Principles of organizing psychological and psychotherapeutic care for patients with viral hepatitis. Psychological assistance to patients with viral hepatitis

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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 progression of the disease, clinical manifestations, methods and prognosis of therapy. Even the symptoms various types hepatitis is 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 infection liver, and also if there has been poisoning different types poisons In acute forms of the disease, the condition of patients quickly deteriorates, which contributes to accelerated development symptoms.

With this form of the disease it is quite possible favorable forecasts. 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, a replacement process occurs connective tissue liver cells. 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 addiction, 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 with violation sanitary rules, sexual intercourse, during blood transfusion, 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 diseases are among the most serious illnesses, 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 acute form HCV is carried out by an infectious disease specialist, chronic forms of the disease are 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 antiviral drugs direct action. 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). He is accompanied by mass destruction liver and acute course diseases. Routes of infection - entry of the disease virus into the blood 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 lightning-fast forms, causing fatal outcome for 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 (accumulation of fluid in 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 others 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 impact. 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.
Reception individual drugs 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 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 malignant tumor. Moreover, in 85% of cases, the disease goes from an acute form to a chronic one. The hepatitis C virus has important feature– diversity of genetic structure. In fact, hepatitis C is a collection of viruses, classified depending on their structural variants and divided into genotypes and subtypes. 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 in clinical studies They mainly use genotypes 1 ÷ 6), and subtypes using 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 in different ways, for example, in Russia the most common ones can be found from 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?

By territory globe hepatitis C genotypes are distributed heterogeneously, and most often you can find genotypes 1, 2, 3, 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.

In the risk zone of possible HCV infection there are people with blood diseases (tumors of the hematopoietic system, hemophilia, etc.), as well as patients undergoing treatment in dialysis units. 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;
magnitude viral load- the fewer viruses there are 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 supports its recommendations in current state 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 most likely can 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. Results clinical trials sofosbuvir pleased doctors with its 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, the profit from the sale of new effective means almost all of it 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 integrated use it shows exclusively 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 names to the drugs they produced. trade names. 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. While interferon with ribavirin, previously used for treatment, increased immune system human, 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 healing characteristics. Maintaining, among other things, pharmacokinetic bioequivalence in relation to the originals.

Requirements for generics

A generic is a drug that is capable of pharmacological properties replace treatment with expensive original medicines 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 last word technology is the pharmaceutical company Beacon Pharmaceuticals Ltd. Project production capacity it 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- complex drug, combining 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 sick people. chronic form 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 combat serious viral diseases, the treatment of which has become impossible for many patients due to high costs original medicines. 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 in terms of production volumes in Indian pharmaceutical market is in fourth place. 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 best option therapy. 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 in Europe when HCV treatment interferon therapy. 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 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 another 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 in the body is maintained. active substances. 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 all the same, all noticed ailments should be reported to the attending physician for treatment. 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 antiviral drugs direct action in places inaccessible to children and direct action sun rays. 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 on English language;
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 one possible options delivery 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.

In terms of its organization and characteristics of the patient population, an infectious diseases hospital is qualitatively different from all other medical institutions, primarily due to the contagiousness of infectious diseases. The largest proportion of those hospitalized in infectious diseases hospital patients are patients with viral hepatitis (VH). Despite the trend towards an increase in the proportion of patients with CH who are treated on an outpatient basis, most often CH requires inpatient treatment - both for clinical and epidemiological reasons.

The majority of patients with CH are persons young. In addition, the illness lasts relatively short; mild forms of its flow predominate. In many cases, restoration of well-being precedes clinical recovery. All this determines a certain specificity of psychological difficulties that infectious disease specialists increasingly have to face when treating patients with CH.

Quite common are various options inadequate attitude of patients towards their illness and treatment. Sometimes neurotic reactions, a tendency to exaggerate the severity of the disease, and fears due to its “contagiousness” are observed. But the opposite picture is more common - underestimation of the danger of the disease, refusal of therapy and hospital stay. There are also quite unique views of patients on treatment - confidence in the need for more wide application medications, or vice versa - thoughts about the supposedly harmful side effects of certain medications. In any case, when the patient's perception of the situation associated with the disease does not correspond to reality, there is a threat to the mutual understanding between the doctor and the patient, which, in the end, negatively affects the completeness of treatment and increases the risk of complications and adverse consequences.

The study of behavioral and psychological changes in patients with CH, which we conducted at the regional clinical infectious diseases hospital in Kharkov, allowed us to present some considerations regarding the solution of these issues.

We believe that in the hepatitis departments of an infectious diseases hospital there is a permanent need for psychological “support” healing process and the need for qualified psychocorrectional work. Refusal of patients from certain therapeutic and diagnostic measures, violation of the treatment regimen, various conflict situations in the department - this is not a complete list of problems, the solution of which requires a professional approach. Persons with mental and behavioral disorders due to drug use require special attention. psychoactive substances, the proportion of which among patients with CH in Lately has grown significantly.

However, despite this, in practical work As an infectious disease specialist, the psychological factors of medical work still seem insignificant. At the same time, the competence of a consultant psychiatrist in an infectious diseases hospital has traditionally been only acute psychotic conditions. As a result, borderline mental disorders, as well as a wide range of patient’s psychological reactions to the disease, most often remain unattended by clinicians.

How should counseling psychological assistance be provided in an infectious diseases hospital? In our opinion, in hospitals with a significant number of patients with CH, there is a need to introduce a full-time position of a medical psychologist or psychotherapist (when carrying out planned advisory work, one will have to deal primarily with preclinical mental disorders and use almost exclusively psychotherapeutic methods for correcting these disorders).

The main part of the advisory work should be advice and recommendations to infectious disease doctors regarding the development of tactics for managing “problematic” diseases. psychologically sick. In cases where the existing behavioral reactions are meaningfully related to the CH disease and the treatment situation (for example, increased anxiety because of possible consequences or vice versa, refusal of treatment after the disappearance of jaundice and improvement of well-being), the infectious disease specialist must carry out psychocorrective measures independently. In this case, the advisory assistance of a psychotherapist or psychologist should be carried out indirectly, according to the principle of supervision (supervision).

A consultant should work directly with a patient only in a situation where a mental disorder (primarily a neurotic level disorder) is in the nature of a concomitant psychoneurological pathology; At the same time, the patient must also have a positive attitude towards psychological counseling. But even in such cases, the therapeutic task of the consultant should be not so much the treatment of the mental disorder itself, and especially not long-term psychotherapeutic measures, but to help the patient complete the most important task. this moment- treatment of an infectious disease and confronting obstacles that may be caused by psychological and behavioral disorders along the way.

Thus, it is necessary to emphasize the main goal of psychocorrectional measures in hepatitis departments - this is the maximum assistance in the treatment of the underlying (infectious) disease, the primary identification and correction of precisely those disorders that jeopardize the adequacy of the patient’s position regarding treatment and compliance with dietary and regime restrictions.

It should be noted that in the event of psychotic disorders in patients, the psychotherapist can also recognize them in a timely manner (during routine counseling work) and raise the question of the need for hospitalization in a psychiatric hospital.

Thus, the need to provide professional-level psychological and psychotherapeutic care in hepatitis departments is obvious. And this should not only solve a wide range of practical everyday issues, but will also contribute to the development of an integrative, systemic approach, which is becoming increasingly necessary in a wide network of general somatic medical institutions.

Literature

Andreichin M. A. Questions of deontology in the work of an infectious disease specialist // Therapeutic archive. - 1984. - T. 56, No. 9. - P. 112–114.
Shkurba A.V. Nutritional tactics for treating patients with viral hepatitis // Current nutritional clinical infectology: Materials from the Infectionists of Ukraine. - Ternopil: Ukrmedkniga, 1998. - P. 81.
Raas B.K.M. Consultative psychiatry: the contribution of psychiatry to the diagnosis and treatment of patients in a general hospital // Social and clinical psychiatry. - 1997. - T. 7, No. 2. - P. 42–46.

Hepatitis in medicine refers to acute and chronic diffuse inflammatory diseases liver, which can be of different nature.

The most common form of hepatitis is viral hepatitis A. The disease is characterized by a long incubation period (from 1 week to 1.5 - 2 months); the main sources of infection are low-quality food products, dirty hands, direct contact with things belonging to the patient.

Hepatitis B is very dangerous. Ways of transmission of the disease: sexually, through blood, through injections of non-sterile syringes. Hepatitis B leads to severe liver damage, its symptoms are presented high temperature, increased size of the spleen, liver, vomiting, nausea, intense and severe pain in the joints.

One of the most severe forms of hepatitis is hepatitis C. With this inflammatory process, liver cancer and cirrhosis often occur. Probable method infections - blood transfusions using unsterile syringes, promiscuity, transmission of infection to the fetus from a sick mother.

Speaking about hepatitis E, it should be noted that the manifestations of the disease are similar to the symptoms of hepatitis A. In severe forms of the disease, not only the liver is affected, but also the kidneys.

Determining the psychological causes of hepatitis

If a person encounters inflammatory process liver of any etiology, it will be useful for him to learn more about the psychological causes of hepatitis. All liver dysfunctions are associated with a person’s inability to accept what is happening to him, his unwillingness to calm down and understand his problems.

Patients with hepatitis are usually aware that something is going wrong in their lives, but they avoid changes in every possible way, mistakenly believing that any changes will make things worse. Such people are prone to prolonged depression, they see the world in gray and black colors, they rarely strive for anything and really want something.

Hepatitis – serious illness, for the treatment of which very serious measures will have to be taken. Patients suffering from hepatitis need to completely rebuild their consciousness: you must learn to be positive, trust the Universe, and get carried away with something to the point of excitement and admiration.

The liver is an organ in which resentment and anger accumulate. If the liver is damaged or destroyed, it means that there are so many negative emotions that they urgently need a way out.

Undoubted benefit for get well soon will bring the ability to express your emotions. Sometimes it is better to show your dissatisfaction right away than to hold back and then keep the negativity within yourself for months and even years.

Repeating the following healing phrases will help cope with the psychological causes of hepatitis:

“I let go of all resentment and anger.”
"I'm staying positive."
“I enjoy life, I look forward to every new day with impatience and joy.”
“I know how to show my emotions, I don’t keep them inside me.”

Copying materials from the publication “How to treat hepatitis at home: eliminating the psychological causes of the disease” is permitted provided that an active link to the site about the causes of disease development “Good Habits” is indicated.

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Among the ancient Chinese, the liver was considered the seat of the soul, and the Babylonians predicted fortunes by reading fortunes on the liver. In the human body there is not a single metabolic function that is not directly or indirectly related to the liver, therefore it is rightly called a biochemical laboratory, and if liver disease occurs, this necessarily affects the metabolism of proteins, fats, carbohydrates, mineral salts and vitamins.

Symptoms and course.

Hepatitis- This inflammatory disease liver. Hepatitis can be acute or chronic.
The spread of viral hepatitis on the planet is acquiring the character of a medieval epidemic. According to World Organization healthcare, every third inhabitant of the planet is infected with this insidious virus.
The mechanism of development of acute hepatitis is either direct damage to the liver or immunological disorders, when the body itself begins to destroy cells of its own liver.
Chronic hepatitis is a long-term (more than 6 months) liver disease. Among chronic diseases liver chronic hepatitis is the most common.
Chronic hepatitis is characterized by liver enlargement, pain or a feeling of heaviness, fullness in the right hypochondrium, dyspeptic symptoms; jaundice is less common, itchy skin, temperature increase. Liver enlargement occurs in approximately 95% of patients, but in most cases it is moderate. The pain in the liver area is not severe, but constant.
Often there is a decrease in appetite, belching, nausea, poor tolerance to fats, alcohol, flatulence, unstable stools, general weakness, decreased ability to work. A third of patients have slight jaundice.

It has been noticed that exacerbation of hepatitis often provokes physical or psycho-emotional stress, therefore the regimen of a child suffering from chronic hepatitis should be gentle at first, and then gentle-training. Prolonged mental stress and uncontrolled viewing of television programs also have an adverse effect on the condition. Nutrition for chronic hepatitis should be complete, sufficiently high in calories and excluding substances that irritate the liver. You should eat 4-5 times a day, in small portions and at strictly established times. The food should be warm. Dishes and drinks from the refrigerator or directly from the fire are unacceptable in the diet. The following are strictly prohibited: meat, fish, eggs, as well as broths made from them; margarine, spicy and fried foods; smoked meats; herbs and spices; beans and others legumes; mushrooms and broths made from them; chocolate and chocolate candies; confectionery with cream; canned food; products containing food coloring. Fresh onions and garlic are significantly limited.
Healthy: vegetables and fruits; boiled onion; milk and dairy products; cottage cheese; not refined vegetable oil(sunflower, corn, olive, etc.). You can eat both wheat and rye bread, but not fresh, but dried. Among easily digestible carbohydrates, marmalade, jam, and honey are recommended. Products must be steamed or boiled.
Psychosomatic causes of hepatitis:

Resistance to change.
Focusing anger and primitive emotions.
Justification of one's own pickiness and self-deception.

In order to understand more clearly psychosomatic reasons this disease, let's remember the functions of the liver.
Functions of the liver in the body:
1. Detoxification (cleansing the blood of toxins). On the subtle (psychological plane) this is the ability or ability to distinguish. The developed human mind allows us to distinguish useful from harmful, good from bad. In addition, the ability to discern implies not just theoretical reasoning, but the ability to ACT in the way that is necessary and useful at the moment.
A person's ability to distinguish between good and evil, as well as the ability to follow good, abstain from evil and overcome difficulties with the help of a strong will is the most best therapy for consciousness. The causes of many diseases lie deep in the mind, so it is wise to first eliminate the subtle mental causes of the disease, and then apply drug therapy.
When every girl gets married, of course, she hopes that she and her husband will have children, but she cannot count on them appearing the day after the wedding. Once married, she can, of course, try to have children, but to do this she must rely on her husband, firmly believing that due date will definitely give birth to a child. Likewise, anyone (especially someone suffering from hepatitis) should be prepared to follow with confidence, as the song sang “...the path of goodness,” from today. Ancient wisdom says:
“...he who does good deeds is not in danger of death either in this life or in the next. O My friend, evil will never overcome one who does good.”

2. The liver reacts very sensitively to excess. For example. Abuse fatty foods or alcohol, leads to a reaction from the liver. In other words, the liver in our body is an indicator of measure.
The purpose of man is to live simply and think loftily. To maintain life in the body, we need food, clothing, money, etc., but we should not accumulate more than is necessary to satisfy our immediate needs. If you adhere to this natural principle, then maintaining existence will not be difficult at all.
Nature has decreed that living beings at lower levels of the evolutionary ladder never eat or collect more than necessary. That is why, as a rule, there are no economic problems in the animal world; there is enough for everyone there. If you leave a bag of rice on the street, the birds will fly in, peck at a few grains and fly away, and the person will take the whole bag with him. He will eat as much as his stomach can accommodate, and leave the rest in reserve. Therefore, a person does not need to take more than he needs. Violation of this principle is the cause of many diseases.

3. Since not understanding the measure and, as a result, the pursuit of what does not belong to me, what is not allocated to me as my share, takes up practically all the time, such a person does not show interest in self-awareness. Therefore, the liver tells us that time is wasted on trifles, on things that will not bring real benefit. Man is endowed developed intellect allowing him to understand the world and myself. Unfortunately, the so-called civilized man, without the slightest interest in self-realization, uses his mind to get more than he needs and eats only to satisfy the tongue. Nowadays, so-called intelligent people use their intelligence to create useless and even harmful things. Thanks to the perfect structure of the world, everyone, depending on his true needs, is given the opportunity to receive his due share of material values, and thus all people can live in peace and harmony if they are guided by the principle “Live simply and think high.”

The question of how to live with hepatitis C worries many people who, after taking tests, are faced with this insidious disease. Often a chronic illness does not manifest itself in any way, and the diagnosis becomes a real blow for the person. It seems that life is ending. Meanwhile, experts recommend not to isolate yourself and not stop communicating with the outside world, because even those with hepatitis C can live a long and happy life. In order not to become isolated from society, you just need to not refuse the help of doctors and follow a number of rules.

Medical support

Every person with hepatitis C virus positive must remember the main thing: for now dangerous illness incurable. And although there is a certain percentage of people in the world who have successfully gotten rid of pathology, this is not a reason to consider the therapy offered modern medicine, effective. But one should not despair: pharmaceuticals are improving and offering more and more new medications for patients with hepatitis C. Already today, many medications are being tested and tested.

Taking this into account, every person suffering from a dangerous illness should maintain constant contact with a specialized specialist. The first action that needs to be taken after diagnosis is to find a good one. You will have to communicate with him for many years, so it is necessary that the doctor’s professional knowledge is not in doubt. Both the patient’s life expectancy and its quality will depend on them.

In the treatment of hepatitis C, even the slightest nuance is important, so a person faced with an insidious disease, you need to carefully monitor your condition, noting any seemingly minor changes. It is advisable to keep a thick notebook and record all your feelings in it. It is these observations that will allow the doctor to adjust the prescription of medications in the future. Their admission is mandatory.

The main danger of hepatitis C is its degeneration into cirrhosis or liver cancer. To prevent this from happening, it is necessary to use hepatoprotectors and other drugs that suppress the proliferation of viruses in the body. But here another problem arises: most medications intended to treat liver pathologies are expensive. Not every person can afford to use them for several months, or even years. What to do if there is no money to purchase medicines?

There are several options for solving the problem that need to be considered in detail.

Budget-friendly treatment options for hepatitis C

Is it possible to cure viral hepatitis C without using medications? The answer is most likely negative, but in the absence of finances to purchase traditional drugs, even the use of funds traditional medicine will help strengthen the liver and maintain its functionality. Recipes for decoctions and infusions medicinal plants There are many that experts recommend taking to improve the condition of hepatitis C.

They are mainly used because they have anti-inflammatory and cleansing properties, allowing the removal of toxins and waste products from the liver. This:

oats;
dandelion root;
nettle;
licorice.

Even ordinary carrot juice capable of becoming good remedy combating pathology to maintain quality of life.

The second treatment option, which is often used when there is no money for treatment, is the use of generics (analogs of original drugs). The choice of such medications must be entrusted to a doctor. It is he who will recommend products that will be relatively cheap in cost, but quite effective in impact.

Another way to reduce the cost of treating this insidious disease is through regional programs created specifically for patients with hepatitis C. Therapy will be carried out using free drugs allocated according to a quota. But, as practice shows, many people have to wait for such medicines for many months, because there are more than a million patients in Russia who need free treatment.

What rules to follow

Not a single medicine, much less folk remedy, will not help if a person does not comply certain rules. The main ones:

If a person lives in a family, his loved ones must do everything so that he does not feel like an outcast. Family support is one of the main components successful treatment. But the patient, in turn, must take care not to harm the people around him.

Points to remember in any case:

The most difficult thing to protect from injury is young children, who due to their activity have a high risk of skin damage. But if a child is sick with hepatitis C, parents should do everything possible to protect the baby from trouble as much as possible.

Lifestyle with hepatitis C is one of the most important factors determining the patient’s well-being. In order not to aggravate the course of the disease, a person will have to give up many familiar things. Not everyone is able to do this without getting depressed. Patients need high-quality moral support throughout their lives, and not just after diagnosis.

In many countries, people with hepatitis C are not left alone with this insidious disease. There are support groups where patients can communicate with their fellow sufferers and cheer each other up.

This allows them not to feel abandoned. Psychologists and psychotherapists provide great help, preventing patients from becoming depressed and supporting their desire for recovery.

In Russia, this practice is not yet very developed. But there is a way out: you can find fellow sufferers on the Internet, visiting special forums and medical sites. People suffering from hepatitis C become like-minded people and help each other to overcome not only a dangerous illness, but also the hardships necessary to cure or maintain the quality of life at the proper level.

Hepatitis C is rarely detected at an early stage. He long time It is asymptomatic, so many people find out about their illness only when the liver is significantly damaged. But even in this case, you cannot give up, because life after diagnosis is not only possible, but can also last until old age.