Is hepatitis C a common disease?
Professor Xing Huichun: Hepatitis C is a worldwide epidemic disease caused by hepatitis C virus infection. According to the statistics of the World Health Organization, the global infection rate of hepatitis C virus is about 2.8% (about 654.38+85 million people worldwide are infected), resulting in about 350,000 deaths every year. Because of the concealment of hepatitis C, most infected people do not know that they have been infected with hepatitis C virus. So the exact infection rate of hepatitis C virus in the world is still uncertain. According to the data of "Guidelines for the Prevention and Treatment of Hepatitis C (updated in 20 15 years)", the infection rate of hepatitis C virus among people aged 1-59 in China in 2006 was 0.43%, and it is estimated that there are about100000 infected people in China.
: What are the transmission routes of hepatitis C?
Professor Xing Huichun: Hepatitis C is a disease mainly caused by blood transmission. The main transmission routes are: (1) blood transfusion and blood products; (2) Transmission through damaged skin and mucous membrane (including the use of non-disposable syringes and needles, acupuncture without strict disinfection products or invasive operations, such as intravenous drugs, razors, toothbrushes, tattoos, pierced earrings, etc.) are all ways to cause hepatitis C virus to spread through blood; (3) Sexual contact transmission, especially sexual partners or same-sex partners, is more dangerous to be infected with hepatitis C virus; (4) Mother-to-child transmission.
Can daily contact infect hepatitis C? Is there a vaccine for hepatitis C?
Professor Xing Huichun: At present, there is no vaccine to prevent hepatitis C, but ordinary daily contact such as courtesy kissing, hugging, sneezing, coughing, food, drinking water, using tableware and cups, and contact without skin damage and other blood contact generally will not spread hepatitis C virus. Therefore, it goes without saying that hepatitis C is discolored.
: Can hepatitis C still have children?
Professor Xing Huichun: Clinical practice in recent years has confirmed that hepatitis C is a curable disease. If the patient does not progress to cirrhosis, but is infected with hepatitis C virus or hepatitis, after effective antiviral treatment, the virus can be eliminated and liver inflammation can disappear. After being cured, you can have children like normal people. At present, there is no hepatitis C vaccine, and mothers with high viral load may spread the virus to their newborns. Therefore, if the patient is in childbearing age, active antiviral treatment should be carried out first, and after the virus is cleared and hepatitis C is cured, the birth should be arranged in time.
What are the symptoms of hepatitis C? Does every patient have symptoms?
Professor Xing Huichun: No matter acute hepatitis C or chronic hepatitis C, there may be general weakness, loss of appetite, nausea, right rib pain and so on. A few patients may have low fever and mild hepatomegaly, some patients may have splenomegaly, and a few patients may have jaundice. If it develops into cirrhosis or decompensation of liver function, serious complications such as ascites, upper gastrointestinal bleeding and hepatic encephalopathy may occur. However, most patients have no obvious symptoms in the early stage (that is, although they have been infected with the virus, they do not feel unwell); Even if you are a little tired or have a poor appetite, you are rarely considered to have liver disease. Some patients have developed liver cirrhosis, which may not be particularly uncomfortable, often found during physical examination, or because of other diseases.
: Can hepatitis C lead to cirrhosis? Will it lead to liver cancer?
Professor Xing Huichun: Hepatitis C can be divided into acute and chronic. Most acute hepatitis C virus infections are naturally eliminated by the body within 3 months, and if they are not eliminated after 6 months, they will turn into chronic hepatitis C (the chronic rate is 55% ~ 85%). Chronic hepatitis C is in a state of slow progress. About 20 years after infection, about 2% ~ 15% people will develop cirrhosis. Alcoholism or other viral infections or obesity and diabetes will promote the progress of liver disease and further develop into liver cancer. After the development of cirrhosis, the incidence of liver cancer is 2% ~ 4% every year.
Can hepatitis C virus damage organs other than the liver?
Professor Xing Huichun: Hepatitis C virus can not only damage the liver, but also damage organs other than the liver, such as rheumatoid arthritis, dry eye, lichen planus, glomerulonephritis, mixed cryoglobulinemia, B-cell lymphoma, and delayed cutaneous porphyria.
Is hepatitis C an easily diagnosed disease? Can the physical examination find out?
Professor Xing Huichun: The diagnosis of hepatitis C must have a clear etiology and syndrome, that is, anti -HCV is positive and HCV RNA is positive to diagnose hepatitis C virus infection. According to the general state of liver function and physical examination, determine whether the patient is hepatitis, cirrhosis or accompanied by extrahepatic damage. Anti-HCV testing is a screening for HCV infection. If it is positive, HCV RNA should be further examined. If only anti -HCV is positive, HCV RNA can not be detected by highly sensitive methods, which in most cases indicates previous infection. Only when HCV RNA is positive can it be diagnosed as the current infection of hepatitis C virus. Routine physical examination does not check anti -HCV, so it is impossible to find out whether there is hepatitis C, but it is included in the physical examination of special industries (such as catering, nursing, joining the army, etc.). ), the physical examination when preparing for blood donation and the examination when the hospital is preparing for surgery, whether there is hepatitis C virus infection can be found.
Should I start taking medicine immediately after discovering hepatitis C virus?
Professor Xing Huichun: China's "Guidelines for the Prevention and Treatment of Hepatitis C" 20 15 points out: "All patients with positive hepatitis C virus nucleic acid should receive antiviral treatment as long as they have the willingness to treat and have no contraindications for treatment. However, in the case of limited medical resources, some patients should be given priority treatment on the basis of considering the patient's wishes, patient's condition and drug accessibility. " At present, the domestic antiviral treatment scheme is still mainly interferon combined with ribavirin, both of which have certain side effects. It is necessary to determine whether the patient has contraindications to antiviral treatment before determining the treatment scheme.
It is said on the Internet that eating "Ji Er" can cure hepatitis C, is it true? How many patients can be cured? How long will it take?
Professor Xing Huichun: "Jidaier" is the generic name of a compound preparation for the treatment of hepatitis C, which is the two links that directly inhibit the virus replication process and achieve the purpose of eliminating the virus. It's an oral medicine, one tablet a day/kloc-0. The course of treatment is about 12 to 24 weeks depending on the virus genotype and whether there is cirrhosis. Generally speaking, the side effects are small and the curative effect is good. According to foreign literature, 93%-99% of the patients' virus was controlled after stopping drug 12 weeks. But at present, the drug has not been listed in China, so the main antiviral treatment scheme for hepatitis C in China at this stage is still pegylated interferon (or common interferon) combined with ribavirin. According to foreign literatures, the effective rate for genotypes 1b and 2a (the majority of patients in China are these two genotypes) can reach 54% (44%)-82% (whereas most patients with hepatitis C in China are foreigners because of their genetic characteristics). The data show that 99% of patients who are still effective after stopping drug 12 weeks can be cured.
If cirrhosis has occurred, is it too late to take medicine? Can it be reversed?
Professor Xing Huichun: Literature shows that patients with obvious liver fibrosis and cirrhosis can significantly reduce the incidence of abnormal liver function and liver cancer after effective antiviral treatment, and the virus can not be detected (commonly known as negative). Foreign data show that the overall SVR rate of hepatitis C patients with gene 1b is 93%-99%. However, if the treatment is started only when there is obvious liver fibrosis or cirrhosis, the effective rate will be significantly reduced.
Is this medicine expensive? Can medical insurance be reimbursed?
Jier is one of the drugs that directly resist hepatitis C virus. In addition, there are many kinds and they are still increasing. At present, there are at least seven anti-hepatitis C drugs (schemes) that do not need interferon. But at present, no such drug has been approved for listing in China. At present, the drugs used by patients we see are all obtained from abroad through various channels, which are expensive. It cannot be reimbursed at present. Maybe there will be drugs listed in China later this year, which will benefit the majority of hepatitis C patients.
What are the side effects of taking medicine?
Professor Xing Huichun: The side effects are not obvious and the incidence is low. Such as fatigue, headache, nausea, diarrhea, insomnia and so on. Most of them do not affect the treatment. However, attention should be paid to the interaction with other drugs during medication (such as not being combined with rosuvastatin and amiodarone). In addition, the second generation of Kyrgyzstan cannot be used when there is serious renal damage.
How often should I check during taking the medicine?
Professor Xing Huichun: The efficacy and safety of patients should be monitored during treatment. A highly sensitive method should be used to detect the number of hepatitis C virus. Generally, the test should be conducted at the time of treatment and the 4th week, 12 week, at the end of treatment and 12 or 24 weeks after treatment. Liver function, renal function and blood routine should be monitored regularly; In addition, it is necessary to monitor the changes of tumor indicators every six months and be alert to the possibility of tumor occurrence.
: What do you mean, cured? Are you sure it won't recur?
Professor Xing Huichun: In the treatment of hepatitis C, there is a concept called persistent virological response rate (SVR), which usually means that after stopping treatment 12 weeks, no virus can be detected in blood by highly sensitive methods. In this case, 99% of patients were cured. 48 weeks after drug withdrawal, the virus could not be detected by highly sensitive method, suggesting that it has been cured. For patients with viral hepatitis C, the cure of viral infection is almost equal to the cure of hepatitis C, but for patients with hepatitis C cirrhosis, even if the hepatitis C virus infection is cured, it is necessary to detect possible problems such as liver decompensation or liver cancer every six months. For persistent high-risk groups, such as intravenous drug users who have not been detoxified, even if they are cured at this time, the possibility of reinfection cannot be ruled out, so it is still necessary to monitor the possible reinfection of hepatitis C virus.
Client question: Good expert: My mother was infected with liver disease in a local hospital more than 20 years ago because of abdominal cyst transfusion. Twenty years later, she was found by physical examination. Ask an expert, can her hepatitis C be cured?
Professor Xing Huichun: It still depends on the viral load. If it is positive, it needs treatment. It depends on the state of liver disease, whether there is cirrhosis or other complications. Then determine the specific treatment plan.
Excuse me, because I have hepatitis C for two years, although the virus has been controlled, the blood vessels in the spleen and stomach have expanded. What should I do?
Professor Xing Huichun: We should use high-precision detection methods to see if the virus can't be detected. The virus will only be controlled if the detection accuracy is not high. Have varicose veins been detected after vasodilation? If varicose veins are detected, there may be cirrhosis, which needs to be diagnosed.
The woman is healthy and the man has hepatitis C. Can this situation be pregnant?
Professor Xing Huichun: If the virus is positive, treat the man first, and then consider giving birth after being cured.
I got hepatitis C when I filled my teeth. It was found at the beginning of this year. Never been treated. Now RNA is negative and liver function is normal. Is it safe to check 1~2 times a year? Is there a good way to turn hepatitis C antibody negative through treatment?
Professor Xing Huichun: RNA must be negative, and the accuracy is very high. Check once every three months, if there is no problem twice in a row. If there is exposure risk, it should be continuously monitored.
Hello, experts! Hepatitis C antibody is positive, quantitative detection of hepatitis C has been negative, and liver function has been normal. Am I hepatitis C?
Professor Xing Huichun: Viruses must be monitored with high precision by RNA. If it is confirmed to be negative, it can be considered as self-healing once every three months. Be sure to use RNA to monitor the virus with high precision.
There are still some abnormal blood routine after interferon injection. There are only a little more white blood cells and a little more neutral particles. Can I continue to take medicine and injections?
Professor Xing Huichun: Yes, if there are no other side effects.
The sixth power of hepatitis C virus 6.6* 10. Since then, antiviral therapy (Vandersonin combined with ribavirin) 18 months has been started, and now the substance echo is thick. Do you need treatment?
Professor Xing Huichun: Thick echo is the manifestation of hepatitis, and antiviral treatment is the problem of treating hepatitis.
Found it during the prenatal examination. I haven't checked yet. I have been breast-feeding. Ask the doctor to give me some treatment advice.
Professor Xing Huichun: It depends on the viral load. If it is not high, you can breastfeed. If it is high, there is still a risk of infection. Still need to do a high-precision viral load monitoring.