Chronic hepatitis C

Chronic hepatitis C is the outcome of acute hepatitis C, the chronic- ness of which is observed in 75-80% of cases. Compared with other pathogens of viral hepatitis, HCV has the highest chronogenic potential.

HCV infection is the main cause of the formation of the entire group of chronic liver diseases - chronic hepatitis, cirrhosis and hepatocarcinoma. Chronic hepatitis C is always potentially dangerous.

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What causes chronic hepatitis C?

Hepatitis C virus was identified in 1989. Houghton et al. Often leads to the development of chronic hepatitis, which can progress to cirrhosis and hepatocellular carcinoma. The transition of acute viral hepatitis C into chronic is observed in 50-80%.

Hepatitis C virus causes more than 90% of cases of posttransfusion hepatitis and cirrhosis in the world. According to the National Institutes of Health, acute post-transfusion hepatitis C develops in 6.1% of patients who received blood transfusion or its components during cardiac surgery, and becomes chronic in 60%. Of the 39 patients observed within 1-24 years, cirrhosis developed in 8 (20%). It is believed that the average period before the development of cirrhosis is about 20 years.

The observation in Germany for patients with HCV infection due to the introduction of a virus-containing immunoglobulin showed that of 56 of them, 52 (92.9%) showed anti-HCV at 6-12 months in serum and 9-10 years after the administration of anti-HCV immunoglobulin in the serum were present in 45 of the 65 examined. However, 10 years after infection, the majority of patients did not develop a chronic disease, and antibodies were not detected later.

Monitoring patients with post-transfusion or domestic acquired HCV infection indicates that 67% of infected patients after 6 months or more have an elevated ALT activity. In individuals with high serum transaminase activity and the presence of anti-HCV, a virus (HCV-RNA) is usually found in the blood.

In the US, 30% of liver transplants are performed in connection with chronic HCV infection.

Throughout the world, the role of HCV as a cause of chronic liver disease and hepatocellular carcinoma appears to be as significant as HBV. In some countries, for example in Japan, HCV may be even more important.

Perhaps such a pronounced ability of HCV to cause persistent infection is due to the extremely high incidence of its mutations and the formation of multiple quasi-species, only slightly different genomes from each other. In many patients, clinical course and biochemical activity indicators are characterized by ups and downs, suggesting that HCV may have the ability to suppress the immune response.

Causes of chronic hepatitis C

Symptoms of hepatitis C

Chronic hepatitis C is a sluggish current disease that lasts for many years. Acute attack usually remains unrecognized and proceeds without clinical symptoms, according to which it would be possible to predict chronicization. Nevertheless, 80% of patients develop chronic hepatitis and 20% have liver cirrhosis.

Symptoms of chronic hepatitis C

Diagnosis of hepatitis C

1. General blood test: anemia, increased ESR. With the development of hypo- or aplasia of the bone marrow, pancytopenia is observed.
2. General urine analysis: without significant changes. Perhaps the appearance of bilirubin in the urine, and with the development of glomerulonephritis - proteinuria.
3. Biochemical blood test: moderate and transient hyperbilirubinemia with increasing conjugated and unconjugated fractions; an increase in the activity of aminotransferases, organ-specific liver enzymes (ornithine carbamoyltransferase, arginase, fructose-1-phosphataldolase), y-glutamyltranspeptadase; decrease in albumin content and increase in γ-globulin.
4. Immunological analysis of blood: it is possible to reduce the number and function of T-lymphocytes-suppressors, increase the content of immunoglobulins, with the development of extrahepatic systemic manifestations - the detection of circulating immune complexes.
5. Serological markers of HCV infection: markers of the replication phase - HCV-RNA, anti-HCVcoreIgM - are revealed in the active phase of the disease with exacerbation of chronic hepatitis C.

Most patients with histological examination of liver biopsy identify more often stepped, less often - bridge necrosis, intralobular and portal lymphohistiocytic infiltration.

Ultrasound and radioisotope scanning show a diffuse increase in the liver of various degrees and often splenomegaly.

Diagnosis of chronic hepatitis C

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Hepatitis C: treatment

Rest regime, diet or intake of vitamins do not have therapeutic effect. Elderly patients with post-transfusion chronic hepatitis C usually die from other causes before the development of liver failure. These patients need attention and psychological support. Others need antiviral therapy, usually lymphoblastoid or recombinant interferon-a. A persistent effect is manifested by the normalization of ALT activity, the disappearance of HCV-RNA in 1 year after discontinuation of interferon treatment and a decrease in the activity of the process in the liver submitted to a histological study. With the partial effect of treatment, it is not the normalization of ALT activity, but only its reduction, that is determined.

Treatment of chronic hepatitis C

What is the prognosis of hepatitis C?

Chronic hepatitis C has a very variable prognosis. In some cases, the pathological process in the liver has a benign course with spontaneous improvement within 1-3 years, in others, progression is observed with transformation into cirrhosis of the liver. According to a study in Italy, chronic hepatitis developed in 77% of 135 patients with posttransfusion hepatitis.

Hepatitis C: prognosis

By the end of the 15-year period, 65 patients with liver biopsy had cirrhosis. A half of patients with cirrhosis developed life-threatening complications.