Hepatitis C can take decades to seem damage with the liver.
The chronic viral hepatitis is now the main reason of the Clerc's Offices of liver.
The current therapy of combination can be individualized to treat chronic infections into 40 to 80 percent of case.
The consequences of the attack of hepatitis C can take years to appear. Thus while the new cases of the disease fell abruptly during the last decades, much of infected people years ago only start to learn that they are carrying the virus, and to attack its potentially serious effects.
For much, there is good news. The half of all the chronic infections can now be treated by a therapy using a combination of drugs. But hepatitis C remains an astute virus, often being low during years and then after a course so unforeseeable that the doctors are not sometimes sure if to recommend the treatment or to advise patients to observe and wait.
The largest obstacle with the effective cure remains the fact that a majority of 3.2 million Americans envisaged who lodge chronic hepatitis C do not return even account they have it. In four out of five people, there is no symptom when the infection occurs initially.
The �major part of the people whom we see discovered that they have chronic hepatitis C when they went to give blood or had a physical examination in order to obtain the insurance,� said Dr. Bruce R. Bacon, director of the division of the gastroenterology and the hepatology at the Medical school of university of Saint Louis.
Almost a third of those exposed to hepatitis C entirely recovers; their immune systems lead the virus and eliminate it. Approximately 70 percent develop the chronic infections, which involve a significant risk of cirrhosis, or marking, liver and cancer of liver. Paradoxically, people who become sickest to be infected shortly after are most likely to fight with far the virus, while those which have initial symptoms little so are with the greatest danger to suffer the persistent infection.
The treatment currently recommended for chronic hepatitis C combines ribavirin, an antiviral drug, with interf�ron, a substance which increases the power of the virus-massacre of the immune system. The treatment offers a perpetual treatment for more than half of the patients. But because drugs are expensive and can have serious side effects, and because the course of the disease varies so much with notice, the decision to begin difficult questions of installations of therapy.
Approximately a third of people with chronic hepatitis will continue to develop the cirrhosis of the liver,� said Dr. Jay H. Hoofnagle, director of the branch of searchs for hepatic affection at the national institutes of health. �Only the 5 to 10 percent will develop the cancer of liver. In other words, much of people can live perfectly well with the chronic infection of hepatitis and never to have any problem. The difficulty is us cannot say who will make well and who will die of the disease.�
Nor can the doctors envisage with certainty how the patients will answer the therapy of combination. In 25 to 30 percent of patients, the interf�ron produces concern and the depression, sometimes thus end which the victims have the suicide attempt. It can also cause to debilitate influenza-like symptoms.
I can usually obtain no matter whom by two or three months of interf�ron and ribavirin. Beyond that, it becomes really hard,� Dr. Hoofnagle said. �At least 10 percent of patients cannot do it by the course recommended of the therapy.�
Fortunately, the doctors put themselves to better optimize the advantages and to order some of the nondesired side effects, thank you partly with new outlines of the virus. The researchers discovered that hepatitis C occurs in at least the final ones, called genotypes. Genotype 1 is more the communal ground and also most difficult to treat, needing 48 weeks of treatment. Only approximately 40 percent of people with this sub-type d�barassent virus. Genotypes 2 and 3 can be successfully treated as Juste 24 weeks, eliminating the virus in approximately 80 percent from case.
The more the levels of virus start to fall into the patients more quickly, plus the chance of a treatment is better. By supervising levels of the virus in blood, some doctors say, it is now possible to individualize the course of the treatment.
I call it the effect of accordion,� said Dr. Ira Jacobsen, head of the division of the gastroenterology and the hepatology at the medical university of Weill Cornell in New York. �If the levels of virus fall with far very quickly, we can shorten run of the therapy. If the answer is slow, we can lengthen it, sometimes with step less than 72 weeks, and improve the chances of success.�
The shortening of the course of the therapy remains discussed because of the risk of relapse after the treatment is stopped. The relapse occurs when the prolonged viruses not removed by the drug multiply and increase behind.
Antid�presseuses drugs, while waiting, are used to relieve of the psychiatric side effects. And the doctors reach to better envisage who will suffer the depression after having begun the interf�ron.
As one could expect it, people with a history of depression are at the greater risk,� said Dr. Francis Lotrich, assistant of psychiatry at the university of Pittsburgh. He and his/her colleagues also observed that the people with chronic problems of sleep are also to have troubles with the depression. The reason is not clear, but the studies are in hand to see whether improving the sleep of the people with the use of the drug of insomnia or other techniques can lower the risk of psychiatric side effects.
Best medicine is prevention, and it is here that the greatest profits were gained against hepatitis C. the number of new infections per annum in the United States is descended from 240.000 the Eighties approximately with 19.000 from 2006. The experts credit a screening test which now prevents hepatitis C from drawing aside via the blood transfusions and from the transplantation of body, as with the messages of public health aimed at discouraging the use of the divided needles, which is the principal transmission channel.
In the absence of an effective vaccine, such messages, supported by intensified monitoring, will remain defense as a chief against this virus. In 2003, chronic hepatitis B and C became the diseases notifiables which must be paid to the federal agents of Health, enabling them to detect new cases in all the country. In 2004, the state of New York began its clean increased the inspection network of viral hepatitis.
Two years ago, the program showed its utility when the civils servant in the department of the county of Erie of health detected a beam of the cases centered in a postal code with suburban Buffalo.
Very that we had initially was a group of points on a chart,� Dr. Anthony J. Billittier IV said, police chief of health of the county of Erie. The investigators went in the community and identified approximately the 20 young people who injected drugs and divided sometimes needles. The county answered by intensifying efforts of prevention, including a free exchange of needle.
We achieved much progress against hepatitis C, but it remains much to make,� Dr. Billittier said. �A thing that we know this virus is him does not leave.�