Chronic Hepatitis C: what is changing and how to take care of?

A chronic disease is often more difficult to treat. Treatments are sometimes heavy and difficult to tolerate; side effects may even appear. However, do not give up, as the signs are followed. It is even more desperate when it comes to the genotype of the virus more resistant to standard treatments ....
Hepatitis C is an infectious disease of the liver due to hepatitis C or HCV, which is transmitted through the blood.

We're talking about chronic hepatitis C infection is present when more than 6 months. The evolution of chronic hepatitis C to be found in over 60% of cases. It is characterized by frequent absence of a sign and its chronicity, cirrhosis and liver cancer. Indeed, the virus remains inactive in the body long a person infected, but could transmit the disease. This progression to cirrhosis occurs in about 20% of cases, and appeared several years (fifteen years) after the manifestations and diagnosis of liver fibrosis.

The evolution of chronic hepatitis C is very different from one person to another. This development mainly depends on several factors that can accelerate the progression of the disease:

- The Age

- The male, in which the evolution is faster

- Alcohol

- Obesity

- The type of HCV in question (because there are six genotypes of HCV) viral load initially detected in the infected person

- The presence of hepatic steatosis

- A possible co-infection with HIV

However, when the treatment is effective, changes may stop or slow down. The virus can be inactive, the disease is often no signs or may present with mild signs. The signs are often organic with obvious inflammation after a biopsy.

When the signs are present, they are often general symptoms such as:

- Fatigue, weight loss

- Muscle and joint pain, abdominal pain

- Fever, headache

- Sleep disturbances, appetite

- Digestive disorders (nausea, diarrhea, ...) ...

In cirrhosis, the disease usually presents with signs of biological deterioration of liver function. Liver enzymes are increased. However, the severity and extent of lesions are mainly evaluated by liver biopsy.

The treatment of hepatitis C is constantly changing depending on the progress of research on this disease. Currently, support is based on the combination of two antiviral drugs (interferon, ribavirin) for several months, depending on the evolution of liver function. However, the effectiveness of interferon on the different genotypes is variable in practice. It is the most appropriate treatment in persistent chronic hepatitis C forms. In general, the rate of remission occurs during this treatment for chronic hepatitis C genotype 1 is estimated at less than 50%. Remission corresponds to a reduction of viral replication during treatment and thus a positive response to treatment. For the rate of remission, treatment should be continued over a period of about 1 to 2 years. It was found that the more resistant genotype 1 treatment.

The presence of signs of decompensated cirrhosis reduces the effectiveness of this treatment.

Two new antiviral drugs (telaprevir, boceprevir), considered to be more effective with fewer side effects, have been the market in some countries. Unfortunately, access to these drugs is still difficult for some countries. These drugs are already used in France but their indications are limited to chronic hepatitis C genotype 1, which are resistant to conventional dual therapy. According to studies and clinical trials for these drugs, the cure rate is higher, and shorter treatment.

These drugs may also be associated with combination therapy commonly used.

Because of the prolonged treatment and drug molecules used term drug treatment of chronic hepatitis C is heavy and can cause signs of fatigue in the person being treated. Side effects exist, but vary from one subject to another (fatigue and exhaustion, muscle pain, sleep disorders, headaches, depression, dehydration, ...). These side effects usually go away after treatment and should not justify an early discontinuation.

The rest is mandatory throughout the treatment period.

According to the WHO policy, a person with chronic hepatitis C requires a vaccination against hepatitis A and hepatitis B, as well as strict medical supervision and proper development of any other liver diseases .

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Hepatitis