is not clear. Although some studies indicate that certain types of this virus accelerate the transition of HIV infection to the AIDS stage, this question still remains open. The effect of hepatitis C on HIV is limited, but in cases of more severe liver damage, especially in people with genotype 1, the disease may be worsened. The development and treatment of HIV and hepatitis must be closely monitored. It is also necessary to carefully observe how the treatments interact.
Treatment options for coinfection
The presence of both viruses makes the treatment process more difficult. You will likely need to weigh the perceived benefits against the risks. This is especially true for people in the later stages of HIV. If treatment for hepatitis is recommended, a decision must be made about which virus should be treated first. Such decisions are based on several factors, the main ones being the CD4 count and the degree of liver damage. Modern methods suggest that it is better to treat hepatitis C before starting ARV treatment, especially if the most “favorable” subtype of the virus for treatment has been identified. If liver biopsy or blood tests reveal severe liver damage, this also indicates the need to begin treatment for hepatitis.
Co-infection with hepatitis C is not a contraindication to the use of ARV therapy, even if the course of treatment for hepatitis C was not extended due to the most likely ineffectiveness or lack of access to this therapy.
Patients with low immune status (CD below 350) may be advised to delay hepatitis treatment. This will allow us to focus on anti-HIV therapy to improve immune status and reduce the viral load. Interferon can significantly reduce CD levels, thereby worsening immunodeficiency. The response to hepatitis C therapy will also be better with a high CD count. Some people undergo both therapies at the same time. In this case, careful monitoring of treatment is necessary, as some drugs may increase susceptibility to treatment and side effects.
The effectiveness of hepatitis C treatment for HIV-positive patients with high CD4 counts is lower than for HIV-negative patients. However, it also remains dependent on the subtype of the virus. Treatment of hepatitis C may slow the process of liver damage and improve tolerability of anti-HIV drugs. If AZT, d4T or ddI are part of the HIV treatment combination, these drugs may need to be changed before How to start treatment for hepatitis C. AZT can contribute to the development of anemia in the same way as ribavirin (which is part of combination therapy for hepatitis C). When taking d4T and hepatitis therapy simultaneously, lactic acidosis may develop. For receiving