Hundreds of suppliers bring hepatitis C medicines from India to Russia, but only M-PHARMA will help you buy sofosbuvir and daclatasvir, while professional consultants will answer any of your questions throughout the therapy.

Hepatitis is called acute and chronic inflammatory diseases of the liver, which are not focal, but widespread. Different hepatitis has different methods of infection, they also differ in the rate of progression of the disease, clinical manifestations, methods and prognosis of therapy. Even the symptoms of different types of hepatitis are different. Moreover, some symptoms are more pronounced than others, which is determined by the type of hepatitis.

Main symptoms

1. Jaundice. The symptom is common and is due to the fact that bilirubin enters the patient's blood during liver damage. Blood, circulating through the body, carries it through the organs and tissues, staining them yellow.
2. The appearance of pain in the region of the right hypochondrium. It occurs due to an increase in the size of the liver, leading to the appearance of pain, which is dull and prolonged, or is paroxysmal in nature.
3. Deterioration of well-being, accompanied by fever, headaches, dizziness, indigestion, drowsiness and lethargy. All this is a consequence of the action on the body of bilirubin.

Hepatitis acute and chronic

Hepatitis in patients have acute and chronic forms. In an acute form, they appear in the case of viral liver damage, as well as if there has been poisoning with various types of poisons. In acute forms of the course of the disease, the condition of patients deteriorates rapidly, which contributes to the accelerated development of symptoms.

With this form of the disease, favorable prognosis is quite possible. Except for its transformation into a chronic one. In the acute form, the disease is easily diagnosed and easier to treat. Untreated acute hepatitis easily develops into a chronic form. Sometimes with severe poisoning (for example, alcohol), the chronic form occurs on its own. In the chronic form of hepatitis, the process of replacement of liver cells with connective tissue occurs. It is weakly expressed, goes slowly, and therefore sometimes remains undiagnosed until the onset of cirrhosis of the liver. Chronic hepatitis is treated worse, and the prognosis for its cure is less favorable. In the acute course of the disease, the state of health worsens significantly, jaundice develops, intoxication appears, the functional work of the liver decreases, and the content of bilirubin in the blood increases. With timely detection and effective treatment of acute hepatitis, the patient most often recovers. With a duration of the disease for more than six months, hepatitis becomes chronic. The chronic form of the disease leads to serious disorders in the body - the spleen and liver increase, metabolism is disturbed, complications arise in the form of cirrhosis of the liver and oncological formations. If the patient has reduced immunity, the treatment regimen is chosen incorrectly, or there is alcohol dependence, then the transition of hepatitis to a chronic form threatens the patient's life.

Varieties of hepatitis

Hepatitis has several types: A, B, C, D, E, F, G, they are also called viral hepatitis, since the cause of their occurrence is a virus.

Hepatitis A

This type of hepatitis is also called Botkin's disease. It has an incubation period ranging from 7 days to 2 months. Its causative agent - an RNA virus - can be transmitted from a sick person to a healthy person with the help of poor-quality products and water, contact with household items used by the patient. Hepatitis A is possible in three forms, they are divided according to the strength of the manifestation of the disease:

• in the acute form with jaundice, the liver is seriously damaged;
• with subacute without jaundice, we can talk about a milder version of the disease;
• in the subclinical form, you may not even notice symptoms, although the infected person is a source of the virus and is able to infect others.

Hepatitis B

This disease is also called serum hepatitis. Accompanied by an increase in the liver and spleen, the appearance of pain in the joints, vomiting, temperature, liver damage. It proceeds either in acute or in chronic forms, which is determined by the state of the patient's immunity. Ways of infection: during injections with violation of sanitary rules, sexual contacts, during blood transfusion, use of poorly disinfected medical instruments. The duration of the incubation period is 50 ÷ 180 days. The incidence of hepatitis B is reduced by the use of vaccination.

Hepatitis C

This type of disease is one of the most serious diseases, as it is often accompanied by cirrhosis or liver cancer, which subsequently leads to death. The disease is difficult to treat, and moreover, having had hepatitis C once, a person can be re-infected with the same disease. It is not easy to cure HCV: after contracting hepatitis C in an acute form, 20% of the sick people recover, and in 70% of patients the body is not able to recover from the virus on its own, and the disease becomes chronic. It has not yet been possible to establish the reason why some heal themselves, while others do not. The chronic form of hepatitis C will not disappear on its own, and therefore needs therapy. Diagnosis and treatment of the acute form of HCV is carried out by an infectious disease specialist, the chronic form of the disease - by a hepatologist or gastroenterologist. You can become infected during a transfusion of plasma or blood from an infected donor, using poorly processed medical instruments, sexually, and a sick mother transmits the infection to her child. The hepatitis C virus (HCV) is rapidly spreading around the world, the number of patients has long ago exceeded one and a half hundred million people. Previously, HCV was difficult to treat, but now the disease can be cured using modern direct-acting antivirals. Only this therapy is quite expensive, and therefore not everyone can afford it.

Hepatitis D

This type of hepatitis D is possible only with co-infection with the hepatitis B virus (co-infection is a case of infection of one cell with viruses of different types). It is accompanied by massive liver damage and an acute course of the disease. Ways of infection - the entry of a disease virus into the blood of a healthy person from a virus carrier or a sick person. The incubation period lasts 20 ÷ 50 days. Outwardly, the course of the disease resembles hepatitis B, but its form is more severe. May become chronic, then progressing to cirrhosis. It is possible to carry out a vaccination similar to that used for hepatitis B.

Hepatitis E

Slightly resembles hepatitis A in its course and transmission mechanism, since it is also transmitted through the blood in the same way. Its feature is the occurrence of fulminant forms that cause death in a period not exceeding 10 days. In other cases, it can be effectively cured, and the prognosis for recovery is most often favorable. An exception may be pregnancy, as the risk of losing a child approaches 100%.

Hepatitis F

This type of hepatitis has not yet been studied enough. It is only known that the disease is caused by two different viruses: one was isolated from the blood of donors, the second was found in the feces of a patient who received hepatitis after a blood transfusion. Signs: the appearance of jaundice, fever, ascites (accumulation of fluid in the abdominal cavity), an increase in the size of the liver and spleen, an increase in the levels of bilirubin and liver enzymes, the occurrence of changes in the urine and feces, as well as general intoxication of the body. Effective methods of therapy for hepatitis F have not yet been developed.

Hepatitis G

This type of hepatitis is similar to hepatitis C, but is not as dangerous as it does not contribute to cirrhosis and liver cancer. Cirrhosis can occur only in case of co-infection of hepatitis G and C.

Diagnostics

Viral hepatitis in their symptoms are similar to one another, just like some other viral infections. For this reason, it is difficult to accurately diagnose the patient. Accordingly, to clarify the type of hepatitis and the correct prescription of therapy, laboratory blood tests are required to identify markers - indicators that are individual for each type of virus. By identifying the presence of such markers and their ratio, it is possible to determine the stage of the disease, its activity and possible outcome. In order to track the dynamics of the process, after a period of time, the surveys are repeated.

How is hepatitis C treated?

Modern regimens for the treatment of chronic forms of HCV are reduced to combined antiviral therapy, including direct-acting antivirals such as sofosbuvir, velpatasvir, daclatasvir, ledipasvir in various combinations. Ribavirin and interferons are sometimes added to enhance effectiveness. This combination of active ingredients stops the replication of viruses, saving the liver from their destructive effects. This therapy has a number of disadvantages:

1. The cost of medicines to fight the hepatitis virus is high, and not everyone can buy them.
2. Taking certain drugs is accompanied by unpleasant side effects, including fever, nausea, and diarrhea.

The duration of treatment for chronic forms of hepatitis takes from several months to a year, depending on the genotype of the virus, the degree of damage to the body and the drugs used. Because hepatitis C primarily affects the liver, patients are required to follow a strict diet.

Features of HCV genotypes

Hepatitis C is one of the most dangerous viral hepatitis. The disease is caused by an RNA virus called Flaviviridae. The hepatitis C virus is also called the "gentle killer". He received such an unflattering epithet due to the fact that at the initial stage the disease is not accompanied by any symptoms at all. There are no signs of classical jaundice, and there is no pain in the area of ​​the right hypochondrium. It is possible to detect the presence of the virus no earlier than a couple of months after infection. And before that, the reaction of the immune system is completely absent and it is impossible to detect markers in the blood, and therefore it is not possible to carry out genotyping. The peculiarity of HCV also includes the fact that after entering the blood during the process of reproduction, the virus begins to rapidly mutate. Such mutations prevent the infected person's immune system from adapting and fighting the disease. As a result, the disease can proceed without any symptoms for several years, after which cirrhosis or a malignant tumor appears almost immediately. Moreover, in 85% of cases, the disease from an acute form becomes chronic. The hepatitis C virus has an important feature - the diversity of the genetic structure. In fact, hepatitis C is a collection of viruses classified according to their structural variants and subdivided into genotypes and subtypes. The genotype is the sum of the genes encoding hereditary traits. So far, medicine knows 11 genotypes of the hepatitis C virus, which have their own subtypes. The genotype is indicated by numbers from 1 to 11 (although genotypes 1 ÷ 6 are mainly used in clinical studies), and subtypes, using the letters of the Latin alphabet:

• 1a, 1b and 1c;
• 2a, 2b, 2c and 2d;
• 3a, 3b, 3c, 3d, 3e and 3f;
• 4a, 4b, 4c, 4d, 4e, 4f, 4h, 4i and 4j;

In different countries, HCV genotypes are distributed differently, for example, in Russia it is most often found from the first to the third. The severity of the course of the disease depends on the variety of the genotype, they determine the treatment regimen, its duration and the result of treatment.

How are HCV strains spread around the world?

On the territory of the globe, hepatitis C genotypes are distributed heterogeneously, and most often you can find genotypes 1, 2, 3, and in some areas it looks like this:

• in Western Europe and its eastern regions, genotypes 1 and 2 are most common;
• in the USA, subtypes 1a and 1b;
• in northern Africa, genotype 4 is the most common.

At risk of possible HCV infection are people with blood diseases (tumors of the hematopoietic system, hemophilia, etc.), as well as patients who are being treated in dialysis units. Genotype 1 is considered the most common in the countries of the world - it accounts for ~ 50% of the total number of cases. In second place in terms of prevalence is genotype 3 with an indicator of slightly more than 30%. The distribution of HCV across the territory of Russia has significant differences from the world or European variants:

• genotype 1b accounts for ~50% of cases;
• for genotype 3a ~20%,
• ~10% of patients are infected with hepatitis 1a;
• genotype 2 hepatitis was found in ~5% of those infected.

But the difficulties of HCV therapy depend not only on the genotype. The following factors also influence the effectiveness of treatment:

• age of patients. The chance of a cure in young people is much higher;
• it is easier for women to recover than for men;
• the degree of liver damage is important - the favorable outcome is higher with less damage to it;
• the magnitude of the viral load - the less viruses in the body at the time of the start of treatment, the more effective the therapy;
• patient's weight: the higher it is, the more complicated the treatment.

Therefore, the treatment regimen is chosen by the attending physician, based on the above factors, genotyping and EASL (European Association for Liver Diseases) recommendations. EASL constantly keeps its recommendations up to date and, as new effective drugs for the treatment of hepatitis C appear, adjusts the recommended treatment regimens.

Who is at risk for HCV infection?

As you know, the hepatitis C virus is transmitted through the blood, and therefore the most likely to become infected can:

• patients receiving blood transfusions;
• patients and clients in dental offices and medical facilities where medical instruments are improperly sterilized;
• due to non-sterile instruments, it can be dangerous to visit a nail and beauty salon;
• lovers of piercings and tattoos can also suffer from poorly processed tools,
• high risk of infection in those who use drugs due to repeated use of non-sterile needles;
• the fetus can become infected from a mother infected with hepatitis C;
• during sexual intercourse, the infection can also enter the body of a healthy person.

How is hepatitis C treated?

The hepatitis C virus was not in vain considered a “gentle” killer virus. It is able to not manifest itself for years, after which it suddenly shows up in the form of complications accompanied by cirrhosis or liver cancer. But more than 177 million people in the world have been diagnosed with HCV. The treatment, which was used until 2013, combining injections of interferon and ribavirin, gave patients a chance of healing that did not exceed 40-50%. And besides, it was accompanied by serious and painful side effects. The situation changed in the summer of 2013 after the US pharmaceutical giant Gilead Sciences patented the substance sofosbuvir, produced as a drug under the Sovaldi brand, which included 400 mg of the drug. It became the first direct-acting antiviral drug (DAA) designed to combat HCV. The results of clinical trials of sofosbuvir pleased physicians with the effectiveness, which, depending on the genotype, reached 85 ÷ 95%, while the duration of the course of therapy was more than halved compared to treatment with interferons and ribavirin. And, although the pharmaceutical company Gilead patented sofosbuvir, it was synthesized in 2007 by Michael Sophia, an employee of Pharmasett, subsequently acquired by Gilead Sciences. From the name of Michael, the substance he synthesized was named sofosbuvir. Michael Sophia himself, together with a group of scientists who made a number of discoveries that revealed the nature of HCV, which made it possible to create an effective drug for its treatment, received the Lasker-DeBakey Award for Clinical Medical Research. Well, almost all the profit from the sale of a new effective tool went to Gilead, which set monopoly high prices for Sovaldi. Moreover, the company protected its development with a special patent, according to which Gilead and some of its partner companies became the owners of the exclusive right to manufacture the original DAA. As a result, Gilead's profits in the first two years of marketing the drug many times overcame all the costs that the company incurred to acquire Pharmasett, obtain a patent and subsequent clinical trials.

What is Sofosbuvir?

The effectiveness of this drug in the fight against HCV was so high that now almost no therapy regimen can do without its use. Sofosbuvir is not recommended for use as monotherapy, but with complex use it shows exceptionally good results. Initially, the drug was used in combination with ribavirin and interferon, which allowed in uncomplicated cases to achieve a cure in just 12 weeks. And this despite the fact that therapy with only interferon and ribavirin was half as effective, and its duration sometimes exceeded 40 weeks. After 2013, each subsequent year brought news of the emergence of more and more new drugs that successfully fight the hepatitis C virus:

• daclatasvir appeared in 2014;
• 2015 was the birth year of ledipasvir;
• 2016 pleased with the creation of velpatasvir.

Daclatasvir was released by Bristol-Myers Squibb as Daklinza, containing 60 mg of the active ingredient. The next two substances were created by Gilead scientists, and since neither of them was suitable for monotherapy, drugs were used only in combination with sofosbuvir. To facilitate therapy, Gilead prudently released the newly created drugs immediately in combination with sofosbuvir. So there were drugs:

• Harvoni, a combination of sofosbuvir 400 mg and ledipasvir 90 mg;
• Epclusa, which included sofosbuvir 400 mg and velpatasvir 100 mg.

In therapy with daclatasvir, Sovaldi and Daklinz had to take two different drugs. Each of the paired combinations of active substances was used to treat certain HCV genotypes according to the treatment regimens recommended by EASL. And only the combination of sofosbuvir with velpatasvir turned out to be a pangenotypic (universal) remedy. Epclusa cured all hepatitis C genotypes with almost the same high efficiency of approximately 97 ÷ 100%.

The emergence of generics

Clinical trials confirmed the effectiveness of the treatment, but all these highly effective drugs had one significant drawback - too high prices that did not allow them to be purchased by the bulk of the sick. The monopoly high prices for products set by Gilead caused outrage and scandals, which forced the patent holders to make certain concessions, granting licenses to some companies from India, Egypt and Pakistan to produce analogues (generics) of such effective and popular drugs. Moreover, the fight against patent holders offering medicines for treatment at biased prices was led by India, as a country in which millions of chronic hepatitis C patients live. As a result of this struggle, Gilead issued licenses and patent developments to 11 Indian companies for the independent production of first sofosbuvir, and then its other new drugs. Having received licenses, Indian manufacturers quickly set up the production of generics, assigning their own trade names to the manufactured drugs. This is how Sovaldi generics first appeared, then Daklinza, Harvoni, Epclusa, and India became the world leader in their production. Indian manufacturers, under a license agreement, pay 7% of their earnings to the patent holders. But even with these payments, the cost of generics produced in India turned out to be ten times less than that of the originals.

Mechanisms of action

As previously reported, new HCV therapies that have emerged are classified as DAAs and act directly on the virus. Whereas previously used for treatment, interferon with ribavirin strengthened the human immune system, helping the body to resist the disease. Each of the substances acts on the virus in its own way:

1. Sofosbuvir blocks RNA polymerase, thereby inhibiting the replication of the virus.

1. Daclatasvir, ledipasvir and velpatasvir are NS5A inhibitors that interfere with the spread of viruses and their entry into healthy cells.

Such a targeted effect makes it possible to successfully fight HCV by using sofosbuvir paired with daklatasvir, ledipasvir, velpatasvir for therapy. Sometimes, to enhance the effect on the virus, a third component is added to the pair, which is most often ribavirin.

Generic manufacturers from India

The pharmaceutical companies of the country have taken advantage of the licenses granted to them, and now India produces the following Sovaldi generics:

• Hepcvir is manufactured by Cipla Ltd.;
• Hepcinat - Natco Pharma Ltd.;
• Cimivir - Biocon ltd. & Hetero Drugs Ltd.;
• MyHep is a manufacturer of Mylan Pharmaceuticals Private Ltd.;
• SoviHep - Zydus Heptiza Ltd.;
• Sofovir is the manufacturer of Hetero Drugs Ltd.;
• Resof - manufactured by Dr Reddy's Laboratories;
• Virso - Releases Strides Arcolab.

Analogues of Daklinza are also made in India:

• Natdac from Natco Pharma;
• Dacihep by Zydus Heptiza;
• Daclahep from Hetero Drugs;
• Dactovin by Strides Arcolab;
• Daclawin by Biocon ltd. & Hetero Drugs Ltd.;
• Mydacla by Mylan Pharmaceuticals.

Following Gilead, Indian drug manufacturers also mastered the production of Harvoni, resulting in the following generics:

• Ledifos - releases Hetero;
• Hepcinat LP - Natco;
• Myhep LVIR - Mylan;
• Hepcvir L - Cipla Ltd.;
• Cimivir L - Biocon ltd. & Hetero Drugs Ltd.;
• LadyHep - Zydus.

And already in 2017, the production of the following Indian generics of Epclusa was mastered:

• Velpanat was released by Natco Pharma;
• the release of Velasof was mastered by Hetero Drugs;
• SoviHep V was launched by Zydus Heptiza.

As you can see, Indian pharmaceutical companies do not lag behind American manufacturers, quickly mastering newly developed drugs, while observing all qualitative, quantitative and medicinal characteristics. Withstanding including pharmacokinetic bioequivalence in relation to the originals.

Requirements for generics

A generic drug is called a drug that, according to its main pharmacological properties, can replace the treatment with expensive original drugs with a patent. They can be released both with and without a license, only its presence makes the produced analogue licensed. In the case of issuing a license to Indian pharmaceutical companies, Gilead also provided them with the production technology, giving license holders the right to an independent pricing policy. In order for an analogue of a medicinal product to be considered a generic, it must meet a number of parameters:

1. It is necessary to observe the ratio of the most important pharmaceutical components in the preparation in terms of qualitative as well as quantitative standards.

1. Compliance with the relevant international standards should be adhered to.

1. Mandatory observance of appropriate production conditions is required.

1. The preparations should maintain an appropriate equivalent of the absorption parameters.

It is worth noting that WHO is on guard for ensuring the availability of medicines, seeking to replace expensive branded medicines with the help of budget generics.

Egyptian generics of sofosbuvir

Unlike India, Egyptian pharmaceutical companies have not become world leaders in the production of hepatitis C generics, although they have also mastered the production of sofosbuvir analogues. True, for the most part, the analogues they produce are unlicensed:

• MPI Viropack, manufactures Marcyrl Pharmaceutical Industries, one of the earliest Egyptian generics;

• Heterosofir is manufactured by Pharmed Healthcare. Is the only licensed generic in Egypt. On the packaging, under the hologram, there is a hidden code that allows you to check the originality of the drug on the manufacturer's website, thereby eliminating its fake;

• Grateziano, manufactured by Pharco Pharmaceuticals;

• Sofolanork, produced by Vimeo;

• Sofocivir manufactured by ZetaPhar.

Hepatitis Generics from Bangladesh

Bangladesh is another country with a large production of generic HCV drugs. Moreover, this country does not even require licenses for the production of analogues of branded medicines, since until 2030 its pharmaceutical companies are allowed to produce such medicines without the appropriate license documents. The most famous and equipped with the latest technology is the pharmaceutical company Beacon Pharmaceuticals Ltd. The design of its production facilities was created by European specialists and meets international standards. Beacon markets the following generics for the treatment of hepatitis C virus:

• Soforal is a generic sofosbuvir containing 400 mg of active ingredient. Unlike traditional packs in bottles of 28 pieces, Soforal is produced in the form of blisters of 8 tablets in one plate;
• Daclavir is a generic of daclatasvir, one tablet of the drug contains 60 mg of the active ingredient. It is also released in the form of blisters, but each plate contains 10 tablets;
• Sofosvel is a generic Epclusa containing sofosbuvir 400mg and velpatasvir 100mg. Pangenotypic (universal) drug, effective in the treatment of HCV genotypes 1 ÷ 6. And in this case, there is no usual packaging in vials, the tablets are packed in blisters of 6 pieces in each plate.
• Darvoni is a complex drug that combines sofosbuvir 400 mg and daclatasvir 60 mg. If it is necessary to combine sofosbuvir therapy with daklatasvir, using drugs from other manufacturers, it is necessary to take a tablet of each type. And Beacon combined them into one pill. Packed Darvoni in blisters of 6 tablets in one plate, sent only for export.

When buying drugs from Beacon based on a course of therapy, you should take into account the originality of their packaging in order to purchase the amount necessary for treatment. The most famous Indian pharmaceutical companies As mentioned above, after obtaining licenses for the production of generic drugs for HCV therapy by the country's pharmaceutical companies, India has become a world leader in their production. But among the many companies, it is worth noting a few whose products are most famous in Russia.

Natco Pharma Ltd.

The most popular pharmaceutical company is Natco Pharma Ltd., whose drugs have saved the lives of several tens of thousands of patients with chronic hepatitis C. It has mastered the production of almost the entire line of direct-acting antiviral drugs, including sofosbuvir with daclatasvir and ledipasvir with velpatasvir. Natco Pharma appeared in 1981 in the city of Hyderabad with an initial capital of 3.3 million rupees, then the number of employees was 20 people. Natco currently employs 3,500 people in India at five Natco enterprises, and there are still branches in other countries. In addition to production units, the company has well-equipped laboratories that allow developing modern medicines. Among her own developments, it is worth noting drugs to combat cancer. One of the most famous drugs in this area is Veenat, produced since 2003 and used for leukemia. Yes, and the release of generics for the treatment of hepatitis C virus is a priority for Natco.

Hetero Drugs Ltd.

This company has set as its goal the production of generics, subordinating its own production network to this desire, including factories with affiliates and offices with laboratories. The production network of Hetero is focused on the production of medicines under licenses received by the company. One of its areas of activity is medicines that allow you to fight serious viral diseases, the treatment of which for many patients has become impossible due to the high cost of original drugs. The acquired license allows Hetero to quickly start producing generics, which are then sold at an affordable price for patients. The creation of Hetero Drugs dates back to 1993. Over the past 24 years, a dozen factories and several dozen production units have appeared in India. The presence of its own laboratories allows the company to carry out experimental work on the synthesis of substances, which contributed to the expansion of the production base and the active export of drugs to foreign countries.

Zydus Heptiza

Zydus is an Indian company with a vision to create a healthy society, which, according to its owners, will be followed by a change in the quality of life for people. The goal is noble, and therefore, to achieve it, the company conducts active educational activities that affect the poorest segments of the country's population. Including through free vaccination of the population against hepatitis B. Zidus is in fourth place in terms of output in the Indian pharmaceutical market. In addition, 16 of its drugs were included in the list of 300 essential medicines of the Indian pharmaceutical industry. Zydus products are in demand not only in the domestic market, they can be found in pharmacies in 43 countries of our planet. And the assortment of drugs produced at 7 enterprises exceeds 850 drugs. One of its most powerful productions is located in the state of Gujarat and is one of the largest not only in India, but also in Asia.

HCV Therapy 2017

Treatment regimens for hepatitis C for each patient are selected by the doctor individually. For the correct, effective and safe selection of the scheme, the doctor needs to know:

• virus genotype;
• the duration of the illness;
• the degree of liver damage;
• presence / absence of cirrhosis, concomitant infection (for example, HIV or other hepatitis), negative experience of previous treatment.

Having received this data after a cycle of tests, the doctor, based on the recommendations of EASL, chooses the best therapy option. The EASL recommendations are adjusted from year to year, new drugs are added to them. Before recommending new therapy options, they are submitted to Congress or a special meeting for consideration. In 2017, a special EASL meeting in Paris considered updates to the recommended schemes. The decision was made to completely discontinue the use of interferon therapy in the treatment of HCV in Europe. In addition, there is not a single recommended regimen using a single direct-acting drug. Here are some recommended treatment options. All of them are given for informational purposes only and cannot become a guide to action, since only a doctor can prescribe therapy, under whose supervision it will then take place.

1. Possible treatment regimens proposed by EASL in the case of hepatitis C monoinfection or co-infection with HIV + HCV in patients without cirrhosis and not previously treated:

• for treatment genotypes 1a and 1b can be used:

- sofosbuvir + ledipasvir, without ribavirin, duration 12 weeks; - sofosbuvir + daclatasvir, also without ribavirin, treatment period 12 weeks; - or sofosbuvir + velpatasvir without ribavirin, course duration 12 weeks.

• in therapy genotype 2 used without ribavirin for 12 weeks:

- sofosbuvir + dklatasvir; - or sofosbuvir + velpatasvir.

• during treatment genotype 3 without the use of ribavirin for a period of therapy of 12 weeks, use:

- sofosbuvir + daclatasvir; - or sofosbuvir + velpatasvir.

• in therapy genotype 4 you can use without ribavirin for 12 weeks:

- sofosbuvir + ledipasvir; - sofosbuvir + daclatasvir; - or sofosbuvir + velpatasvir.

1. EASL recommended treatment regimens for hepatitis C monoinfection or co-infection with HIV/HCV in previously untreated patients with compensated cirrhosis:

• for treatment genotypes 1a and 1b can be used:

- sofosbuvir + ledipasvir with ribavirin, duration 12 weeks; - or 24 weeks without ribavirin; - and another option - 24 weeks with ribavirin with an unfavorable response prognosis; - sofosbuvir + daclatasvir, if without ribavirin, then 24 weeks, and with ribavirin, the treatment period is 12 weeks; - or sofosbuvir + velpatasvir without ribavirin, 12 weeks.

• in therapy genotype 2 apply:

- sofosbuvir + dklatasvir without ribavirin, the duration is 12 weeks, and with ribavirin, with an unfavorable prognosis, 24 weeks; - or sofosbuvir + velpatasvir without combination with ribavirin for 12 weeks.

• during treatment genotype 3 use:

- sofosbuvir + daclatasvir for 24 weeks with ribavirin; - or sofosbuvir + velpatasvir again with ribavirin, treatment duration 12 weeks; - as an option, sofosbuvir + velpatasvir is possible for 24 weeks, but already without ribavirin.

• in therapy genotype 4 apply the same schemes as for genotypes 1a and 1b.

As you can see, the result of therapy is influenced, in addition to the patient's condition and the characteristics of his body, also by the combination of prescribed drugs chosen by the doctor. In addition, the duration of treatment depends on the combination chosen by the physician.

Treatment with modern HCV drugs

Take tablets of drugs of direct antiviral action as prescribed by a doctor orally once a day. They are not divided into parts, they are not chewed, but they are washed down with plain water. It is best to do this at the same time, so that a constant concentration of active substances in the body is maintained. It is not required to be tied to the timing of food intake, the main thing is not to do it on an empty stomach. Starting to take drugs, pay attention to how you feel, since during this period it is easiest to notice possible side effects. The DAAs themselves do not have a lot of them, but the drugs prescribed in the complex have much less. The most common side effects are:

• headaches;
• vomiting and dizziness;
• general weakness;
• loss of appetite;
• pain in the joints;
• a change in the biochemical parameters of the blood, expressed in a low level of hemoglobin, a decrease in platelets and lymphocytes.

Side effects are possible in a small number of patients. But all the same, all noticed ailments should be reported to the attending physician so that he can take the necessary measures. In order to avoid an increase in side effects, alcohol and nicotine should be excluded from consumption, as they have a harmful effect on the liver.

Contraindications

In some cases, taking DAAs is excluded, this applies to:

• individual hypersensitivity of patients to certain ingredients of medicines;

• patients under the age of 18, as there is no accurate data on their effects on the body;

• women who are pregnant and breastfeeding babies;

• women should use reliable methods of contraception to avoid conception during the period of therapy. Moreover, this requirement also applies to women whose partners are also undergoing DAA therapy.

Storage

Store antiviral drugs of direct action in places inaccessible to children and direct sunlight. The storage temperature should be in the range of 15 ÷ 30ºС. When you start taking medications, check their manufacturing and shelf life indicated on the package. Expired drugs should not be taken. How to buy DAAs for residents of Russia Unfortunately, it will not be possible to find Indian generics in Russian pharmacies. The pharmaceutical company Gilead, having granted licenses for the production of drugs, prudently banned their export to many countries. Including all European countries. Those who wish to purchase budget Indian generics for the fight against hepatitis C can use several ways:

• order them through Russian online pharmacies and receive the goods in a few hours (or days) depending on the place of delivery. Moreover, in most cases, even an advance payment is not required;
• order them through Indian online stores with home delivery. Here you will need an advance payment in foreign currency, and the waiting time will last from three weeks to a month. Plus, the need to communicate with the seller in English will be added;
• go to India and bring the drug yourself. This will also take time, plus the language barrier, plus the difficulty of verifying the originality of the goods purchased at the pharmacy. To everything else, the problem of self-exportation will be added, requiring a thermal container, a doctor's report and a prescription in English, as well as a copy of the receipt.

People interested in purchasing medicines decide for themselves which of the possible delivery options to choose. Just do not forget that in the case of HCV, a favorable outcome of therapy depends on the speed of its initiation. Here, in the literal sense, the delay of death is similar, and therefore you should not delay the beginning of the procedure. Discipline presentation
"Infectious diseases with a course of HIV infection and epidemiology"
on the topic: "Viral hepatitis B, C, D".
2013

VIRAL HEPATITIS

Group of anthroponotic viral diseases,
united mainly by hepatotropy
pathogens and leading clinical manifestations:
1) liver damage with the development of general toxic
syndrome,
2) hepatosplenomegaly,
3) impaired liver function and the appearance of jaundice.

The structure of the liver

Liver functions

Chronic viral hepatitis (parenteral hepatitis)

Chronic viral hepatitis
(CVH) is a chronic inflammation
liver caused by hepatotropic
viruses, continuing without a trend
improvement for at least 6 months.
The vast majority of cases of CVD
caused by hepatitis B, C and D viruses.

Viral hepatitis B

Hepatitis B is one of the most
common infections. In the world
are approximately 300-500 million.
patients with chronic hepatitis B.
to regions with high
prevalence (10-20%) include
South Asia, China, Indonesia, countries
tropical africa, pacific islands
ocean, Alaska.

Etiology

The causative agent of HBV infection is a DNA virus
from the Hepadnaviridae family.
The HBV genome is incomplete
double-stranded circular DNA molecule.
There are 9 genotypes of the virus (from A to H).
The virus is stable in the environment.

Epidemiology

Source: sick person.
Infection mechanism:
1) parenteral
2) sexual
3) vertical
4) straight
The main route of transmission is parenteral
(injection, blood transfusion), as well as through
damaged mucous membranes and skin.
Natural susceptibility is high. For hepatitis
B is characterized by high contagiousness, infection
possible in case of contact with broken skin or
mucous membranes are negligible
infected material (0.0001 ml of blood).

Risk group

Persons with multiple sexual partners
(prostitutes).
Men practicing homosexual contacts.
Sexual partners of infected individuals.
Persons who inject drugs.
Family members of a patient with chronic hepatitis B.
Children born to infected mothers.
Honey. workers.
Patients on hemodialysis ("artificial kidney") or
receiving frequent blood transfusions.

Pathogenesis

The virus enters the human body, then
disseminates hematogenously to the liver
fixed on hepatocytes due to
surface receptors containing HBsAg.
In this case, the pathogen does not directly
cytopathic effect on liver cells.
Virions multiply and
antigens. dystrophic and
necrobiotic changes in hepatocytes,
focal necrosis occurs, and in severe cases
massive necrosis in the liver parenchyma.

Viral Hepatitis B Clinic

The duration of the incubation period is from 30 to 180 days (usually 2-3 months).
There are the following variants of the clinical course of viral hepatitis B:
A. According to the cyclical flow:
I. Cyclic forms:
1. Acute hepatitis B - asymptomatic (inapparent and subclinical), anicteric, icteric
(with a predominance of cytolysis or cholestasis);
2. Acute HB with cholestatic syndrome.
II. Persistent forms:
1. Carriage of HBV - chronic asymptomatic form (carriage of HBsAg and other
virus antigens)
2. Chronic viral hepatitis B, integrative phase.
III. progressive forms:
1. Fulminant (fulminant) hepatitis;
2. Subacute hepatitis;
3. Chronic viral hepatitis B, replicative phase (including with cirrhosis of the liver).
IV. Viral hepatitis B, acute or chronic mixed, in combination with viral hepatitis
A, C, D, E, G.
B. According to the severity of the disease: mild, moderate, severe.

Viral Hepatitis B Clinic

Preicteric period (prodromal):
lasts 3-15 days. and is characterized by symptoms
intoxication (fever, general weakness, lethargy,
apathy, irritability, sleep disturbance, decreased
appetite), arthralgia, pain in the right hypochondrium.
In some cases, a skin rash is observed. AT
the last 1-2 days of the period occur
discoloration of feces and darkening of urine.

Viral Hepatitis B Clinic

The icteric period lasts from 10-14 to 3040 days. icteric staining at first
appears on the mucous membranes, then on the skin.
Symptoms of intoxication after the onset of jaundice
usually intensify. Liver and spleen (in 30-50%
cases) are increasing. There is bradycardia
decrease in blood pressure, weakening of cardiac tones. At
severe forms develop CNS depression
varying degrees of severity, dyspeptic,
hemorrhagic syndromes.

Viral Hepatitis B Clinic

The recovery period begins
after the disappearance of jaundice and
ends after complete clinical and laboratory resolution of the disease, which
usually occurs 3 months after
its beginning.

Viral hepatitis C

Hepatitis C is the most common form
chronic liver disease in
most European countries and
North America.

Etiology

The causative agent of HCV infection is an RNA-containing virus from the family
Flaviviridae. The genome of the virus is formed
single stranded RNA. HCV genetically
heterogeneous: there are 6 main
genotypes (1-6) and at least 50 subtypes.

Epidemiology

According to the WHO, there are no
less than 170 million infected with HCV.
The prevalence of HCV infections is also
varies greatly in different regions,
averaging 0.5 - 2% (up to 6.5% in
tropical African countries). HCV-
infection causes approximately 40
% of cases of chronic liver pathology.
The total number of HCV-infected in
Russia - 1 million 700 thousand people.

Epidemiology

The source of infection is a sick person or a virus carrier.
Infection mechanism:
1) parenteral
2) sexual
3) vertical
4) straight
Transmission routes:
1) when transfusing contaminated blood and blood products and when
organ transplant;
2) with injections with contaminated syringes and injection injuries
needle in medical institutions;
3) when using injection drugs;
4) a newborn child from an infected with hepatitis C
mother.

Pathogenesis

The virus enters the body in the same way as the virus
hepatitis B. Having tropism for hepatocytes,
the virus has a direct effect on them
cytopathic action. Due to
genetic heterogeneity of the hepatitis virus
C it has many antigenic variants,
which makes it difficult to implement adequate
immune response. virus particles
enter the cells of the macrophage system
organism and cause a certain reaction
on their part, aimed at eliminating
virus.

Pathogenesis

Due to the fact that the antigenic composition of the viral
particles are similar to the antigenic composition of hepatocytes,
and on the surface of hepatocytes there are also
fragments of viral particles synthesized on
viral RNA for subsequent assembly into a virus, then
there is an autoimmune mechanism
hepatocyte damage. In addition, not
the direct mutagenic effect of the virus is also excluded
hepatitis C on macrophages, changing their properties
so that they become able to react with
HLA histocompatibility antigens and
give rise to an autoimmune reaction.

Clinic of viral hepatitis C

From the moment of infection to clinical manifestations
takes from 2-3 weeks to 6-12 months.
In the case of an acute onset of the disease, the initial period
lasts 2-3 weeks, accompanied by joint pain,
fatigue, weakness, indigestion.
Rise in temperature is rare. jaundice as well
little characteristic. Acute hepatitis C is diagnosed very
rarely and more often by chance.
After the acute phase of the disease, a person may
recover, the disease can become chronic
form or virus carrier. In most patients
(in 70–80% of cases) a chronic course develops.
The transition of acute hepatitis C to chronic occurs
gradually: increases over several years
damage to liver cells, fibrosis develops. Function
liver at the same time can be stored for a long time. BUT
first symptoms (jaundice, abdominal enlargement,
spider veins on the skin of the abdomen, growth
weakness) may appear already with cirrhosis of the liver.

Viral hepatitis D

Hepatitis D (hepatitis delta) - viral
anthroponotic infection with parenteral
infection mechanism for which
characteristically inflammatory
liver.

Etiology

The disease is caused by an incomplete RNA virus (HDV, δ-virus), for expression
which requires HBV with genome size
19 nm. Belongs to the Deltavirus family.

Epidemiology

Reservoir and source of pathogen - human,
sick or carrier. In distribution
of the virus, persons with
chronic forms of viral hepatitis B,
co-infected with the virus
hepatitis D. Period of contagiousness of sources
infection indefinitely, but sick
most dangerous in the acute period of the disease.
Infection mechanism:
1) parenteral
2) sexual
3) vertical

Epidemiology

The risk of infection is especially high for permanent recipients.
donated blood or its preparations, for persons exposed to frequent
parenteral interventions, as well as for drug addicts introducing
intravenous drugs.
Transplacental transmission of hepatitis D is possible from
pregnant fetus.
High incidence of infection among persons leading
promiscuous sex life (especially among homosexual men), gives reason to believe that sexual intercourse is also possible
route of infection.
Natural susceptibility is high. to viral hepatitis D
all persons with viral hepatitis D are susceptible or
carriers of viral hepatitis B. Most likely
development of viral hepatitis D in chronic carriers of HBsAg.
Particularly susceptible population in areas hyperendemic
for viral hepatitis B. Severe forms of the disease can occur
even in children.

Pathogenesis

The causative agent is integrated into the genome of the hepatitis B virus, affecting
on its synthesis and enhancing the replication of the latter. The disease can
manifest as co-infection with simultaneous infection with viruses
viral hepatitis B and viral hepatitis D and superinfection in those cases
when the hepatitis D virus enters the human body, previously
infected with the viral hepatitis B virus. Replication of the viral hepatitis B virus
hepatitis D occurs in liver cells.
Pathologically, viral hepatitis D has no specific
features that distinguish it from viral hepatitis B, and is characterized by
a pronounced picture of necrosis, which prevails over inflammatory
reaction. In hepatocytes, massive necrosis and small droplet
obesity. The interaction of viral hepatitis B viruses and viral
hepatitis D aggravates the pathological process and leads to the development of acute
liver failure or chronicity.

Viral Hepatitis D Clinic

incubation period. Similar to that for
viral hepatitis B. In cases of coinfection
the clinical course of the disease is similar
clinical manifestations of viral hepatitis B, but with
the predominance of heavy currents. With superinfection
observed a sharp aggravation of the course of the viral
hepatitis B with severe insufficiency of function
liver and the development of a large number of chronic forms,
leading to the rapid formation of cirrhosis of the liver.

1. Dyspeptic syndrome is associated with
impaired detoxification function
liver, concomitant pathology of the duodenum and pancreas.
2. Asthenic syndrome (weakness,
fatigue, decreased performance,
irritability) is expressed in greater or
to a lesser extent in patients with HCV.

Clinical manifestations of chronic viral hepatitis

Signs of liver damage:
enlargement, hardening and soreness of the liver;
jaundice;
telangiectasia and palmar erythema (due to
an increase in estrogen levels and
sensitivity of vascular receptors
portal hypertension (ascites, splenomegaly,
varicose veins of the esophagus) appear and
progressive signs of liver failure.
amenorrhea, gynecomastia, decreased libido
associated with impaired metabolism of sex hormones in
liver (usually in the stage of cirrhosis).

Diagnostics

1. Epidemiological history data
(indications for parenteral
interventions, patient contact,
intravenous drug use in
terms corresponding to the incubation
period).
2. Clinical examination (identification
characteristic cyclicity of the disease and
clinical and biochemical syndromes).

Laboratory research

Mandatory examination methods:
KLA: possible ESR, leukopenia,
lymphocytosis, with fulminant form of AVH
- leukocytosis.
OAM: with AVH and exacerbation of CVH
possible appearance of bile pigments
(mainly direct bilirubin),
urobilin.

Laboratory research

Blood chemistry:
- cytolysis syndrome: increased content of ALT, AST;
- cholestasis syndrome: increased content of total
bilirubin, cholesterol, alkaline phosphatase, γ-glutamyl transpeptidase, usually observed with
jaundice;
- mesenchymal inflammation syndrome: increased
the content of immunoglobulins, increased thymol
samples, reduction of sublimate samples;
- syndrome of hepatocellular insufficiency:
decrease in prothrombin index, concentration
serum albumin, cholesterol, total
bilirubin: detected in severe forms of CVH.

Markers:
Hepatitis B virus:
HBsAg is detected 1-10 weeks after
infection, its occurrence precedes
development of clinical symptoms and
increased activity of ALT / AST. At
adequate immune response, it disappears
4-6 months after infection
HBeAg indicates viral replication in
hepatocytes; found in serum
almost simultaneously with HBsAg;
Anti-HBe (AT to e-Ag) in complex with anti-HBc
IgG and anti-HBs indicate complete
completion of the infectious process.

Anti-HBc (AT to nuclear Ag) is an important
diagnostic marker of infection. AntiHBc IgM is one of the earliest serum
markers of CHBV and a sensitive marker of HBV infection. Indicates virus replication and
process activity in the liver; his disappearance
serves as an indicator of either sanitation of the body from
pathogen, or the development of an integrative phase
HBV infections.
Anti-HBc IgG persist for many years;
indicate an existing or previously
transferred infection.
HBV-DNA and DNA polymerase - diagnostic
viral replication markers.

Hepatitis C virus:
HCV RNA is the earliest biochemical marker
infection, occurs within a few days to 8
weeks after infection. In cases
recovery from OVGS, viral RNA disappears from
blood within 12 weeks after the appearance of the first
symptoms.
Anti-HCV is determined in the blood no earlier than after 8
weeks after infection. It is present in the blood
in approximately half of patients with clinical
manifest OVGS at the onset of the disease. At
subclinical AT infections usually appear
much later.
Hepatitis D virus: anti-HDV IgM, HDV RNA (marker
HDV replication).

Additional examination methods:

Fecal analysis: decrease in content or
lack of stercobilin due to discontinuation
the flow of bile into the intestines; appearance
stercobilin in feces during the icteric period
OVG - evidence of resolution of jaundice.
The concentration in the blood of α-fetoprotein
(screening for hepatocellular carcinoma).
This research needs to be done in
dynamics.

Instrumental Research

Required Methods
examinations:
Ultrasound of the liver and spleen:
characterized by an increase in echogenicity
parenchyma, seals along the way
vessels of the liver;
A liver biopsy is needed for
assessment of the degree of liver damage.
Additional Methods
examinations:
CT scan of the abdominal organs;
FEGDS.

Treatment

1. Patients with viral hepatitis are subject to mandatory
hospitalization in an infectious diseases hospital (department,
hospital).
2. Long term, possibly lifelong diet
mode (table number 5).
Acute viral hepatitis: treatment is predominantly
symptomatic - detoxification infusion
therapy, enterosorbents, ursodeoxycholic acid in
severe cholestasis, in severe cases - GCS.
Specific antiviral therapy is indicated for
OVGS. Interferon alfa is usually used at 3 million
IU subcutaneously for 12-24 weeks in combination with
ribavirin, which can significantly reduce the risk
development of HCV.

Treatment

Chronic viral hepatitis B:
- Interferon alfa at a dose of 5 million IU / day subcutaneously or 10 million IU
3 times a week for 4-6 months.
- Peginterferon alfa-2a (PEGASYS) dose 180 mcg, subcutaneously 1
once a week. The duration of treatment is 1 year.
-Lamivudine is prescribed at 100 mg/day orally.
The duration of the course of treatment is 1 year.
Chronic viral hepatitis C:
Usually combined therapy is carried out:
- peginterferon alfa-2a 180 mcg/kg subcutaneously once a week with
ribavirin or peginterferon alfa-2b 1.5 mcg/kg subcutaneously
once a week with ribavirin, the dosage of which depends on
body weight.
Monotherapy with peginterferon alfa-2a or alfa-2b is carried out
in the presence of contraindications to taking ribavirin.

Treatment

Chronic viral hepatitis D:
treatment of chronic hepatitis D
currently remains unresolved.
problem. It is recommended to use
interferon-alpha in high doses (9-10
million IU subcutaneously every other day for not
less than 48 weeks), however, the effectiveness of such
therapy is quite low.

Prevention

1. Non-specific prophylaxis:
a) hygiene, personal and public;
b) if there is a threat of infection, use individual means
protection, disinfection and sterilization
medical instruments;
c) hospitalization and treatment of chronic patients,
infected with hepatitis B C D viruses or their combinations,
separately from other patients;
d) cultural and educational work with the population;
e) because the likelihood of infection and development of the virus is significantly
least depends on the initial state of the organism, then as
prevention, we can consider measures that heal and
strengthening their own immune defenses, including
phytohealth (immunomodulatory preparations and
adaptogens).

Prevention

2. Specific prevention:
Specific prevention of viral hepatitis
divided into prevention before infection and prevention
after potential infection.
Specific prophylaxis before infection today
performed only for hepatitis B. Method
immunization with hepatitis B vaccine
all workers).
A vaccine against the hepatitis C virus is being developed.
Specific prophylaxis after possible
infection is an urgent appointment
antiviral drugs in combination with
interferon.

Clinical examination

At least 1 year.
Regular check-ups of patients with
obligatory determination in the blood
main biochemical indicators:
bilirubin, protein and its fractions,
activity of aminotransferases, prothrombin,
HBsAg markers. The base or
other treatment options.

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Slides captions:

Hepatitis B

What is hepatitis B? Hepatitis B is a dangerous infection caused by the hepatitis B virus that affects the liver Chronic or long-term hepatitis B infection can lead to severe liver damage, cirrhosis (scarring of the liver) and hepatocellular carcinoma (liver cancer)

Hepatitis B information Hepatitis B is a global health problem 350-400 million people worldwide are infected with chronic hepatitis B virus despite the availability of a vaccine Hepatitis B has an infection rate 100 times higher than that of human immunodeficiency virus (HIV) ranked among the most common causes of death worldwide

How is hepatitis B transmitted? Hepatitis B is a highly contagious disease that is transmitted through contact with the body fluids of an infected person: Direct contact of an infected person's blood with the blood of an uninfected person Unprotected sexual contact Use of unsterile needles From an infected mother to her baby during childbirth Other routes of transmission: Sharing such items with an infected person like a razor, toothbrush, earrings Piercing, tattooing, and acupuncture with non-sterile needles Hepatitis is not transmitted by accident, that is, by sneezing, coughing, or eating food prepared by a person who is infected with the hepatitis B virus (HBV)

Who is at risk of contracting hepatitis B? Family members of a person who carries the hepatitis B virus People with multiple sex partners Children born to infected mothers Adopted children from countries with a high prevalence of hepatitis B Health and safety workers People who inject drugs Tourists who have visited areas with a high prevalence of hepatitis B Immigrants from countries with a high prevalence of hepatitis B People with tattoos and piercings

STAGES OF THE DISEASE After the hepatitis B virus enters the body, the disease successively passes through several stages: infection, incubation period, acute and finally chronic hepatitis. It should be noted that not all infected people develop acute hepatitis or the disease becomes chronic. The incubation period - the disease cannot be detected even with the help of blood tests. Acute hepatitis B Symptoms of acute hepatitis are malaise, weakness, nausea, joint pain, fever, jaundice. They may not be pronounced or absent at all, there may not be jaundice, so the acute phase of hepatitis is not always diagnosed. During this period, the DNA of the virus is detected in the tests, indicators of the acute phase of the infection (virus antigens and some antibodies), liver enzymes are significantly increased.

Chronic infection with the hepatitis B virus can last for years. Its most severe consequences are the formation of cirrhosis and liver cancer. It should be remembered that chronic HBV infection is a dynamic process. It is distinguished by a relatively rapid change in the stages of the disease. In this regard, constant monitoring of laboratory and clinical parameters is required. Can the body deal with hepatitis on its own? Yes. But only with acute hepatitis. If hepatitis has become chronic, you will not be able to recover on your own - you definitely need the help of a doctor. Why does hepatitis become chronic? It depends on the characteristics of the body, the strength of the immune system and the amount of virus that has entered the body. When the immune system cannot cope with the infection, hepatitis becomes chronic, that is, permanent.

Who is at risk for developing chronic hepatitis B? The risk of developing chronic infection depends on the person's age at the time of infection with the hepatitis B virus In 90-95% of patients who become infected with the hepatitis B virus in adulthood, the symptoms of the disease disappear on their own, biochemical tests become normal, and protective immunity develops In 90% of children infected with the virus hepatitis B infection will develop chronic hepatitis B infection 50% of young children who become infected with the hepatitis B virus between the ages of 1 and 5 years will develop a chronic infection

Global impact of hepatitis B World population 6 billion 2 billion people with evidence of HBV infection 350–400 million people with chronic hepatitis B (CHB) 15–40% (75–160 million) die of cirrhosis (scarring of the liver) or liver cancer 3

Surveillance and control Vaccination Hepatitis B is a disease that can be prevented by vaccination. Vaccination is the most effective way to prevent HBV transmission More than 1 billion people have been vaccinated worldwide Taking the initiative to get tested is the first step towards a healthy future

Who should get vaccinated? Hepatitis B vaccination is for everyone. Groups of persons who must be vaccinated against hepatitis B: newborns; adolescent children; persons whose family members are infected with hepatitis B; patients who often receive drugs intravenously; people who frequently change sexual partners (more than one in 6 months); men who have homosexual contacts; medical workers; patients receiving hemodialysis.

Surveillance and control Surveillance Established recommendations will help direct treatment based on the results of tests for the presence of HBV in the body In general, patients with chronic hepatitis B are examined AT LEAST every 6-12 months Lifestyle criteria for preventing infection People infected with HBV should follow a few rules to reduce the risk of passing the infection to other people. Infected people should not share razors, toothbrushes, or anything else that can become contagious from blood HBV virus can survive for more than a week in dried blood Infected people should always use appropriate condoms when having sex Infected people should not donate blood or organs

Facts about chronic hepatitis B Hepatitis B is a serious and highly contagious disease Anyone who carries the hepatitis B virus can infect others With active treatment, the effects of hepatitis B can be reversed or at least slowed down.

THANK YOU FOR YOUR ATTENTION! BE HEALTHY!

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Presentation on the topic: Hepatitis B

slide number 1

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What is hepatitis B? Hepatitis B is a dangerous infection caused by the hepatitis B virus that affects the liver Chronic or long-term hepatitis B infection can lead to severe liver damage, cirrhosis (scarring of the liver) and hepatocellular carcinoma (liver cancer) There is no cure for hepatitis B, but treatment prescribed by your doctor may slow liver damage 1. World Health Organization Fact Sheet/204. Hepatitis B. Geneva: World Health Organization; 2000. (WHO Fact Sheets, available at www.who.int Accessed July 26 2005); 2. Lavanchy D. Hepatitis B virus epidemiology, disease burden, treatment, and current and emerging prevention and control measures. J Viral Hepat 2004;11:97-107.

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Hepatitis B information Hepatitis B is a global health problem 350-400 million people worldwide are infected with chronic hepatitis B virus despite the availability of a vaccine Hepatitis B has an infection rate 100 times higher than that of human immunodeficiency virus (HIV) place among the most common causes of death worldwide 1. World Health Organization Fact Sheet/204. Hepatitis B. Geneva: World Health Organization; 2000. (WHO Fact Sheets, available at www.who.int Accessed July 26 2005); 2. Lee W.M. Hepatitis B virus infection. N Engl J Med 1997;337(24):1733-45.; 3. Lin KW, Kirchner JT. Hepatitis B. Am Fam Physician 2004;69:75-82.; 4. Lavanchy D. Hepatitis B virus epidemiology, disease burden, treatment, and current and emerging prevention and control measures. J Viral Hepat 2004;11:97-107.

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Hepatitis B is a highly contagious disease that is transmitted through contact with the body fluids of an infected person: Direct contact of an infected person's blood with the blood of an uninfected person Unprotected sexual contact Use of unsterile needles From an infected mother to her baby during childbirth Other routes of transmission: Sharing such items with an infected person , like a razor, toothbrush, earrings Piercing, tattooing, and acupuncture with non-sterile needles Hepatitis is not transmitted by accident, that is, by sneezing, coughing, or eating food prepared by a person who is infected with hepatitis B virus (HBV) How is hepatitis B transmitted? 1. World Health Organization Fact Sheet/204. Hepatitis B. Geneva: World Health Organization; 2000. (WHO Fact Sheets, available at www.who.int Accessed July 26 2005); 2. Lin KW, Kirchner JT. Hepatitis B. Am Fam Physician 2004;69:75-82.; 3. Hepatitis B: Out of the Shadows. The Foundation for Liver Research. Gilead Sciences Ltd., October 2004.; 4. Previsani N, Lavanchy D. Hepatitis B. Report from the World Health Organization, 2002. (Available at www.who.int/emc)

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Who is at risk of contracting hepatitis B? Family members of a person who carries the hepatitis B virus People with multiple sex partners Children born to infected mothers Adopted children from countries with a high prevalence of hepatitis B Health and safety workers People who inject drugs Tourists who have visited areas with a high prevalence of hepatitis B Immigrants from countries with a high prevalence of hepatitis B People with tattoos and piercings 1. Hepatitis B: Out of the Shadows. The Foundation for Liver Research. Gilead Sciences Ltd., October 2004.; 2. Previsani N, Lavanchy D. Hepatitis B. Report from the World Health Organization, 2002. (Available at www.who.int/emc)

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What are the symptoms of hepatitis B? Common symptoms include: Fever, fatigue, muscle or joint pain Loss of appetite Mild nausea and vomiting Less common but serious symptoms that require immediate medical attention: Severe nausea and vomiting Eyes and skin turn yellow (jaundice) Bloating 1 Hepatitis B: Out of the Shadows. The Foundation for Liver Research. Gilead Sciences Ltd., October 2004.; 2. Lin KW, Kirchner JT. Hepatitis B. Am Fam Physician 2004;69:75-82.

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The global impact of hepatitis B World population 6 billion 2 billion people with evidence of HBV infection 350–400 million people with chronic hepatitis B (CHB) 15–40% (75–160 million) die of cirrhosis (scarring of the liver) or liver cancer3 1. World Health Organization Fact Sheet/204. Hepatitis B. Geneva: World Health Organization; 2000. (WHO Fact Sheets, available at www.who.int Accessed July 26 2005); 2. Lee W.M. Hepatitis B virus infection. N Engl J Med 1997;337(24):1733-45.; 3. Lok AS. Chronic hepatitis B. N Engl J Med 2002; 346:1682–1683.; 4. Conjeevaram HS, Lok AS. Management of chronic hepatitis B. J Hepatol 2003; 38:S90–S103.

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Surveillance and control Surveillance Established recommendations will help direct treatment based on the results of tests for the presence of HBV in the body In general, patients with chronic hepatitis B are examined AT LEAST every 6-12 months Lifestyle criteria for preventing infection People infected with HBV should follow a few rules to reduce the risk of passing the infection to other people. Infected people should not share razors, toothbrushes or anything else that can become contagious from blood HBV virus can survive for more than a week in dried blood Infected people should always use appropriate condoms for intercourse and cunnilingus or fellatio Infected people should not donate blood or organs

Description of the slide:

Surveillance and control High-risk groups need vaccination Health care workers People who inject drugs People who frequently change sexual partners Children born to mothers with CHB Sexual contact with people with CHB People attending health facilities or disability centers Patients on artificial kidney

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Prevention HBV prevention is the world's highest priority Immunization is the most effective way to prevent HBV infection and its consequences Hepatitis B immunoglobulin (HBV) is an immediate immunization that protects against HBV if given within 48 hours of possible infection. However, this is an expensive procedure and lasts about 3–6 months HBV in children Prevention of HBV transmission in early childhood is very important Chronic HBV infection and chronic liver disease are likely to occur in children under 5 years of age