Liver damage in chronic syphilis. Liver syphilis, photos, symptoms

Testing for HIV (AIDS), syphilis, hepatitis C and B is taken when a person is being prepared for hospitalization, surgery, upcoming pregnancy, before donating blood, after casual sexual contact, during regular examination of risk groups, and also if a person exhibits symptoms , indicating one of these diseases. A test for AIDS (HIV), syphilis and hepatitis allows for differential diagnosis of one disease from another, determining the subsequent treatment of the patient. However, due to the severe consequences of infection with spirochetes for the body, cases of a combination of these diseases are not uncommon.

With long-term therapy for treponema pallidum, syphilitic hepatitis develops, which can be caused either by the second stage of the disease or by an infectious-allergic reaction. Typically, liver diseases of various etiologies are combined under the name hepatitis, while syphilis, affecting the liver, causes necrotic foci in it that disrupt the functioning of the organ, which is manifested by intense pain in the liver area, an increase in its density during palpation, and an increase in the liver in size. As the disease progresses, itching and jaundice join the general symptoms. A similar clinical picture is observed with HIV infection leading to the development of AIDS.

If a patient has, in addition to syphilis, hepatitis or HIV infection (AIDS), the doctor most often prescribes treatment, focusing on the disease that can cause more harm to the body, that is, first of all they try to remove Treponema pallidum from the body, and only then begin treatment liver. Such therapeutic tactics are justified in most cases, but it should be taken into account that in the process the fight between antibiotics and spirochetes, the liver will be subject to additional stress, and the processes of its destruction will accelerate. In this regard, during therapy, both with and without liver damage, patients are advised to refrain from drinking alcohol and pay due attention to proper nutrition.

However, it should be borne in mind that the test for syphilitic hepatitis can be false positive in more than 20% of cases, which is associated with tumors, hepatocholecystitis, cirrhosis of alcoholic origin, HIV and some other diseases. Therefore, in order to be absolutely sure that liver damage was caused by a syphilitic factor (syphilis), they are guided by the data of RIBT, RIF and the results of trial therapy.

Syphilitic hepatitis occurs in 4-6% of patients with late visceral syphilis. Syphilitic liver lesions can be congenital or acquired.

Syphilitic hepatitis symptoms

Congenital syphilitic hepatitis

The clinical picture of congenital syphilitic hepatitis corresponds to chronic interstitial hepatitis of another etiology or liver cirrhosis. As a rule, jaundice does not occur.

The baby may be stillborn or die from spirochetal septicemia soon after birth. Other (extrahepatic) manifestations of congenital syphilis come to the fore. Hepatosplenomegaly and, very rarely, jaundice are noted.

Acquired syphilitic hepatitis develops as one of the forms of either early or late visceral syphilis.

Early syphilitic hepatitis manifests itself in anicteric forms with a simultaneous enlargement of the compacted liver and spleen.

In the secondary period of syphilis, liver damage is manifested by hysteria, skin itching and other symptoms of acute syphilitic hepatitis.

Late syphilitic hepatitis can occur in four forms: chronic epithelial, chronic interstitial, limited gummous and miliary gummous hepatitis.

Symptoms of chronic epithelial hepatitis are nonspecific: general malaise, pain and heaviness in the liver area, anorexia, nausea, vomiting, severe itching. The liver is slightly enlarged, protrudes 4-5 cm from under the edge of the costal arch, rather dense, but painless.
Chronic: interstitial hepatitis is characterized by intense pain in the liver area, its enlargement, density on palpation, but jaundice is absent in the early stages of the disease. In the later period, when syphilitic cirrhosis of the liver develops, jaundice and severe itching of the skin occur.
Miliary gummous hepatitis. It manifests itself as pain in the liver area, its uniform enlargement (with a smooth surface). The functional activity of liver marks persists for a long time, and jaundice is usually absent.
Limited gummous hepatitis is accompanied by severe pain, fever, and chills. Hysteria of the sclera and skin, other liver function disorders are mild; in the initial stages of the disease, jaundice occurs only as a result of mechanical obstruction of the bile ducts.

The clinical picture of gummous hepatitis can mimic stomach or liver cancer, cholelithiasis, malaria, cirrhosis of the liver and other diseases. Patients complain of periodic pain in the hypochondrium, which is cramping in nature. Pain often persists throughout the disease, sometimes only in the initial period. Body temperature can be normal or rise to 38 o C and sometimes more. Often the temperature curve becomes incorrect. An increase in body temperature is sometimes combined with chills. Fever and chills are the result of exacerbation of inflammatory changes in the liver. The liver is enlarged, dense, lumpy, painful. In some cases, during the disintegration of peripheral gummas, softening of individual areas of the liver is determined by palpation. Jaundice is a rare occurrence. Its occurrence is explained by mechanical compression of large bile ducts by gumma. Also rarely observed are portal hypertension and ascites. The composition of the blood changes little. Only in severe cases of the disease is a slight anemia detected. Moderate leukocytosis is often detected.

Course of syphilitic hepatitis

The course of liver syphilis in untreated cases leads to the death of the patient due to severe changes in both the liver and other organs. Prolonged intoxication, combined with fever and pain, causing insomnia, dramatically depletes patients. Death can occur due to symptoms of cachexia and intoxication. In other cases, death occurs from complications of cirrhosis, cholemia due to compression of the bile ducts by scars, hepatargia, which can suddenly overlap with the previous course of the disease. Treatment of gummous processes may not always lead to recovery; Treatment is especially unsuccessful where scarring has already developed.

Syphilis can lead to serious complications in people with HIV. A number of authors consider syphilitic hepatitis to be an HIV-associated disease.

Congenital liver damage due to syphilis

Congenital liver lesions in syphilis are interstitial hepatitis with the proliferation of connective tissue caused by multiple mil pairs and gummas, which leads to an enlargement of the organ and gives it greater density. The structure of the liver is sharply disrupted, lobulation is not detected. The liver enlarges and becomes dense; a large number of spirochetes are found in it. Diffuse hepatitis develops, fibrosis occurs, and subsequently the formation of cirrhosis of the liver.

Early congenital syphilis. Histological examination of liver tissue reveals cholestasis, fibrosis and foci of extramedullary hematopoiesis.

Late congenital syphilis is now extremely rare. It is characterized by chronic inflammation and hypersensitivity reactions. In this case, gummas can form in the liver.

Acquired syphilitic hepatitis

Diagnosis of syphilitic hepatitis

The diagnosis is made based on anamnestic data on syphilis and the past use of specific antisyphilitic therapy for clinical manifestations; detection of a positive Wasserman reaction. However, a negative Wasserman reaction does not exclude syphilitic hepatitis. Crucial importance is attached to the data of the immunofluorescence reaction, the immobilization reaction of Treponema pallidum, as well as ELISA, RIGA, microprecipitation reaction and the results of trial treatment.

The liver is one of the favorite localizations of the syphilitic virus. Let's take a closer look at this topic of liver syphilis, photos, symptoms. Its specific lesions occur even in the earliest period of generalization of the infection. Already in the prodromal stage of the disease, even before the appearance of a positive blood reaction to syphilis, the so-called icterus syphiliticus praecox is observed. More often, however, it develops in the early secondary stage of the disease, simultaneously with or following the first syphilitic rashes on the skin and mucous membranes.

Symptoms of liver syphilis

In addition to icteric staining of the skin, conjunctiva and mucous membranes, the following are observed, although not always clearly:

swelling of the liver, pain when palpating it;
enlarged spleen and moderate fever in most cases;
the presence of urobilin and urobilinogen is determined in the urine;
stool is colored normally.

Much less often (when it comes to congestive jaundice caused by a delay in the outflow of bile), bilirubin is found in the urine, the feces lose their normal color and become achylic.

Early syphilitic jaundice

In the vast majority of cases, early syphilitic jaundice ends favorably. But sometimes it is the first noticeable symptom of acute yellow liver atrophy - a serious disease that almost always ends in death. The picture of this disease is as follows:

with a good general condition of the patient, a slight, then quickly increasing icteric coloration of the integument appears;
the pulse is usually accelerated (a manifestation of general toxicosis).

The liver quickly, almost before our eyes, begins to decrease in size. At the same time, the spleen increases moderately. The general condition is sharply disturbed: the patient has a fever, the fever is of the wrong type. The temperature sometimes reaches high numbers: severe pain in the liver area is often observed, reminiscent of hepatic colic. Apathy and prostration, drowsiness and convulsions appear, then coma develops, ending in death.

Gummous stage of syphilis

In the later stage of syphilis - gummous - two forms of liver damage are observed: interstitial hepatitis and liver gummas in the literal sense of the word. Interstitial hepatitis usually develops in late stages of infection, after 10-40 years. As an exception, it was observed very early, 4 months after infection. In the vast majority of cases, only one lobe of the liver is affected (with acquired syphilis), usually the left one.

The lesion is based on diffuse growth of interlobular connective tissue, spreading into the lobules in the form of cords. Often the connective tissue around the portal vessels grows strongly. In the further course of the disease, this connective tissue shrinks and causes the picture of a “flint liver”: the organ decreases in volume, becomes denser to the density of a stone. Information about liver syphilis, photos, symptoms is given for educational purposes.

In addition to this diffuse process, a more limited, focal proliferation of connective tissue also occurs. In such cases, as a result of shrinking of the lesions, individual sections of the liver become detached in the form of cone-shaped lobes, limited by scar retracts (hepar lobatum). With the development of these changes in the area of the portal vein, stagnation phenomena occur with their usual clinical symptoms. With focal processes, compensatory hypertrophy of neighboring areas of the liver often develops. The development of perihepatitis is often observed, often resulting in adhesions of the liver to neighboring organs.

Clinical picture of interstitial hepatitis

According to these anatomical changes, the clinical picture of interstitial hepatitis is as follows: initially, with diffuse hepatitis, the liver appears enlarged, its surface is smooth. More often the left lobe is enlarged. Subsequent wrinkling of the overgrown connective tissue causes a change in both the size of the liver and its surface. The liver shrinks more often in one part or another, the surface becomes uneven, especially in the presence of compensatory hypertrophy. The organ takes on a multi-lobed shape with protrusions and sometimes deep depressions, especially noticeable at the edge of the liver.

Jaundice is a variable phenomenon, perhaps even relatively rare. It develops when larger bile ducts or ducti hepatici are compressed by shrinking connective tissue. Subjective sensations boil down to a feeling of heaviness in the right side, which intensifies with bodily tension.

Sometimes, however, there is pain, sometimes excruciating. In some cases, feverish temperature fluctuations are also observed. The spleen does not always swell. However, its increase can be observed both as a result of congestion caused by cirrhosis of the liver, and as a manifestation of an independent specific lesion. Ascites and edema are also variable. Various disorders of the digestive system are often noticed:

vomiting,
nausea,
diarrhea, etc.

In advanced cases, not recognized in time and not subjected to rational treatment, cachexia and death occur. It is extremely important to recognize early hepatitis early: antisyphilitic treatment in such cases gives excellent results.

Liver gumma in humans

Hepatitis gummosa is slightly less common than interstitial hepatitis; sometimes it is observed simultaneously with him. In the liver parenchyma, gummous nodules and nodes develop in varying numbers and sizes, from poppy seeds to walnuts and apples. At the same time, liver syphilis, photo, the symptoms here are completely different. The localization of gummas is not the same: they are located mainly close to the surface of the organ, less often in depth. More often, one lobe of the liver is affected.

In terms of histological structure, as well as evolution, liver gummas are no different from gummas of other tissues. Their final outcome is scar tissue that is prone to wrinkling. When the gummas are located close to the surface of the liver, the latter appears lumpy, and in the final stage - covered with deep recesses-furrows.

And with this form, perihepatitis can develop. Isolated single gummas of the liver often occur completely secretly. With a more common process, especially in the stage of decay of gummas, a number of symptoms appear.

Subjective complaints of patients are reduced to indications of pain (especially in the presence of perihepatitis):

then constant
then colicky, worsening with movements.

Diverse digestive disorders are common: nausea, vomiting, and sometimes diarrhea. The fever, sometimes reaching high numbers, is (during the period of softening of the gummas) septic in nature, sometimes accompanied by stunning chills. However, persistent fever is also observed.

When examining the liver, nodes of various sizes are felt on its surface, quite dense, spherical or flattened, sensitive to pressure. Later, more or less deep retractions appear, especially clearly along the edge of the liver. The spleen is rarely enlarged in the gummous form of hepatitis: only with pronounced symptoms of stagnation in the portal vein system. Jaundice is an almost constant occurrence. Ascites occurs frequently.

Liver amyloid

In conclusion, a few words about liver amyloid. Like any other etiology, long-term suppurative processes in the skin, bones, mucous membranes, etc. Syphilitic lesions of this nature can cause the development of amyloid in internal organs, including liver syphilis, photos, symptoms that we discussed above.

Modern medicine has studied hundreds of viruses and infections, many of which are able to coexist peacefully with humans without causing dangerous diseases. However, there are other pathogens - those whose penetration into the body can cause severe illness, even death. Of course, the most dangerous and widespread “micro-killers” for many years have been HIV (human immunodeficiency virus), hepatitis virus and Treponema pallidum, the causative agent of syphilis.

Contrary to the prevailing belief in society that HIV infection and chronic hepatitis cannot be cured and inevitably bring the patient closer to death, modern medicine has developed a number of effective techniques that can completely suppress the development of the disease or, as in the case of HIV, achieve stable remission. Today, together with specialists from the Raduga medical clinic, we will figure out how to avoid infection and what to do if these dangerous viruses and infections do penetrate the body.

HIV, syphilis, hepatitis: be on alert!

Even the mention of sexually transmitted infections causes fear and anxiety in any person, but the number of infected people is growing every day. But protecting yourself from HIV infection, hepatitis and syphilis is not difficult; you just need to learn a few rules.

These dangerous pathogens are transmitted primarily through sexual contact. According to research, their highest concentration is found in biological fluids - sperm and vaginal secretions. Also, the highest level of viral and infectious agents is observed in the blood of the carrier, which means that transfusion of blood from a sick person or the use of shared medical equipment (needles, scalpels, etc.) poses a direct threat of infection. Finally, some types of hepatitis can be transmitted through household contact, but the most dangerous forms of pathogens, like the immunodeficiency virus and treponema pallidum, are not able to remain viable outside the body and quickly die in the natural environment.

Based on the above, it follows:

Always use a condom during sexual intercourse - this rule is especially important when having sexual relations with an unfamiliar partner. A condom should be used not only during traditional vaginal sex, but also during oral and anal forms of sexual intercourse, and should be of excellent quality.
Be careful with medical and cosmetic equipment and manipulations - you should use only disposable syringes and thoroughly disinfected instruments. If the clinic is not 100% sterile, it is not worth the risk. Moreover, you should not visit underground beauty salons and tattoo parlors.
Monitor your health and strengthen your immune system - even with a single unprotected sexual contact with a carrier, the likelihood of infection increases significantly in people with weakened immune systems.

Based on statistical data, doctors have formed risk groups - that is, categories of people who are most susceptible to infection with HIV, syphilis and hepatitis. The greatest risk of infection is observed among people who constantly practice unprotected sex, injection drug users, homosexual partners, sex workers and medical personnel who have direct contact with the blood of infected people.

Attention! Even careful attention to one’s own health and discernment in one’s sexual life cannot always protect a person from force majeure. Such unforeseen circumstances in the form of a broken condom or unscrupulous actions of a nurse can affect everyone, which means everyone who cares about their health should know what to do in this situation and whether it is possible to protect themselves from infection.

Bad news after good tests

So, the most unpleasant thing has happened and you suspect that an infection may have occurred - what should be your next steps? Most patients in this situation choose the path of passive waiting. Without doing anything, they hope for luck and wait with horror for the appearance of symptoms of dangerous diseases. Unfortunately, according to statistics, even with a single unprotected sexual intercourse with a carrier, the probability of infection is quite high and exceeds 30%. In addition, symptoms of the disease may not appear, even if infection has occurred. The insidious pathogens of HIV, syphilis and hepatitis may not appear for a long time, while actively multiplying and “capturing” more and more new parts of the body.

More reasonable patients, the day after unprotected sex, run to the laboratory and... After a few more days, such patients receive negative results from the diagnostic center and, with relief, continue to lead their usual lifestyle. In fact, this approach is also incorrect. It is possible to detect the pathogen or antibodies to it in the blood only 3-6 weeks after infection, which means that any studies conducted before this period are uninformative. Thus, having received confirmation of his complete health, the patient may be a carrier of HIV infection, hepatitis virus or syphilis pathogen, without taking any action for treatment.

Attention! The best decision if you suspect a possible infection is to immediately contact a dermatovenerologist for emergency prevention!

HIV, syphilis, hepatitis: emergency prevention will save

You should consult a dermatovenerologist no later than 72 hours after the suspected infection. This period allows for emergency prevention of HIV, syphilis and hepatitis using medication. The essence of the method is that the patient takes a certain dose of an antiviral or antibacterial drug in order to suppress any activity of the pathogen in the body. The technique provides almost one hundred percent protection of the patient from the causative agent of syphilis. For HIV, this figure is lower, but a four-week course of highly active antiretroviral therapy can significantly reduce the likelihood of infection. The maximum effect can be achieved through additional chemoprophylaxis.

It is impossible to immediately determine how effective the emergency prophylaxis carried out is. To do this, the patient will have to wait until the end of the incubation period for HIV, hepatitis and syphilis, after which it will be possible to undergo.

Also, the patient should definitely listen to his body and be attentive to the appearance of possible symptoms of the development of the disease. The first signs for each disease are different:

Syphilis. The development of syphilis can be suspected first of all by the appearance of ulcers on the genitals. Further, the symptoms of syphilis cover the entire body and appear as symmetrical rashes. The last stage of the disease is accompanied by massive damage to internal organs and the nervous system.
Hepatitis. The signs of hepatitis are quite clear and specific. The disease is determined by the yellowness of the skin, sclera of the eyes and mucous membranes, as well as by changes in the color of urine and feces. The patient's urine takes on a rich dark color, while the feces become discolored. .
HIV. Symptoms of HIV infection are extremely difficult to determine, since they are nonspecific and often completely absent. General weakening of the body, low-grade fever, enlarged lymph nodes and a tendency to secondary diseases - sore throats, pneumonia, skin diseases, etc. may indicate the development of the disease. .

If the results of laboratory diagnostics confirm that the patient is infected with a virus or infection, do not despair. To date, effective methods for treating hepatitis and syphilis have been developed, based on the use of antiviral drugs and antibiotics. Treatment of these pathologies also requires lifestyle adjustments - changes in diet, physical activity and giving up bad habits.

As for HIV, unfortunately, a drug that can completely cure the disease has not yet been developed. However, thanks to the discovery of antiretroviral drugs, patients suffering from HIV infection can live long and fulfilling lives, because the drugs suppress the activity of the virus. In the case of properly organized therapy, the likelihood of a patient developing fatal acquired immunodeficiency syndrome (AIDS) is reduced to 0.7-1.2%.

Only timely consultation with a doctor will preserve the patient’s health and life in case of infection with HIV, hepatitis and syphilis. However, thanks to the successes of modern medicine, these dangerous killer diseases commit “murder” of patients less and less often, only making an attempt on human life and health.

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

Hepatitis is the name given to acute and chronic inflammatory diseases of the liver that are not focal, but widespread. Different hepatitises have different methods of infection; they also differ in the rate of disease progression, clinical manifestations, methods and prognosis of therapy. Even the symptoms of different types of hepatitis are different. Moreover, some symptoms are stronger than others, which is determined by the type of hepatitis.

Main symptoms

Jaundice. The symptom occurs frequently and is due to the fact that bilirubin enters the patient’s blood when the liver is damaged. Blood, circulating throughout the body, carries it to organs and tissues, coloring them yellow.
The appearance of pain in the area of the right hypochondrium. It occurs due to an increase in the size of the liver, leading to pain that can be dull and prolonged or of a paroxysmal nature.
Deterioration of health, accompanied by fever, headaches, dizziness, indigestion, drowsiness and lethargy. All this is a consequence of the effect of bilirubin on the body.

Hepatitis acute and chronic

Hepatitis in patients has acute and chronic forms. In 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 disease, the condition of patients quickly deteriorates, which contributes to the accelerated development of symptoms.

With this form of the disease, favorable prognosis is quite possible. Except for its transformation into chronic. In its 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 independently. In the chronic form of hepatitis, the process of replacement of liver cells with connective tissue occurs. It is weakly expressed, progresses slowly, and therefore sometimes remains undiagnosed until cirrhosis of the liver occurs. Chronic hepatitis is less treatable, and the prognosis for its cure is less favorable. In the acute course of the disease, health deteriorates significantly, jaundice develops, intoxication appears, the functional functioning of the liver decreases, and the bilirubin content in the blood increases. With timely detection and effective treatment of acute hepatitis, the patient most often recovers. When the disease lasts more than six months, hepatitis becomes chronic. The chronic form of the disease leads to serious disorders in the body - the spleen and liver enlarge, metabolism is disrupted, complications arise in the form of cirrhosis of the liver and cancer. 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.

Types of hepatitis

Hepatitis has several types: A, B, C, D, E, F, G, they are also called viral hepatitis, since they are caused by a virus.

Hepatitis A

This type of hepatitis is also called Botkin's disease. It has an incubation period lasting from 7 days to 2 months. Its causative agent, an RNA virus, can be transmitted from a sick person to a healthy person through poor-quality food and water, or contact with household items used by the sick person. Hepatitis A is possible in three forms, they are divided according to the severity 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 the source of the virus and is capable of infecting others.

Hepatitis B

This disease is also called serum hepatitis. Accompanied by an enlarged liver and spleen, joint pain, vomiting, fever, and liver damage. It occurs either in acute or chronic forms, which is determined by the state of the patient’s immunity. Routes of infection: during injections in violation of sanitary rules, sexual contact, during blood transfusions, and the use of poorly disinfected medical instruments. The duration of the incubation period is 50 ÷ 180 days. The incidence of hepatitis B decreases with 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 infected with the same disease again. It is not easy to cure HCV: after contracting hepatitis C in an acute form, 20% of patients recover, but 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 on their own and others do not. The chronic form of hepatitis C will not disappear on its own and therefore requires therapy. Diagnosis and treatment of the acute form of HCV is carried out by an infectious disease specialist, and the chronic form of the disease is carried out by a hepatologist or gastroenterologist. You can become infected during a plasma or blood transfusion from an infected donor, through the use of poorly processed medical instruments, through sexual contact, and a sick mother transmits the infection to her child. The hepatitis C virus (HCV) is rapidly spreading throughout the world; the number of patients has long 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. But this therapy is quite expensive, and therefore not everyone can afford it.

Hepatitis D

This type of hepatitis D is possible only with coinfection with the hepatitis B virus (coinfection is the 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. The route of infection is the entry of the disease virus into the blood of a healthy person from a virus carrier or a sick person. The incubation period lasts 20 ÷ 50 days. Externally, the course of the disease resembles hepatitis B, but its form is more severe. It can become chronic, later turning into cirrhosis. It is possible to carry out vaccination similar to that used for hepatitis B.

Hepatitis E

It is slightly reminiscent of hepatitis A in its course and transmission mechanism, since it is also transmitted through the blood. Its peculiarity is the occurrence of lightning-fast 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, since the risk of losing a child is close to 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 (fluid accumulation 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 urine and feces, as well as general intoxication of the body. Effective methods of treating hepatitis F have not yet been developed.

Hepatitis G

This type of hepatitis is similar to hepatitis C, but is not as dangerous because it does not contribute to the development of cirrhosis and liver cancer. Cirrhosis can only appear in cases of co-infection with hepatitis G and C.

Diagnostics

Viral hepatitis is similar in its symptoms to one another, just like some other viral infections. For this reason, it can be difficult to accurately diagnose a sick person. Accordingly, to clarify the type of hepatitis and the correct prescription of therapy, laboratory blood tests are required to identify markers - indicators 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, the examinations are repeated after a period of time.

How is hepatitis C treated?

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

The cost of drugs to combat the hepatitis virus is high; not everyone can buy them.
Taking certain medications 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 attacks 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 classic jaundice, and there is no pain in the area of the right hypochondrium. The presence of the virus can be detected no earlier than a couple of months after infection. Before this, the reaction of the immune system is completely absent and markers cannot be detected in the blood, and therefore genotyping is not possible. Another feature of HCV is that after entering the bloodstream 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 for several years without any symptoms, after which cirrhosis or a malignant tumor appears almost immediately. Moreover, in 85% of cases, the disease goes from an acute form to a chronic one. The hepatitis C virus has an important feature - a variety of genetic structure. In fact, hepatitis C is a collection of viruses, classified depending on their structural variants and divided into genotypes and subtypes. The genotype is the sum of genes encoding hereditary traits. So far, medicine knows 11 genotypes of the hepatitis C virus, which have their own subtypes. The genotype is designated by numbers from 1 to 11 (although genotypes 1 ÷ 6 are mainly used in clinical studies), and subtypes are designated by 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, the most common genotypes are the first to the third. The severity of the disease depends on the type of genotype; they determine the treatment regimen, its duration and the result of treatment.

How are HCV strains distributed across the planet?

Hepatitis C genotypes are distributed heterogeneously across the globe, and genotypes 1, 2, 3 can most often be found, and in certain 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.

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

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

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

age of patients. The chance of cure is much higher in young people;
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;
the magnitude of the viral load - the fewer viruses in the body at the time of treatment, the more effective the therapy;
the patient’s weight: the higher it is, the more complicated the treatment becomes.

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

Who is at risk for HCV infection?

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

patients receiving blood transfusions;
patients and clients in dental offices and medical institutions where medical instruments are improperly sterilized;
visiting nail and beauty salons can be dangerous due to unsterile instruments;
piercing and tattoo enthusiasts can also suffer from poorly processed tools,
there is a high risk of infection for those who use drugs due to repeated use of unsterile 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?

It was not for nothing that the hepatitis C virus was considered a “gentle” killer virus. It can remain silent for years, and then suddenly appear 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 that was used until 2013, combining injections of interferon and ribavirin, gave patients a chance of healing that did not exceed 40-50%. Moreover, 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 in the form of a drug under the Sovaldi brand, which included 400 mg of the drug. It was the first direct-acting antiviral drug (DAA) to combat HCV. The results of clinical trials of sofosbuvir pleased doctors with the effectiveness, which reached 85 ÷ 95% depending on the genotype, 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, which was later acquired by Gilead Sciences. From Michael’s last name, the substance he synthesized was named sofosbuvir. Michael Sofia 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 of the profit from the sale of the new effective product 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 DPP. As a result, Gilead's profits in just the first two years of sales of the drug many times covered 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 has proven to be so high that now almost no treatment regimen can do without its use. Sofosbuvir is not recommended for use as monotherapy, but when used in combination it shows exceptionally good results. Initially, the drug was used in combination with ribavirin and interferon, which made it possible to achieve a cure in just 12 weeks in uncomplicated cases. And this despite the fact that therapy with interferon and ribavirin alone 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 year of birth of ledipasvir;
2016 pleased with the creation of velpatasvir.

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

Harvoni, combining sofosbuvir 400 mg and ledipasvir 90 mg;
Epclusa, which included sofosbuvir 400 mg and velpatasvir 100 mg.

During therapy with daclatasvir, two different drugs, Sovaldi and Daklinza, had to be taken. Each paired combination of active ingredients was used to treat specific HCV genotypes according to treatment regimens recommended by EASL. And only the combination of sofosbuvir with velpatasvir turned out to be a pangenotypic (universal) drug. Epclusa cured all genotypes of hepatitis C with almost equally high effectiveness 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, which prevented the majority of patients from purchasing them. Monopoly high prices for products set by Gilead caused outrage and scandals, which forced patent holders to make certain concessions, granting some companies from India, Egypt and Pakistan licenses to produce analogues (generics) of such effective and popular drugs. Moreover, the fight against patent holders offering drugs for treatment at biasedly inflated prices was led by India, as a country where millions of chronic hepatitis C patients live. As a result of this struggle, Gilead issued licenses and patent developments to 11 Indian companies to independently produce first sofosbuvir, and then its other new drugs. Having received licenses, Indian manufacturers quickly began producing generics, assigning their own trade names to the drugs they produced. This is how generics Sovaldi first appeared, then Daklinza, Harvoni, Epclusa, and India became the world leader in their production. Indian manufacturers, under a licensing agreement, pay 7% of earnings to patent holders. But even with these payments, the cost of generics produced in India turned out to be tens of times less than the originals.

Mechanisms of action

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

Sofosbuvir blocks RNA polymerase, thereby inhibiting viral replication.

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

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

Manufacturers of generics from India

Pharmaceutical companies in the country have taken advantage of the licenses granted to them, and now India produces the following generic Sovaldi:

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

Analogs of Daklinza are also made in India:

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

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

Ledifos - released by 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 the pharmaceutical company 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 their newly developed drugs, while observing all qualitative, quantitative and medicinal characteristics. Maintaining, among other things, pharmacokinetic bioequivalence in relation to the originals.

Requirements for generics

A generic is a drug that, based on its basic pharmacological properties, can replace treatment with expensive original drugs with a patent. They can be produced either with or 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 the production technology for them, giving the license holders the right to an independent pricing policy. In order for a drug analogue to be considered a generic, it must meet a number of parameters:

It is necessary to observe the ratio of the most important pharmaceutical components in the drug according to qualitative as well as quantitative standards.

Compliance with relevant international standards should be adhered to.

Proper production conditions are required.

The preparations should maintain the appropriate equivalent absorption parameters.

It is worth noting that the WHO is guarding 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 generic drugs for hepatitis C, although they have also mastered the production of sofosbuvir analogues. True, the bulk of the analogues they produce are unlicensed:

MPI Viropack, produces the drug Marcyrl Pharmaceutical Industries - one of the very first Egyptian generics;

Heterosofir, produced by Pharmed Healthcare. Is the only licensed generic in Egypt. There is a code hidden on the packaging under the hologram that allows you to check the originality of the drug on the manufacturer’s website, thereby eliminating its counterfeit;

Grateziano, manufactured by Pharco Pharmaceuticals;

Sofolanork produced by Vimeo;

Sofocivir, manufactured by ZetaPhar.

Generics to fight hepatitis from Bangladesh

Another country producing large volumes of generic anti-HCV drugs is Bangladesh. 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 medications without having the appropriate licensing documents. The most famous and equipped with the latest technology is the pharmaceutical company Beacon Pharmaceuticals Ltd. The design of its production capacity was created by European specialists and meets international standards. Beacon produces the following generics for the treatment of hepatitis C virus:

Soforal is a generic version of sofosbuvir, containing 400 mg of active substance. Unlike traditional packaging in bottles of 28 pieces, Soforal is produced in the form of blisters of 8 tablets in one plate;
Daclavir is a generic version of daclatasvir, one tablet of the drug contains 60 mg of the active substance. It is also produced in the form of blisters, but each plate contains 10 tablets;
Sofosvel is a generic version of Epclusa, containing sofosbuvir 400 mg and velpatasvir 100 mg. A pangenotypic (universal) drug, effective in the treatment of HCV genotypes 1 ÷ 6. And in this case, there is no usual packaging in bottles, the tablets are packaged 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, you must take a tablet of each type. And Beacon combined them into one pill. Darvoni is packaged in blisters of 6 tablets in one plate and sent for export only.

When purchasing medications from Beacon for a course of therapy, you should take into account the originality of their packaging in order to purchase the quantity required for treatment. The most famous Indian pharmaceutical companies As mentioned above, after the country's pharmaceutical companies received licenses to produce generics for HCV therapy, India has become a world leader in their production. But among the many companies, it is worth noting a few whose products are the 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 people 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 Hyderabad with an initial capital of 3.3 million rupees, then the number of employees was 20 people. Now in India, 3.5 thousand people work at five Natco enterprises, and there are also branches in other countries. In addition to production units, the company has well-equipped laboratories that allow it to develop modern medications. Among her own developments, it is worth noting drugs to combat cancer. One of the most well-known drugs in this area is Veenat, produced since 2003 and used for leukemia. And the production of generics for the treatment of hepatitis C virus is a priority area of activity for Natco.

Hetero Drugs Ltd.

This company has set its goal to produce generics, subordinating its own network of production facilities, including factories with branches and offices with laboratories. Hetero's production network is designed to produce medicines under licenses received by the company. One of its areas of activity is medications that help fight serious viral diseases, the treatment of which has become impossible for many patients due to the high cost of original drugs. The acquired license allows Hetero to quickly begin producing generics, which are then sold at a price affordable 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 that has set as its goal the creation of a healthy society, which, according to its owners, will be followed by a positive change in the quality of life of 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 production volumes on the Indian pharmaceutical market. In addition, 16 of its drugs were included in the list of 300 most important drugs of the Indian pharmaceutical industry. Zydus products are in demand not only on the domestic market; they can be found in pharmacies in 43 countries on our planet. And the range of drugs produced at 7 enterprises exceeds 850 drugs. One of its most powerful production facilities is located in the state of Gujarat and is one of the largest not only in India, but also in Asia.

HCV therapy 2017

Hepatitis C treatment regimens for each patient are selected by the doctor individually. To correctly, effectively and safely select a regimen, the doctor needs to know:

virus genotype;
duration of illness;
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 series of tests, the doctor, based on EASL recommendations, selects the optimal treatment option. EASL recommendations are adjusted from year to year, with newly introduced drugs being added to them. Before new treatment options are recommended, they are submitted to Congress or a special session. In 2017, a special EASL meeting in Paris considered updates to the recommended schemes. The decision was made to completely stop using interferon therapy in the treatment of HCV in Europe. In addition, there is not a single recommended regimen left that uses one single direct-acting drug. Here are several recommended treatment options. All of them are given for informational purposes only and cannot become a guide to action, since the prescription of therapy can only be given by a doctor, under whose supervision it will then be carried out.

Possible treatment regimens proposed by EASL in case of hepatitis C monoinfection or concomitant HIV+HCV infection in patients who do not have cirrhosis and have not previously been treated:

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

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

during 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.

during therapy genotype 4 You can use without ribavirin for 12 weeks:

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

EASL recommended treatment regimens for hepatitis C monoinfection or concomitant HIV/HCV infection in patients with compensated cirrhosis who have not previously been treated:

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

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

during therapy genotype 2 apply:

- sofosbuvir + dklatasvir without ribavirin the duration is 12 weeks, and with ribavirin in case of poor 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 period is 12 weeks; - as an option, sofosbuvir + velpatasvir is possible for 24 weeks, but without ribavirin.

during 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, by the combination of prescribed medications chosen by the doctor. In addition, the duration of treatment depends on the combination chosen by the physician.

Treatment with modern drugs for HCV

Take tablets of direct antiviral drugs as prescribed by a doctor orally once a day. They are not divided into parts, not chewed, but washed down with plain water. It is best to do this at the same time, this way a constant concentration of active substances in the body is maintained. There is no need to be tied to the timing of meals, the main thing is not to do it on an empty stomach. When you start taking medications, pay attention to how you feel, since during this period it is easiest to notice possible side effects. DAAs themselves do not have very many of them, but drugs prescribed in combination have much less. Most often, side effects appear as:

headaches;
vomiting and dizziness;
general weakness;
loss of appetite;
joint pain;
changes in biochemical blood parameters, expressed in low hemoglobin levels, a decrease in platelets and lymphocytes.

Side effects are possible in a small number of patients. But still, all noticed ailments should be reported to the attending physician so that he can take the necessary measures. To avoid increased side effects, alcohol and nicotine should be avoided, 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 drug ingredients;

patients under 18 years of age, since there is no accurate data on their effect on the body;

women carrying a fetus and breastfeeding babies;

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

Storage

Store direct-acting antiviral drugs in places inaccessible to children and out of direct sunlight. Storage temperature should be in the range of 15 ÷ 30ºС. When starting to take medications, check their production and storage dates indicated on the packaging. Expired medications should not be taken. How to purchase 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 to produce drugs, prudently banned their export to many countries. Including all European countries. Those wishing to purchase budget Indian generics to combat hepatitis C can use several options:

order them through Russian online pharmacies and receive the goods in a few hours (or days) depending on the delivery location. 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 there will be the need to communicate with the seller in English;
go to India and bring the drug yourself. This will also take time, plus the language barrier, plus the difficulty of checking the originality of the product purchased at the pharmacy. Added to this is the problem of self-export, which requires 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, delay is like death, and therefore you should not delay the start of the procedure.