Swelling of the feet with hepatitis

What is hepatitis C?

Hepatitis C ("C") is an infectious disease. It is caused by the hepatitis C virus, which lives and multiplies in the cells of the human liver. Reproduction of the virus in cells leads to their death and the occurrence of inflammation of the liver - viral hepatitis C. In the vast majority of cases (70-90%), hepatitis C does not pass independently, the virus remains in the body for life and causes chronic inflammation of the liver - chronic hepatitis C.

Hepatitis C transmission routes

Virus hepatitis C is transmitted only from person to person in three ways.
1. Through the blood
Infection through the blood can occur when used:

-others, second-hand syringes, needles, spoons, cotton wool, filters, etc .;
- Men's razors, toothbrushes, scissors, manicure tools;
- Unprocessed tools for piercing, tattoos;
- Unprocessed medical instruments;
-and also with direct contact with someone else's blood.
2. Sexual transmission

There is still no consensus on how high the risk of sexual transmission of hepatitis C, but in any case, this risk exists, especially if there is a contact with blood during intercourse.

3. From mother to child - during pregnancy and childbirth
The risk of transmission of hepatitis C during pregnancy and inchildbirth is low - up to 5%. At the same time, about half of the children who received the hepatitis C virus from their mother are cured of it themselves. Breastfeeding in itself does not carry the risk of transmission of the virus, since the breast milk does not contain the virus. However, when breastfeeding a woman, one should monitor the absence of cracks in the nipples and damage to the oral mucosa in the child in order to avoid contact with infected blood.

The hepatitis C virus has a high infectiousability. Infection is possible by contact even with the invisible eye amount of blood. Against hepatitis C, there is no vaccination, so you can protect yourself from infection only if the following simple rules are observed.

When injecting, always usesterile tools: dishes, samples, syringes and needles, filters, spoon (or other containers for water, preparation and distribution of drugs), neck, water for washing syringes. Injections should be carried out only on a clean surface, avoiding contact with objects on which traces of foreign blood could be preserved (even if these traces are not visible). It must be remembered that even the slightest contact with someone else's blood can lead to the transmission of the virus. There are no sterilization methods that completely protect against the transmission of the hepatitis C virus, since the virus is very tenacious. Therefore, in any situation it is better to use only sterile or your injecting equipment! However, if you are in an extreme situation when your tools are completely inaccessible, you must take all possible measures for sterilizing the equipment: thoroughly wash the syringe with bleach or cold running water. Do not wash the syringe with boiling water, as the blood can curdle and harden. Therefore, even if you decide to boil a syringe, you must first rinse it thoroughly with cold water, without forgetting that the rinse water should be used only once.

It is necessary to treat everyone carefullyThe subjects on which the smallest particles of blood can remain. You only need to use your personal hygiene items: toothbrush, loofah, manicure tools, razor - store them separately, since the virus can remain viable in the environment for up to several days (16 hours - 4 days).

Tools for piercing and tattooing inIdeals should be disposable or properly sterilized (including not only needles, but also accessories such as paint containers or piercing machines). A tattooist or piercing master should wear disposable gloves and be in them throughout the procedure. This will protect him and you. When piercing, use only your accessories. You can not use other people's accessories - they can also retain the smallest particles of blood.

When having sex it is necessary to use condoms. In addition, watch for the safety of mucous membranes, the absence of cracks and micro-injuries. Remember that inflammatory diseases of the genital organs damage the mucosa, increase bleeding, which increases the risk of transmission of hepatitis C. It is not recommended to practice unprotected sex during menstruation, regardless of who is infected with hepatitis C: man or woman.

A feature of hepatitis C is a latent current. For a long period after infection (months-years), there may not appear any clear signs (symptoms) indicating the presence of a person with hepatitis C. Clearly, the presence or absence of hepatitis C is possible only when testing blood. Think about whether there have been episodes in your life when infection with hepatitis C could occur. The state of persistent fatigue, a periodic sense of heaviness in the right upper quadrant, a decrease in appetite can also serve as an occasion for testing for viral hepatitis, including hepatitis C. However, these symptoms not all arise.

To detect hepatitis C, blood tests are used for the presence of antibodies or the virus itself. In the widespread practice, the most common method is the first method - the determination of antibodies.

With hepatitis C it is believed that if there is an antibody, then there is a virus. At the overwhelming majority of people a hepatitis With independently does not pass or take place, and remains for all life.

However, it is important to remember that antibodies to the virusappear not immediately after infection - their appearance to the level determined by the test systems can take up to 6 months, although most often they can be determined in 2-3 months. The time interval between infection and the definition of antibodies is called the incubation period.

Thus, finally make sure thatyou do not have a virus if you do an antibody test 6 months after a risky contact. If you received a positive result during the examination, you should conduct a confirmatory analysis. A confirmatory analysis will show if you have had hepatitis C or become sick now. it is aimed at direct detection of the virus. To determine if the virus is present at the moment, a special test-polymerase chain reaction (PCR) is used. This test is more expensive. If the result of the test is negative, it means that either you have had hepatitis C and recovered, or the virus has disappeared from the body as a result of treatment, or the activity of virus multiplication has become so low that PCR can not detect it. It should be remembered that the viral load is not as informative for indicating the progression of the disease, as with other chronic viral infections (eg, HIV infection).

The liver is the second largest organ in your body.organism (after the skin), which is located on the right side of the torso. An important function of the liver is to provide a person with energy. It breaks down food and recycles it into carbohydrates, which are stored and further used as needed. Carbohydrates turn into glucose and then are deposited (mainly in the liver and muscles) in the form of a special substance - glycogen. If the body urgently needs energy, a certain amount of glycogen again turns into glucose.

Damage to the liver can reduce its abilityconvert carbohydrates into glucose: it can start producing either too much glucose or too little. The liver also produces bile: a greenish-yellow liquid that helps to break down food. Bile is stored in the gallbladder. After eating, the gallbladder shrinks and releases bile into the intestine. Blood, passing through the liver, is filtered and purified. The liver helps the body get rid of various processed foods. The liver also produces substances that affect blood clotting (they are involved in stopping bleeding).

Permanent long-term damage to liver tissue can lead to the formation of scars - fibrosis. The formation of scars leads to a change in the normal structure of the organ.

Scars squeeze the liver tissue itself, the bloodvessels and, as a result, the liver stops working normally. This condition is called cirrhosis. One of the frequent causes of the formation of cirrhosis is chronic hepatitis C.

The more damaged the liver, the moreprobability of the appearance of marked signs of this lesion. As the liver is damaged, its ability to neutralize poisons and process substances decreases, which can lead to chronic fatigue, weakness, loss of appetite, nausea, weight loss. Other symptoms that indicate liver problems include jaundice, darkening of urine and clarification of feces, the appearance of vascular asterisks (when capillaries become visible), ascites (when fluid accumulates in the abdominal cavity), varicose veins of the umbilical veins, bleeding from the esophagus.

If you have hepatitis C.

The news that you have found hepatitis. C, - the news is not from the category of pleasant. Undoubtedly, the disease will require you to pay more attention to your own health and a certain adaptation of lifestyle. It is important to remember that even if there is a virus, following certain rules, one can live a long and full life. In most cases, the period of development of the disease to the stage when it begins to cause significant damage to the liver with the development of fibrosis, is from 12 to 20 years.

With hepatitis C, the liver works in "emergencyconditions ". Any additional burden can lead to serious consequences for your health. Try to stop or significantly reduce the use of alcohol. Street injecting drugs, as a rule, contain a small amount (from 5 to 15%) of the "active substance", the rest is what they are bred. All this "ballast" settles in the liver, which, naturally, is not indifferent to it. The conclusion is the same - it is better to stop or minimize the use of drugs.

If you are taking any medications, be sure to check with your doctor if you can take them with hepatitis. You may need to change the regimen of taking the drug or replacing one medicine with another.

If a woman takes oral contraceptives, it is necessary to consult a gynecologist. they also affect the liver.

Heavy physical work, work with variousToxic substances (varnishes, paints, household chemicals, etc. production of chemical products) also negatively affect the liver. During periods of exacerbation of hepatitis C, it is recommended to limit physical activity.

The liver plays an important role in the processing processfood, so many people living with hepatitis, a change in diet will feel better. Compliance with a strict diet is mainly necessary for acute hepatitis and with exacerbation of chronic hepatitis. In case there is no exacerbation, it is enough just to adhere to certain rules and not to allow excesses. For each person it is important to carefully treat your body, keep track of what it takes or does not accept, because the features can be different for everyone. A few general recommendations will help you understand the principles of a diet for hepatitis. The general idea of ​​a diet is to limit or stop the use of those products that create an extra burden for the liver. It is important to completely eliminate or minimize the use of alcohol.

Exclude from the menu or reduce the use:

-saturated fats. Try to reduce the amount of fat you eat. Such products include animal fats and everything that is cooked with them (fries, broths), as well as smoked products. Replace foods high in fat (such as sour cream, yogurt) for foods with a lower content. If you eat meat and fish, then use low-fat meat and low-fat fish. Avoid excessive amounts of fried foods, sugar. Avoid excessive consumption of sugar, especially that added to food, drinks, etc. Sugar contained in fruits is not so harmful. Eliminate from your menu or reduce the consumption of sugary carbonated drinks, replacing them with plain water. It is better to use honey for sweetening foods.

× artificial colors and preservatives
× tea and coffee. These foods can increase nausea, heartburn and insomnia.
× salt. With hepatitis, the water exchange processes in your body are disturbed. The accumulation of water in the body and swelling are characteristic. One way to cope with puffiness is to regulate the use of salt. Salt works like a sponge: when it is absorbed by the body, it absorbs moisture. Therefore, by reducing the amount of salt, it is possible to influence the retention of the amount of water.

Turn on the menu or increase use:
-fresh vegetables and fruits
-cereal cereals and legumes
-fat fish
-antioxidants. Food rich in antioxidants helps protect cells from oxidative damage. Antioxidants include betacarotene (carrots, pumpkin, dark green leafy vegetables, spinach, beets, apricots), vitamin C (citrus fruits, kiwi, berries, plums, dark green vegetables.) Long cooking destroys vitamin C).

zinc (raw nuts and seeds, almonds, walnuts, whole grains, lentils, fish, lean meat).
milk protein. The methionine contained in the curd is a good hepa-
-better products. They promote digestion. Eat bitter salads and greens, as well as grapefruits and lemons.
- Beverages (water, fresh fruit or vegetable juices, herbal teas: chamomile,
mint, fennel).

Hepatitis C examinations

Many of us do not like to go to doctors andoften turn to them only when there are obvious manifestations of the disease. The peculiarity of hepatitis C is that it is quite a "silent" disease. Inflammation occurs in the liver, despite the absence of obvious manifestations of the disease. Significant health problems may appear in the late stages, for example, with severe exacerbation of chronic hepatitis and in the formation of liver cirrhosis. In order to monitor the liver and the behavior of the virus, it is necessary to regularly see a doctor and undergo examinations.

ALT (ALT, transaminase) and bilirubin
These tests allow you to determine the presence and severity of inflammation in the liver, as well as the severity of abnormalities in the body. ALT (transaminase) is a substance that is contained in the liver cells.
Normally, cells are updated periodically. In connection with this, a small amount of transaminase from the old dead cells is constantly in the blood. Inflammation of the liver, including hepatitis C, leads to the death of more than usual number of cells. As a result, the amount of ALT in the blood increases. The stronger the inflammation, the more cells die, and the higher the level of ALT in the blood. Bilirubin is a substance formed during the splitting of hemoglobin. Normally, it is captured by the liver from the blood, it is processed in it and is excreted with bile into the intestine. If the liver is broken, its cells are unable to capture all the bilirubin from the blood. It accumulates in the blood and penetrates the skin - jaundice appears. The body tries to get rid of excess bilirubin and takes it out with urine - as a result, it gets dark. As the processing of bilirubin with the liver is broken, it ceases to enter the intestine - the chair becomes lighter. Transfer transaminase and bilirubin in chronic hepatitis C is recommended 3-4 times a year.

This is the standard way to determine if there is aliver damage. The biopsy procedure can be uncomfortable and sometimes painful. When a biopsy is performed, a hollow needle is inserted into the liver surface through the skin in the hypochondrium. From the liver take a small piece (several millimeters), which is pulled at the end of the needle. Then this piece is examined to determine the level of liver damage, if such damage is present. A biopsy usually takes at least 2_ weeks.

A liver biopsy is the only, most informative way to determine the indications for the beginning of treatment for hepatitis C.

Ultrasound examination of the liver (ultrasound)provides experts with valuable information about what is happening with the liver at the moment. For example, ultrasound can detect initial signs of cirrhosis of the liver. This enables you and your doctor to begin treatment in time. It is advisable to undergo ultrasound 1-2 times a year.

An important moment in assessing the state of the bodyhepatitis C is an examination of the condition of the gallbladder. This organ is located directly under the liver, its work is closely related to the work of the liver. With hepatitis C, health problems are often associated not so much with the liver as with the gallbladder (for example, pain in the right side after gross violations of the diet are most often caused not by inflammation in the liver, but by a violation of the gallbladder). The presence of hepatitis C can contribute to the development of inflammation in the gallbladder-cholecystitis, which will require a separate treatment.

It is customary to talk about hepatitis C as a single virus. In fact, it's a fairly large group of very similar viruses. Varieties of the hepatitis C virus are called genotypes. The presence in the body of one type of virus does not protect against infection with the remaining five.

So, if you do not protect yourself from re-engaginginfection, you can, as a result, collect a whole "collection" of hepatitis C viruses. The ingestion of new varieties of the virus naturally leads to a worse prognosis of the disease and increases the risk of cirrhosis.

When deciding on the treatment of hepatitis C,"Mixture" of several varieties of the virus will reduce the likelihood of a successful outcome of therapy. At the moment, it is not completely clear how the genotypes of the virus affect the length of time before the onset of cirrhosis, but the relationship between genotypes and the effectiveness of treatment is established. It is widely recognized that, in general, genotypes 2 and 3 are better susceptible to antiviral treatment based on interferon than other genotypes. Determine what kind of genotype you have possible only when passing a special test for genotypes. Execution of this study is strongly recommended before the start of interferon therapy, because allows the doctor to evaluate the possible effectiveness of treatment. Thus, when treated with the standard peginterferon + ribavirin regimen, the efficacy of treatment reaches 50% for genotypes of group 1 (a and b) and up to 80% for genotypes 2 and 3.

What to consider when deciding to start treatment

To make a decision to start treatment,To receive consultation of the expert and to pass or take place the profound inspection. The best result of treatment is the complete destruction of the hepatitis C virus. Unfortunately, it is unlikely to achieve such a result even with the help of modern methods. A more realistic goal is to suppress the multiplication of the hepatitis C virus for a long time. Achieving this goal allows, in particular, to reduce the risk of developing cirrhosis and improve the quality of life of a person.

Before you begin treatment, you need to solve the following questions:

- What is the prognosis of the effectiveness of treatment in your case?
- When do I start treatment?
- Which treatment will be more effective?
- How long should it last?
The following factors play an important role in solving these issues:
- degree of liver damage - symptoms of fibrosis, cirrhosis;
- genotype (subtype) of the virus;
- sex and age;
- Your ability to adhere to the treatment regimen.

Interferon Is a protein produced naturally by the body as a response to infection. It is because of the development of interferon that you feel unwell.

Interferon blocks the penetration of viruses intohealthy cells (thereby inhibiting their reproduction) and stimulates the immune system to fight them. Interferon has been used to treat hepatitis for many years. Currently, the international standard for the treatment of hepatitis is the combination of pegylated interferon and ribavirin. The process of the so-called pegylation - the addition of non-toxic inert polyethylene glycol to the interferon molecule - enhances the activity of biologically active proteins. Pegylated interferon (peginterferon alfa) differs from the standard duration of exposure: peginterferon is enough to be administered once a week, so that the necessary therapeutic concentration remains in the blood, and standard interferon is 3 times a week. Interferon is used in the form of intramuscular injections. According to the standard international treatment regimen, interferon is used in combination with ribavirin. Ribavirin Is a drug that slows down reproductionhepatitis C virus and changes the response of the immune system to the effect of the virus. Ribavirin is used only in combination with interferon, because in itself it does not affect the virus. Ribavirin is used in the form of capsules. Some patients (insignificant number) do not tolerate ribavirin, and only in this case interferon monotherapy is prescribed.

Under the influence of interferon (in any form) inthe same phenomena occur in the human body as in any viral infection: fever, weakness, sweating, nausea, muscle and headaches, depression. Side effects of the drug begin soon after the injection of the drug and can last about 12 hours. The severity of side effects varies depending on the characteristics of the body. They are most pronounced in the first few weeks of treatment. After that, the body gradually adapts, and the side effects become less noticeable. To overcome side effects, some help paracetamol, if taken an hour before the injection of interferon (some injected right before going to bed to sleep the most unpleasant sensations). It is useful to drink plenty of liquid - about 10 glasses of water a day is recommended (water can be replaced with juices, but not caffeinated preparations and not alcoholic beverages).

It is extremely important to avoid admission passes: adherence to the regime significantly affects the effectiveness of the course of treatment.

During the treatment it is necessary to do monthlyblood tests to determine if the inflammation of the liver decreases. After the end of the course of treatment, you need to continue to do the tests for a few more months, since after stopping injections of interferon, signs of liver inflammation may reappear.

If a woman undergoes interferon treatment, pregnancy can be planned no earlier than 1 year after the end of therapy.

Russia has not yet developed standardstreatment of hepatitis C, and the availability of effective treatment depends on the region in which you live. Compulsory health insurance (MHI) includes interferon-therapy as permitted, but the MHI standards proposed in most regions do not include interferon as an obligatory component paid by the insurance company. Therefore, depending on the region, you will be offered either completely free therapy, or fully or partially paid by the patient. To date, the state as an obligatory aid assumes only the provision of advice on the regime, diet and the need for inpatient treatment: droppers in combination with enzymes (see below).

When deciding on the admission of a particular speciestherapy, remember: monotherapy with any forms of interferon is not recommended by international standards. Therefore, when deciding on it, you should carefully weigh and discuss with the doctor all the pros and cons. The only recommended standard of treatment to date is the combination of peginterferon and ribavirin (except for patients who can not take ribavirin).

Before starting treatment it is important to discuss with your doctorthe question of the stability of the supply of drugs, since it is necessary to be treated within 24-48 weeks (depending on the genotype), without interruptions. If you buy drugs for your money, this factor should also be borne in mind.

In Russia, some drugs are popular,it is customary to classify as hepatoprotectors. These drugs, unlike interferon with ribavirin, do not act on the virus, but are meant to support the functioning of the liver. The most common drugs in this group are "Karsil", "Essentiale", "Legalon", "LIV-52".

Do not use these drugs withoutcareful consultation with a doctor and a preliminary examination. It is established that with the exacerbation of hepatitis C, some of them are capable of increasing inflammation in the liver. The effectiveness of hepatoprotectors has not been established in treatment, and negative data exist for some. So, LIV-52 has long been discontinued and banned in Western Europe due to carcinogenicity. In relation to Essentiale, the only condition in which its effectiveness is scientifically proven is alcoholic liver disease (namely steatosis). With viral hepatitis, its effectiveness is not proven, and in acute viral hepatitis it is contraindicated.

For example, "Festal", "Creon", "Mezim_forte", etc.) help the body to digest food faster and thereby reduce the burden on the liver. There is an opinion that with chronic hepatitis C it is necessary to periodically "cleanse the blood". In fact, the liver cleanses blood perfectly and without droppers. It is important to create favorable conditions for her by means of a regime and a diet.

There is an opportunity to receive moneycompensation for purchased medications. The new legislation, namely Chapter 23 of the Tax Code of the Russian Federation, provides tax deductions for individuals in four types: standard, social, property, professional. Social tax deductions (Article 219 of the Tax Code) allow you to reduce the taxable income by amounts that are sent by the taxpayer from personal funds to his / her treatment and / or the treatment of the spouse, his parents and / or children under the age of 18, medicines, appointed by the attending physician, in the amount of actual expenses, but not more than 38 000 rubles. To exercise the right to social deductions, you must:

• be a payer of income tax;
• stock up the necessary documents proving the right to deduct;
• in time to apply to the tax office with a statement and a declaration.
Before deciding on the purchase of medicines andreceiving paid medical services in the expectation of further compensation, you need to carefully consult a lawyer or a tax inspection. Currently, only "Interferon alfa" - "Ribavirin" is included in the list of medicines for which compensation is provided.

Pregnancy and Hepatitis C

Two scientifically proven facts:
1. The risk of transmission of Hepatitis C from mother to child during pregnancy and childbirth is small - up to 5%.
2. Pregnancy does not affect the course of hepatitis C.
The risk of acquiring a child with hepatitis C during pregnancy and childbirth is higher if:
• Hepatitis C occurred during pregnancy, especially after the 23-24th week;
• There was inflammation of the placenta (placenta) or severe changes in the placenta.

It is advisable to undergo pregnancy planningin-depth examination, in particular to determine the amount of hepatitis C virus in the blood - a viral load. It is extremely important to exclude the presence of liver cirrhosis, t. In this state, pregnancy is not recommended, and in some cases even contraindicated.

Today it is considered that the cesarean section is notreduces the risk of transmission of the hepatitis C virus in childbirth, in connection with which the delivery is carried out "in the usual way". In the presence of hepatitis C, breastfeeding is permitted, because it is believed that the virus does not penetrate into breast milk, but when breastfeeding it is strongly recommended to monitor the condition of the mother's nipples and the oral mucosa of the baby to avoid getting the mother's blood into the baby's body.

It is certainly true to talk about the presence or absence of hepatitis C in a child not earlier than one year after birth.
Until this time, the child may persistantibodies received from the mother. If a child is tested for hepatitis C soon after his birth, the analysis can be positive (as if there is a virus). The immune system of a woman reduces its activity during pregnancy. After childbirth, it is activated, which can lead to an exacerbation of hepatitis C.

Hepatitis C and liver cirrhosis

In some patients, viral hepatitis C (about20-40% of cases) develops a severe irreversible condition-liver cirrhosis. Cirrhosis is the replacement of normal liver tissue with scarring. Scars pull the tissue of the liver, deform it, squeeze the blood vessels that pass through the liver, and as a result, it ceases to perform most of its functions normally. Regular observation and examination make it possible to detect liver cirrhosis and begin treatment in a timely manner. In a number of cases, the changes that have begun can disappear, in most cases the process will be strongly "braked".

The most serious health problems with cirrhosis are:

1. The liver ceases to adequately purify the blood.
Harmful substances that form in the intestine,not destroyed by the liver, "go" bypassing and adversely affect the body as a whole. In the first place, the nervous system suffers. In the most severe cases, it is possible to develop a so-called hepatic encephalopathy associated with severe impairment of the brain. Most of the harmful substances that act on the nervous system, give proteins. Therefore, it is necessary to minimize the use of products containing animal proteins. They can be replaced with soy products.
2. Violated water-salt metabolism.
The liver is the organ that supports andregulates the ratio of water and various salts (potassium, sodium, etc.) in our body. Violation of water-salt metabolism and compression of the blood vessels of the liver by scars, which are formed with cirrhosis, leads to the development of edema of the legs. In severe cases, fluid begins to accumulate in the abdomen (ascites). When swelling occurs, it is strongly recommended that you limit the intake of salt and water. Salt "holds" water on itself: the more salt in the blood, the more water it "holds", and the stronger the swelling. The reduction in the use of salt will cause the water to "go away" from the body, swelling will decrease or even disappear.
3. The coagulability of blood decreases.
Increased risk of hemorrhages, bleeding(for example, from the nose) and bruises. In this case, always consult a doctor. It may be necessary to take special drugs that increase blood coagulability. To solve a number of problems with cirrhosis helps to maintain a proper diet.
Cirrhosis often reduces appetite: taste sensations are distorted, smells change, there is aversion to certain kinds of food. Try to pick up the food that suits you best, taking into account the protein and salt content in it. If the appetite is "at zero", you can switch to a fractional food: in small portions, but often (5-7 times a day).

Hepatitis C and HIV infection

In Russia, many people infected with HIV alsoare infected with hepatitis C. Hepatitis C is one of the most common causes of chronic liver diseases that cause severe damage to the health of people with HIV. The presence of human hepatitis C may require changes in HIV therapy. Since 1999, hepatitis C is considered an opportunistic infection for people with HIV. Timely diagnosis and treatment of hepatitis C in people with HIV allows:
- Reduce the risk of mother-to-child transmission of the virus;
to slow the development of liver disease.
Every year, more and more information appears about the co-infection of HIV and hepatitis C, but today more is known about how HIV affects hepatitis C; The effect of hepatitis C on HIV has been less studied.

The impact of HIV on hepatitis C

HIV-positive people undergoingantibodies to hepatitis C, can get a false negative result, especially if they have a low level of CD4 (this is evidence of a poor immune response to hepatitis C). In this regard, a PCR test can be used to diagnose hepatitis C in HIV-positive patients. The risk of transmission of both HIV and hepatitis C from mother to child during pregnancy, childbirth and breastfeeding increases if the mother is co-infected. The level of risk is also associated with the viral load of both viruses.

HIV infection disrupts the immune systemand thereby accelerates the development of hepatitis C: increases the possibility of transition from acute to chronic hepatitis C, the development of fibrosis and, subsequently, cirrhosis.

Influence of hepatitis C on HIV

The effect of hepatitis C on progressionHIV infection is not unambiguous. Although some studies indicate that certain types of this virus accelerate the transition of HIV infection to the stage of AIDS, this issue is still open. The impact of hepatitis C on HIV is limited, but in cases of more severe liver damage, especially in people with genotype 1, the burden of the disease is possible. The development and treatment of HIV and hepatitis should be carefully monitored. It is also necessary to closely monitor how the treatment interacts.

Treatment options for co-infection

The presence of both viruses makes the process of treatmentmore complex. You will probably need to weigh the anticipated benefits and risks. This is especially true for people at later stages of HIV. If treatment of hepatitis is recommended, it is necessary to decide which virus should be treated first. Similar decisions are based on several factors, the main of which are the number of CD4 and the extent of liver damage. Modern methods suggest that before the initiation of ARV treatment it is better to treat hepatitis C, especially if the most "favorable" for the treatment of the subtype of the virus is identified. If liver liver biopsy or blood tests show serious liver damage, this also indicates the need to start treatment for hepatitis.

Co-infection of hepatitis C is notcontraindication to the appointment of ARV therapy even if the treatment for hepatitis C has not been prolonged because of the most likely inefficiency or lack of access to this therapy.

Patients with low immune status (CD below350) may be asked to delay treatment of hepatitis. This will allow focusing on anti-HIV therapy to raise the immune status and reduce the viral load. Interferon can significantly reduce the level of CD, thereby exacerbating immunodeficiency. The response to hepatitis C therapy will also be better with a high CD count. Some people undergo both therapy at the same time. In this case, careful monitoring of treatment should be undertaken, as some drugs may increase susceptibility to the course of treatment and side effects.

The effectiveness of treatment of hepatitis C forHIV-positive patients with a high CD4 count are lower than those who are HIV-negative. It also preserves dependence on the virus subtype. Treatment of hepatitis C can slow down the process of liver damage and improve the tolerability of anti-HIV medications. If part of the combination in the treatment of HIV is AZT, d4T or ddI, it is possible that these drugs will need to be replaced before , how to start treatment of hepatitis C. AZT can promote the development of anemia in the same way as ribavirin (which is part of the combination therapy for hepatitis C). With the simultaneous administration of d4T and hepatitis therapy, it is possible to develop lactic acidosis. For getting