Which genotype of hepatitis C is the mildest? Carrying out genotyping of hepatitis C and which genotype is the most dangerous? Treatment of hepatitis C

Date: 05/30/2019
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Scientists have identified the following genotypes of hepatitis C: 1a, 1b, 1c, 2a, 2b, 2c, 3a, 3b, 4a, 4b, 4c, 4d, 4e, 5a, 6a, 7a, 7b, 8a, 8b, 9a, 10a, 11a . Hepatitis is an acute or chronic inflammation of the liver of various origins:

viral hepatitis (A, B, C, D, E, F, G);
toxic (alcohol, medicinal, poisoning with toxic chemicals);
ray;
hepatitis in autoimmune diseases.

General information about the virus

Hepatitis C virus is characterized as a systemic HCV infection. Since the virus in question is constantly mutating, changing its genetic structure, the body is not able to develop antibodies to it. There is no vaccine against hepatitis C. In 15-20% of cases of infection, the immune system copes with the virus on its own. Hepatitis C (HCV) can cause cirrhosis and liver cancer.

Liver diseases are asymptomatic. Pain may be felt in the membrane that covers the liver (as it increases in size) or in other organs located around it. There are no pain receptors in the liver itself. The body gives signals only when scars have already formed on the liver (cirrhosis). Symptoms of the disease manifest themselves in the form of loss of appetite, general weakness, nausea, diarrhea, and sudden weight loss.

Hepatitis C is transmitted through blood. Doctors identify the following ways of contracting the virus:

during blood transfusion;
through manicure tools;
when applying tattoos;
for piercing;
when using drugs (if 1 syringe is used for several people);
sexually;
during pregnancy;
in medical institutions with improper disinfection of instruments (including in dental offices).

In the CIS, genotypes 1, 2 and 3 of the hepatitis C virus are most common. Genotype 1b is more common than others. It is more difficult to treat. Genotype 3a occurs in 20% of patients. The following pattern is observed among patients:

patients whose infection occurred through a blood transfusion are more likely to have type 1b;
in drug-dependent patients, genotype 3a is most common, and 1b is much less common;
in Russia, the prevalence of genotypes 1b and 4 is much higher than 1a, 2a, 3a;
mixed hepatitis occurs in 10% of patients (3a and 1b).

Distinctive characteristics

Hepatitis A, unlike B and C, is caused by intestinal infections. Infection occurs through contact, through dirty hands, food, and water. Treatment of the disease is carried out with the help of hepatoprotectors. In this case, a special diet is prescribed. This species is characterized by yellowness of the skin and sclera of the eyeballs. Treatment can take from 1 week to 2 months. The recovery period after illness can last up to six months. Hepatitis A does not cause complications. Prevention of the disease consists of vaccination and compliance with hygiene rules.

Hepatitis B is caused by hepadnaviruses. They are resistant to chemical and physical influences. When frozen, they can remain viable for 20 years. They can be stored in the refrigerator for about 6 years. At room temperature they live for about 3 months. Hepadnaviruses die in boiling water after 30 minutes. This disease, with strong immunity, occurs in an acute form. Immunostimulants, hepatoprotectors, hormones and antibiotics are prescribed for treatment. Vaccination allows you to develop antibodies to this virus, preventing the development of various complications.

Hepatitis C is caused by flaviviruses. They are unstable in the environment, maintaining their viability for a short period of time. In 70-80% of cases, a chronic form of the disease develops. In this case, cirrhosis or liver cancer may develop. The incubation period of HCV ranges from 20-140 days. Hepatitis C can be combined with other types of virus, which worsens the patient’s well-being. The difficulty of treatment lies in the constant mutation of the virus.

Basic diagnostic methods

External manifestations of hepatitis C at the initial stage of disease development are nonspecific.

The patient may complain of fatigue and loss of appetite. These signs may be characteristic of other diseases. This factor makes diagnosis difficult in the early stages of the disease. Often, the diagnosis of hepatitis C is made during a routine examination of the patient or when the development of other diseases is suspected.

In the chronic course of the disease, the virus infects a large number of cells. The presence of leukocytes in the liver signals an inflammatory process. White blood cells destroy and remove dead liver cells. Scars then form. Their appearance is associated with the development of fibrosis and cirrhosis of the liver. Jaundice may appear at the stage of cirrhosis, when most of the organ is affected.

Patients with hepatitis C genotype 3a often develop steatosis. This is a phenomenon in which fat cells become embedded in the structure of the liver. Because of this, the liver increases in size, and pressing pain appears in the right hypochondrium.

Genotyping can provide an accurate description of the course of the disease. You can determine the presence of a virus in the blood:

by isolating the RNA of the virus;
by isolating antibodies to the virus.

Antibodies to HCV remain in the patient’s blood for a long time (even after recovery). But in this case there is no RNA of the virus. The main method for determining HCV in the blood is enzyme-linked immunosorbent assay. This test detects virus antigens and antibodies in the blood.

Scientists have developed test systems to determine antibodies in the human body. This makes it possible to detect the presence of the virus in the early stages of the disease. 3rd generation diagnostics are capable of identifying up to 97% of infected individuals. Tests can give positive, negative or neutral results. In the latter case, it is recommended to repeat the test after a few months.

If tests for the presence of antibodies to HCV are positive, then a PCR test is prescribed. A qualitative test reveals the genetic structure of the virus. Quantitative research allows you to calculate the concentration of the virus in the blood. This diagnostic method allows you to prescribe the correct treatment. By checking the quantitative indicator during therapy, you can track the effectiveness of the treatment.

Patients with chronic hepatitis C have an increased risk of liver cancer. Therefore, they are recommended to be tested for tumor markers (alpha-fetoproteins) at intervals of 6-12 months. It is recommended to undergo an ultrasound scan of the liver at a similar interval.

In some cases, a hepatologist may order a liver biopsy. A puncture is performed using a special needle. Through a small puncture, a piece of liver tissue is taken for analysis. The procedure is performed under local anesthesia. This analysis allows us to determine the severity of the disease and the presence of concomitant diseases.

To determine the complete picture of the disease, an analysis is performed to determine the genotype of the virus (genotyping). Having determined the genotype, stage of liver inflammation, the degree of liver damage, and the amount of fibrosis, the doctor can prescribe the most effective treatment in a particular case.

Patient management tactics

According to statistics, 5% of infected patients recover. Antibodies remain in their body for a long time, but the RNA of the virus in the blood cannot be identified. What treatment is necessary in a particular case can only be determined by a doctor. The course of therapy is prescribed taking into account the following criteria:

age;
stage of the disease;
time the virus remains in the body;
virus genotype;
genetic predisposition to fibroformation.

If a close relative is diagnosed with cirrhosis, then the patient should be tested for the following markers:

cytokines;
immunoregulatory proteins;
fibrogenesis factors.

In most cases, complex therapy is used. The patient is prescribed Interferon in combination with Ribavirin. The first drug has immunomodulatory and antiviral effects. Laboratory studies have proven the antiviral effect of Ribavirin against hepatitis C. This drug is contraindicated:

persons under 18 years of age;
pregnant women;
during breastfeeding;
persons who have undergone organ transplantation;
patients with hyperfunction of the thyroid gland;
patients with diseases of the cardiovascular system, diabetes mellitus or chronic obstructive pulmonary diseases.

Combined treatment of hepatitis allows you to get rid of the symptoms of the disease in 50% of cases. During treatment, hepatoprotectors are prescribed. They increase the protective functions of the liver, promoting cell regeneration. The emergence of new generation antiviral drugs (Boceprevir, Telaprivir) has increased the number of recoveries to 70-80%.

If you have hepatitis, you must follow certain nutritional rules:

drink 1.5-2 liters of water daily;
exclude alcoholic drinks;
balance the diet;
not to starve;
divide food into small portions for consumption 5-6 times a day;
minimize the consumption of sweets;
eat vegetables and fruits daily;
exclude fatty, fried, spicy, smoked foods, fast food;
add nuts and legumes to your diet;
exclude sorrel, fatty fish and meat, cocoa, meat broths, spices.

You cannot self-medicate or use folk remedies without consulting a doctor.

Description

Determination method real-time polymerase chain reaction (real-time PCR).

Material under study Blood plasma (EDTA)

Home visit available

Detection of hepatitis C virus (HCV) RNA and determination of HCV genotypes 1 (subtypes 1a and 1b), 2, 3a/3b (without division into genotype 3 subtypes).

It is known that the hepatitis C virus has 6 genotypes and a large number of subtypes. In the Russian Federation, genotypes are distributed in decreasing frequency: 1 (more often subtype 1b than 1a) > 3 (more often subtype 3a) > 2. The genotype of the virus is a reliable factor influencing the nature of the course of hepatitis C virus infection, the frequency of chronicity, the likelihood of response to antiviral therapy. Knowledge of the virus genotype is used to plan the duration of treatment, which is especially important given the wide range of side effects of interferon drugs used and the poor tolerance of therapy by many patients. According to the recommendations of the Ministry of Health of the Russian Federation dated September 3, 2014, genotyping of the hepatitis C virus should be performed on all patients before starting antiviral therapy in order to plan its duration, predict effectiveness, and in some cases, to calculate the dose of antiviral drugs.

See also test, genotyping - the study provides additional information about the likelihood of achieving a sustained virological response (SVR) during antiviral therapy in patients with hepatitis C.

Analytical characteristics of the tests: to determine the genotype, a fragment-specific region of the hepatitis C virus RNA, characteristic of a specific genotype, is used.

Sensitivity of the analysis: 200 copies of RNA in 1 ml of blood plasma.

Specificity: the method allows you to detect the presence of hepatitis C virus RNA (subtypes 1a, 1b, 2a, 2b, 2c, 2i, 3, 4, 5a, 6) and identify genotypes 1a, 1b, 2, 3a/3b (without dividing into genotype subtypes 3).

Indications for use

A genotype study is prescribed to patients when confirming the presence of hepatitis C virus RNA in the blood to predict the course of the infectious process, determine treatment tactics, and predict the effectiveness of therapy.

Interpretation of results

Interpretation of research results contains information for the attending physician and is not a diagnosis. The information in this section should not be used for self-diagnosis or self-treatment. The doctor makes an accurate diagnosis using both the results of this examination and the necessary information from other sources: medical history, results of other examinations, etc.

Form of presentation of the result and interpretation:

Hepatitis C virus RNA detected, indicating the subtype - issued if the presence of HCV RNA is detected in the patient and the possibility of its typing is possible. Hepatitis C virus RNA detected - issued if the presence of HCV RNA is detected in a patient, which cannot be attributed to genotypes 1a, 1b, 2, 3a/3b. Not detected - RNA of the hepatitis C virus has not been detected or the concentration of the pathogen is below the sensitivity limit of the method.

The hepatitis C virus is currently considered an incurable disease. Hepatitis C is dangerous due to the development of complications in the form of cirrhosis and liver cancer. But with the help of therapy, it is possible to achieve remission, when the virus is not detected in the blood, thereby not leading to pathological changes in liver cells. The success of such therapy directly depends on the genotype of the virus.

It is generally accepted that with hepatitis C there are six of them, according to other sources - 11 or more. In addition, each genotype has its own subtypes. As a rule, a patient is diagnosed with one genotype, less often several. Each genotype also includes quasispecies. They tend to change at a high rate and are resistant to drugs. It is precisely because of this high virulence that there is still no vaccine for hepatitis C.

The virus itself does not have its own mechanism for restoring genomic information. This leads to an increase in the number of its quasispecies. The antibodies that the body produces act against one quasispecie of the virus, and at this time a mutation occurs, a new quasispecie appears and the antibodies no longer act on it.

Genotypes of the hepatitis C virus are designated by Arabic numerals, and a Latin letter is added to indicate the subtype: 1a, 1b, and so on.

Prevalence of different genotypes

There is a certain geographical pattern. Genotypes 1, 2, and 3 are found throughout the world. In the Middle East and Central Asia, genotype 4 is found, in South Africa - 5, and in Asia, genotype 6 predominates.

In our region, among adult patients, the most common genotype is 1b (in 50% of patients with the acute form of the disease, and in 60% with the chronic form), 3a is less common (about 20%), 1a and 2 - less than 5%.

Determining the genotype of the virus

Genotyping is an analysis performed to determine the genotype of a particular virus. The technique is polymerase chain reaction. It is determined together with a quantitative indicator of the hepatitis C virus, called viral load. Genotyping is carried out before prescribing antiviral therapy and poses certain tasks:

determining the need for treatment and prognosis of the disease;
planning therapy, its duration, prescription of drugs, their dosage;
predicting the effectiveness of treatment;
deciding whether to perform a liver biopsy.

The results of determining the virus RNA and genotype are deciphered as follows:

“Virus RNA was detected, subtype 1b, 2, 3a...” means that the hepatitis C virus was detected in the patient’s blood and its genotype was determined.
“Virus RNA detected” - the virus is detected, but the RNA is not typed (perhaps the laboratory does not have reagents for a certain genotype).
“Not detected” - the sample does not contain a sufficient amount of virus RNA for testing.

The result may be false if the storage or transportation conditions of the material are violated or if it is contaminated. The genotype is not determined if the viral load is less than 750 IU/ml.

Features of genotype 1b

Genotype 1b, which is most common in Japan, is sometimes called Japanese genotype, but it is found throughout the world. In Europe, the largest percentage of people with hepatitis are carriers of this particular subtype. It has some distinctive characteristics compared to others:

It is mainly determined in people who have become infected with hepatitis C through blood.
Has high resistance to treatment. Typically, longer treatment times are required.
Has the greatest likelihood of relapse.
The clinical picture often includes the following symptoms: chronic fatigue, unmotivated weakness, drowsiness, dizziness.
It is a risk factor for the development of liver cancer as a complication of fibrosis - hepatocellular carcinoma.

Patients with the first genotype of the hepatitis C virus are conventionally divided into groups. Each of them has different antiviral treatment regimens. If the patient has not been previously treated, he is prescribed Peginterferon, Ribavirin, Boceprevir or Telaprevir. The duration of this course of therapy ranges from 24 to 72 weeks.

Protease inhibitors (Boceprevir, Telaprevir) may not be prescribed if viremia is low and there is no fibrosis. At the same time, treatment is monitored for possible correction of the applied regimen. If a relapse occurs after a course of double therapy, triple therapy is prescribed: in this case, Interferon and Ribavirin are used together with a protease inhibitor.

Treatment of this genotype is a difficult task, but with modern methods, remission can be achieved in 90% of cases. In addition, it is possible to slow down the development of fibrosis.

Features of genotypes 2 and 3

These genotypes are more susceptible to antiviral therapy. But they have a much lower frequency of distribution. The characteristic features of type 2 are:

low frequency of occurrence;
good response to antiviral therapy;
low relapse rate;
less chance of developing liver cancer.

Treatment is carried out by a hepatologist or infectious disease specialist on an outpatient basis or in a hospital. The duration of antiviral therapy is 24–48 weeks. Additionally, hepatoprotectors are prescribed. It is necessary to follow a diet and avoid drinking alcohol, as with other types of hepatitis.

The third genotype is one of the predominant ones in the world. Its two most common subtypes are 3a and 3b. It also has several distinctive features:

Most often, the age of patients with this hepatitis is up to 30 years.
Cirrhosis develops faster. Therefore, treatment should be prescribed as early as possible.
More than 70% of patients develop hepatic steatosis (accumulation of fat in hepatocytes).
Increased risk of developing liver malignancy.

The treatment regimen combines drugs such as Peginterferon alfa and Ribavirin. Protease inhibitors are not used in this case. The course of treatment is from 24 to 48 weeks.

Determining the genotype is one of the main diagnostic tasks before starting antiviral therapy. When types 2 and 3 are determined, the prognosis is favorable; in this case, hepatitis can be cured in 90% of patients.

Although virus genotyping is a significant diagnostic and prognostic method, it is not enough. For patients with hepatitis C, the amount of viral RNA (viral load) must be determined and a biopsy or elastometry performed.

Until recently, the hepatitis virus was considered the only virus of the Hepacivirus genus. But it turned out that horses, dogs, rodents and bats are also susceptible to this disease. Let's try to figure out how dangerous hepatitis C is for humans, how to detect and treat it, since timely diagnosis of the disease greatly simplifies therapy. In addition, young children are susceptible to the disease, and the earlier it is detected, the greater the chance of a favorable outcome.

What is the hepatitis C virus

When a person is diagnosed with this disease, he immediately begins to be tormented by many questions about hepatitis C: what it is (photos of manifestations of the disease), which doctor to contact for help, etc. The hepatitis or jaundice virus is a particle consisting of a core of genetic material (RNA), surrounded by an icosahedral protective shell of protein and enclosed in a lipid (or fatty) envelope of cell origin.

Hepatitis C is one of several viruses that cause diffuse serious illness. Up to 85% of people who survive the acute form of the disease remain chronically infected for the rest of their lives. Infection most often occurs through blood (intravenous injections with unsterile needles, scratches, wounds). The risk of contracting this virus through sexual contact is considered low, but does occur.

Causes of hepatitis in adults

Hepatitis C is a disease caused by a virus that attacks the liver. The liver's responsibilities include removing harmful chemicals from the body, improving digestion, processing vitamins and nutrients from food, and helping to thicken the blood from cuts and wounds. Hepatitis C in women poses a great danger to infants, since the newborn can be infected from a sick mother during childbirth. This is why it is important for a woman to monitor her health when planning a pregnancy.

The jaundice virus can spread in an adult in the following cases:

Hepatitis is not transmitted by sneezing, coughing, sharing food, sharing cutlery, or other accidental tactile contact.

Causes of hepatitis in children

The symptoms and treatment of hepatitis C in children are somewhat different from the signs of the disease in adults. Childhood hepatitis spreads in two ways: from mother to fetus (vertical route of infection) and through direct contact with the blood of an infected person (parenteral route of infection). The virus can be transmitted from an infected mother to a newborn during childbirth, the frequency of such cases is about 4-5%. If such a situation arises, the woman is offered a caesarean section, which slightly reduces the risk of transmitting the hepatitis virus to the newborn. Infection of children by the second route usually occurs during various medical interventions, dental treatment, administration of drugs through unsterile instruments, hemodialysis, blood transfusions and other medical procedures.

Teenagers, like adults, have an increased chance of developing hepatitis when they use drugs. In addition, the risk of infection in adolescent children increases if the rules of skin hygiene are violated when applying tattoos, piercings, and other things. When shaving with common hygiene items, viruses can also enter the body through cuts and abrasions on the skin.

in adults

Often, many people who become infected with hepatitis C do not have symptoms characteristic of the disease. Signs of chronic infection do not appear until the liver becomes scarred (cirrhosis develops). In this case, the disease is usually accompanied by general weakness, increased fatigue and has nonspecific symptoms even in the absence of cirrhosis.

Signs of the disease usually appear much later than infection, since the incubation period of hepatitis ranges from 15 to 150 days. An infected person without symptoms of the disease poses a threat to others, since he acts as a carrier of the virus and can transmit it to other people using the above methods. The main symptoms of the disease include the following:

Loss of appetite;

Malaise, weakness;

Nausea, attacks of vomiting;

Sudden sharp weight loss for no apparent reason;

Yellowing of the skin, sclera of the eyeballs (this is why the disease is popularly called jaundice);

Change in color of urine (dark brown) and stool (whitish feces).

Symptoms of hepatitis in children

On average, the incubation period of childhood hepatitis can last from 15 days to 6 months. Symptoms of jaundice in children occur in less than 50% of cases and are expressed mainly by yellowing of the skin and whites of the eyes. The icteric period usually lasts up to 3 weeks. Since hepatitis is characterized by inflammation of the liver, the child experiences general intoxication of the body, which is accompanied by nausea, vomiting, and diarrhea. The acute form of the disease begins slowly, symptoms increase gradually, with the development of dyspeptic disorders and asthenovegetative syndrome. Symptoms of jaundice in children may be accompanied by fever and headache. The feces become discolored, while the urine, on the contrary, acquires a dark brownish tint.

The identified symptoms and treatment of hepatitis C are closely interrelated, since with late diagnosis or lack of proper treatment, in 10-20% of all cases of the disease, the acute form of jaundice becomes chronic. Chronic jaundice, as a rule, is asymptomatic and is usually detected during a random examination of a child, when time has been lost and the disease remains with him for life. These children experience increased fatigue, asthenia, and extrahepatic symptoms (telangiectasia, capillaritis).

Diagnostics

Due to the fact that the acute form of hepatitis C is usually asymptomatic, early diagnosis of the disease is very important. When it becomes chronic, the chances of detecting an infection are reduced, the disease remains undiagnosed, and serious complications such as cirrhosis or liver cancer may develop.

Detection of the virus in the body occurs by determining the level of antibodies in the blood, and then confirmed by additional tests to determine viral RNA. The amount of RNA in the blood (the indicator does not correlate with the severity of the disease, but can be used to monitor the body's response to treatment. A liver biopsy is used to assess the extent of its damage by the disease (damage to organ cells and scarring), the value of which is important for planning therapy.

Diagnostics is carried out in 2 stages:

Screening for antibodies to the jaundice virus can determine whether a person has been infected with the virus;

If the antibody test is positive, a nucleic acid test is performed to determine the form of the disease (acute or chronic).

After this, if the tests are positive, the doctor needs to assess the degree of damage or cirrhosis). This can be done through a biopsy or through various non-invasive tests. In addition, the patient should undergo a laboratory test to determine the genotype of the hepatitis C strain. The degree of liver damage and the genotype of the virus are used to make decisions about treatment and management of the disease.

Hepatitis C genotypes

In order for the treatment of the disease to be effective, it is important to determine which genotype the virus belongs to. Hepatitis C genotypes are divided into six different types. Typically, patients are infected with a virus of only one genotype, but each is actually a mixture of closely related viruses called quasi-species. They tend to mutate and become resistant to current treatment. This is what explains the difficulty in treating chronic jaundice.

Below is a list of different genotypes of chronic hepatitis C:

Genotype 1a.
Genotype 1b.
Genotype 2a, 2b, 2c, 2d.
Genotype 3a, 3b, 3c, 3d, 3e, 3f.
Genotype 4a, 4b, 4c, 4d, 4e, 4f, 4g, 4h, 4i, 4j.
Genotype 5a.
Genotype 6a.

Hepatitis C genotypes are of great importance for doctors when making therapeutic recommendations. For example, genotype 1 is the most difficult to treat, and patients with hepatitis with genotypes 2 and 3 respond better to therapy using a combination of interferon alpha with ribavirin. In addition, when using combination therapy, the recommended duration of treatment depends on the genotype.

Treatment of hepatitis C

The symptoms and treatment of hepatitis C are closely interrelated, since therapy is also based on the signs of the disease. Before starting treatment, a thorough examination should be carried out to determine the optimal approach to the patient and his disease. In addition, based on diagnostic data, the doctor can determine which hepatitis C medicine will be most effective for each specific case. Modern jaundice is a combination of antiviral therapy with Interferon and Ribavirin, which are effective against all genotypes of viruses. Unfortunately, Interferon is not widely used in medicine, which has a bad effect on the condition of most patients, but the combination of ribavirin with this drug is perhaps the best cure for hepatitis C today.

Scientific advances have led to the development of new antiviral drugs for jaundice that are more effective, safer, and more tolerable than existing ones. These are direct-acting antiviral drugs (DAAs), which can not only simplify the treatment of the disease, but also increase the recovery rate of patients. However, antiviral drugs have serious side effects and often cause the following ailments in patients:

Headache;

Flu-like symptoms;

Nausea;

Fatigue;

Body aches;

Depression;

Skin rashes, allergic reactions.

If a child is diagnosed with hepatitis C, treatment should be aimed at preventing the transition of the acute form of the disease to the chronic form. Therapy is also mainly complex in nature and includes such combinations as recombinant interferon preparations, parenteral reaferon and Viferon rectal suppositories. Treatment regimens are selected for each child individually.

For children over 7 years of age and adolescence, it is possible to prescribe a combination of the drugs Interferon and Ribavirin. Inducers (Cycloferon) and immunomodulators (Tactivin) are also prescribed. The duration of treatment for jaundice in children depends on many factors and ranges from 24 to 48 weeks. If hepatitis C is diagnosed, treatment should be accompanied by following a diet, maintaining a healthy diet and lifestyle, and quitting smoking and alcohol. It is important to maintain bed rest and avoid taking unnecessary medications.

There are also traditional methods for treating jaundice, but when resorting to them, you should definitely consult with your doctor so as not to harm the body or aggravate the disease.

Predictions and consequences

When patients are diagnosed with hepatitis C, how long can they live with it is probably one of the most important questions they ask their doctor. It should be said right away that the forecasts will directly depend on the timeliness of detection of the disease and the effectiveness of the prescribed therapy. Timely identification of symptoms and treatment of hepatitis C, chosen correctly, is the key to success. The therapy has a good effect on the general condition of the patient, gives positive dynamics and increases the chances of a favorable outcome of the disease. According to statistics, about 20% of patients who become infected with hepatitis are completely cured, although this does not mean that they are protected from future infection. The remaining 80% of patients develop a chronic infection (with the appearance of characteristic symptoms or asymptomatic). These people remain infectious to others for the rest of their lives as they become carriers of the virus.

When a doctor detects hepatitis C in a patient (symptoms), treatment, consequences of the disease - information that should be conveyed to the patient as soon as possible and in an accessible form. If a person lives with hepatitis C for a number of years, they usually develop the following complications:

Chronic hepatitis;

Cirrhosis of the liver;

Liver cancer.

Prevention of disease

Unfortunately, there is currently no vaccine against jaundice. Patients who have had hepatitis C leave reviews that it is better to prevent the disease than to treat it later. So, to avoid the spread of the disease and other blood-borne diseases, people must adhere to the following requirements:

Avoid sharing personal items and using items that may be contaminated with blood (for example, razors, toothbrushes, etc.).
Avoid ear piercing, piercings, acupuncture procedures, and tattoos in places of questionable sterility and poor hygiene.
People with the hepatitis C virus, when visiting a dental clinic or any other health care facility, are required to inform the doctor that they are carriers of the virus. Ignoring this requirement puts many visitors to the dental clinic at risk.
Any cuts and abrasions should be thoroughly treated with disinfectant solutions and a waterproof bandage should be applied over them.
People who have multiple sexual partners should use barrier methods of contraception, such as condoms, to limit the risk of contracting hepatitis C virus and other sexually transmitted diseases.
It is important to carry out preventive measures aimed at safe methods of using injection instruments, injections, tattooing and other things.

It should be understood that the hepatitis C virus is not transmitted through everyday contact. Shaking hands, kissing and hugging are safe and there is no need to use special isolation procedures when dealing with infected patients. Contacts that increase the risk of transmission of infection are necessarily accompanied by bleeding.

The hepatitis C genotype is a specific set of genetic information of the pathogen. Under the general name of the disease, several varieties of the virus are hidden. They are called types and quasitypes. “Working” together, they lead to a million deaths every year. Therefore, hepatitis C is considered dangerous on a par with acquired immunodeficiency syndrome (AIDS) or cancer. So how many genotypes of the C-type liver inflammatory pathogen are there and why is such a classification needed?

Viruses are living microorganisms. They have a non-cellular structure, but they have a set of genes. This set is individual for each virus. Therefore, pathogens have different effects on the body. However, differences in the genome may be minimal, as is the case with subtypes of the hepatitis C pathogen.

The genotype of hepatitis C is determined by a set of ribonucleic acid (RNA) and deoxyribonucleic acid (DNA). In different combinations they cause the same disease.

Determining the genotype of the hepatitis C virus can give several results. Scientists count 11 varieties of the pathogen. Not all of them are recognized by the World Health Organization (WHO). According to its classification, 6 genotypes are distinguished:

First. If you ask the question which genotype of hepatitis C is the most dangerous, doctors will indicate this. The first type of virus strain easily adapts to a changing environment and treatment. This makes therapy difficult. The first genotype has 3 varieties - a, b and c. The second of them is considered the most dangerous. In people diagnosed with hepatitis C 1b, in 60% of cases the disease becomes chronic.
Second genotype. Hepatitis C of this type is less common than the first and has a “gentle” treatment. The viral load on the liver and the body as a whole is minimal, inflammatory processes are inactive. Approximately 90% of those infected recover. There are also 3 subtypes of the second genotype.
Third. It is the answer to the question of which genotype of hepatitis C is more treatable. This is partly due to the study of the pathogen and the wide range of drugs against it. If medications are selected correctly, complete recovery occurs within 24 weeks. The genotype has two quasitypes - a and b.
Fourth, fifth and sixth genotypes. Combined in one paragraph because they have been little studied. Accordingly, they are still working on treatment regimens. The fourth genotype has nine subtypes at once. These are a, b, c, d, e, f, h, i, j. The fifth and sixth have only one quasitype a.

The hepatitis C virus was discovered in the late 1980s. Therefore, the identification of genotypes continues. As noted above, scientists point to 11 varieties. Perhaps, over time, the World Health Organization will include them in the classifier. The emergence of new types is also not excluded.

The identification of the types of hepatitis C pathogens began in the 90s. Scientists have found a certain pattern in the distribution of one or another genotype.

First of all, the expansion of pathogens is territorial:

Genotype number 1 is found in all corners of the planet, but is most common in the countries of the former Soviet Union. Subtypes 1a and 1b are more common in the European part.
The second genotype is distributed evenly throughout the world. In contrast to the first type of virus, the second is rare.
The third genotype of the disease is most often detected in Australia, South Asian countries and the territory of the former Soviet Union. Thanks to the prevalence and ease of treatment, it was possible to study the disease well.
The fourth, fifth and sixth genotypes of the hepatitis C virus are unevenly distributed and are rare. All 9 subtypes of the fourth type of pathogen are found in northern Africa, mainly in Egypt. The fifth type of pathogen is common in the Republic of South Africa. The sixth genotype is typical for Asian countries.

If we talk about the age categories of people affected by one or another subtype of hepatitis C, there are no clear boundaries. There are only some patterns. Thus, quasitype 1b affects mainly the adult population. Among the sick, 52% are over 30 years old. At the same time, only 25% of small patients.

There is also an age “link” for the fifth and sixth genotypes. Not a single child was registered among the sick people.

Mixed genotypes of hepatitis C

Being a non-cellular structure, the virus is small and easily enters the body. Often a pathogen of one genotype penetrates. However, during treatment, when the immune system is weakened, the following may occur:

another pathogen;
several different genotypes of the virus at once.

The latter case is diagnosed in only 1% of those infected with hepatitis C. The first option is recorded in 8% of patients.

A certain pathogen requires specific therapy. If there are several types of pathogens, treatment is complex, takes a long time, and is difficult to tolerate.

As is clear, it is not the genotype itself that may be mixed, but the disease. The slightest change in the pathogen obliges scientists to classify it as a separate quasitype. It cannot be that the pathogen is not completely 1a, but also not completely 1b. If so, then a separate, new genotype is being considered.

Trends in the spread of different virus genotypes

According to international medical organizations, there are up to 500 million people on the planet who are carriers of different types of hepatitis C.

The most widespread in Russia are:

genotype 1c;
subtype 3a.

In the first case, 80% of patients received the virus during a blood transfusion. Hepatitis type 3a is contracted mainly through household contact and sexual contact.

The varieties of hepatitis C that emerged as the “leaders” left only 10% of infections to others. Most of them are related to Russians traveling abroad. The disease is brought from countries where it is common.

Basically, pathogens alien to domestic territories come from Latin America, Africa, and Australia.

It is necessary to know what type of virus that causes hepatitis C.

The result of the analysis is important for the following reasons:

The information allows doctors to decide how the patient should be treated. The infection can be eliminated with different drugs, and their dosages are selected depending on the genotype of the virus.
The difference in “behavior” of one or another genotype determines the nature of the disease. Assuming it, doctors prescribe therapy, so to speak, proactively.
Analysis allows you to make predictions. We are talking about the time it will take for treatment.

It’s a good idea for anyone to donate blood for testing. All subtypes of hepatitis C develop asymptomatically.

Basic tests determine hepatitis C itself. Genotypes and their description are a topic for those who have been diagnosed with the causative agent of the disease. In this case, citizens undergo additional research. They reveal which genotype the pathogen belongs to.

To determine the genotype of hepatitis C, one of the following methods is used:

Direct sequencing. A modern analysis that helps identify “fragments” of DNA and RNA. The entire hepatitis C virus has not been isolated in almost 40 years.
Polymerase chain reaction. Experimental study. Using the polymerase chain reaction, even the small presence of certain parts of ribonucleic acid or DNA in biological material is determined.
Reverse hybridization with membrane probes. Nucleic acids are transferred to the membrane, where they multiply. After collecting a sufficient amount of biological material, the genotype of the virus is determined.

It is worth noting that even modern testing methods do not always make it possible to identify the pathogen. Firstly, this is due to the possibility of contamination of the provided biological material during sampling or during transportation. Secondly, the viral load level may be too low.

For a productive analysis, the viral load should not be less than 750 IU (international units)/ml.

Where and at what price are tests done?

To obtain an accurate diagnosis, you cannot do without an examination. Anyone can be tested for the presence of hepatitis C. It does not matter whether there are symptoms of the disease. If a doctor gives a referral for a blood test, the test will be performed free of charge. The scheme is relevant for public clinics and private medical institutions operating under compulsory insurance.

If the patient decides to have the test done without a referral, he will have to pay.

The cost depends on the nature of the study:

if you need to get a high-quality test for antibodies to DNA or RNA of the virus, you will have to pay from 300 to 900 rubles;
a quantitative analysis that reveals the volume of virus in the blood can cost from 1,200 to 10 thousand rubles;
to determine whether the therapy being used is effective, it is necessary to find out the viral load with real-time detection, which costs up to 20 thousand rubles.

The results of the study give a negative or positive result. In the first case, we are talking about the absence of viruses in the body. Some tests indicate levels of viral RNA or DNA envelope particles below a critical level. In this case, we are also talking about a negative result of the study.

Violations of analysis techniques.
Use of low-quality reagents.
Presence of other errors by medical workers.

To exclude “accidents” it is necessary to re-donate blood for analysis. Ideally, you need to go through it 3 times. If all results are positive, the diagnosis is undisputed.

All relate to medications:

First of all, antiviral drugs are prescribed. The drugs containing ribavirin and interferon are mainly used. When using medications with the first active substance, the patient may experience headaches. Interferon-based drugs have a wider range of side effects. Muscle pain, fever, chills and depression occur. However, there is also adaptation to the drugs. After a month of use, the side effects disappear.
The course of treatment also includes immunostimulants and hepatoprotectors. The first group serves to improve the protective functions of the body. Hepatoprotectors restore liver function.
Vitamins. They are necessary to improve the functioning of the immune system. For hepatitis C, it is recommended to take some beneficial substances separately, and not in combinations. We are talking about folic acid, vitamins C, B12 and E.

Interferon in our country until recently was considered the main drug in the fight against hepatitis C and other liver diseases. The active substance stimulates the immune system. But interferon has many contraindications and side effects.

Inhibitors began to be used as a replacement for interferon. Instead of stimulating the immune system, they block the activity of the virus. Inhibitors have several advantages:

the treatment period is significantly reduced;
there are no numerous side effects.

The final choice of drugs for the treatment of hepatitis C should be made by the doctor. Self-medication is dangerous and leads to serious and sometimes irreversible consequences.

Genotyping of hepatitis C allows you to expand and complement general therapy.

Doctors have developed methods to combat each type of virus:

Genotype 1. Subtype b is the most dangerous. His treatment lasts from 5 months to one and a half years. In this case, double therapy is used. Patients are prescribed both interferon and ribavirin. In addition, medications are prescribed to restore liver function and prevent complications. The value of therapy is great. If treatment is started untimely and is carried out incorrectly, serious complications cannot be avoided.
The difference between genotype 2 is its “gentle” effect on the body. The viral load is minimal. The course of treatment takes from 3 months to six months. Drug therapy is used. Either interferon or ribavirin is used. In addition, direct antiviral agents may be prescribed. These include Sofosbuvir, Ledipasvir, Daclatasvir.
Genotype 3. Also treated with only one of the active substances. The disease has been studied better than other genotypes. There are practically no problems with complete recovery. With proper treatment and following the recommendations of doctors, it occurs in 90% of patients. The therapeutic course usually lasts 24 weeks.
Genotypes 4 to 6 are rare. For this reason, there are no special methods for treating them. Get by with general recommendations.

To monitor the progress of treatment, additional studies are periodically carried out. Tests should show a decrease or increase in the level of viral activity.

In the first case, we are talking about successful therapy. If the number of foreign particles does not decrease, adjustment of the treatment used is required. This may involve changing the dosage of medications or replacing them completely.

In addition to drug therapy, a diet must be prescribed. For hepatitis C, as well as for other problems with the liver and gall bladder, table No. 5 is used. It allows you to reduce the load on the affected organ. This simplifies the process of treating hepatitis C.

According to doctors' recommendations, you should not eat fried or smoked foods. The amount of fat consumed also needs to be reduced. Preference is given to vegetables and fruits. It is advisable that the dishes be boiled, baked or steamed. It is necessary to reduce the consumption of caffeinated drinks, and alcohol should be completely avoided. The same applies to smoking.

The diet for any of the hepatitis C genotypes must contain all the nutrients, vitamins and microelements necessary for the normal functioning of the body. The diet is aimed at eliminating harmful foods, not starvation.