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راهی جدید برای درمان هپاتیت «ب»
ایران آنلاین /مطالعات محققان سوئدی و آلمانی نشان می دهد ایجاد وقفه در درمان هپاتیت B ،ظرفیت سلول های ایمنی را برای نابودی ویروس هپاتیت افزایش می دهد.
به گزارش ایرنا از پایگاه خبری مدیکال ساینس، هپاتیت B مزمن یا CHB بر اثر ویروس هپاتیت B بوجود می آید و در حال حاضر 250 میلیون نفر در سراسر جهان به آن مبتلا هستند. محل عفونت این ویروس در کبد است و بیماران مبتلا مستعد سیروز کبدی و سرطان کبد می شوند.
شایع ترین داروها برای درمان این عارضه Nucleoside/nucleotide analogues (NAs) هستند؛ ولی این روش درمانی فقط ویروس را سرکوب می کند و به ندرت منجر به ریشه کنی عفونت می شود و همین امر درمان را با مشکل مواجه می کند.
مطالعات جدید محققان موسسه کارولینسکا در سوئد و مدرسه پزشکی هانوور در آلمان نشان می دهد یک روش برای ریشه کنی کامل بیماری، ایجاد وقفه در درمان NA است. محققان با بررسی 15 بیمار مبتلا دریافتند ایجاد وقفه در درمان با استفاده از NA، ظرفیت سلول های ایمنی را برای نابودکردن ویروس هپاتیت به میزان قابل توجهی افزایش می دهد. در واقع این روش سبب می شود سیستم ایمنی تجدید قوا کند. البته این مطالعه نیازمند بررسی بیشتر است.
به التهاب کبد هپاتیت گفته می شود. تاکنون پنج ویروس اصلی هپاتیت شناخته شده است که به عنوان هپاتیت نوع A، B، C، D و E شناخته می شوند. احتمال سیروز کبدی و سرطان در دو نوع B و C بیشتر است. هپاتیت نوع A و E معمولا بر اثر مصرف آب و غذای آلوده ایجاد می شوند. هپاتیت نوع B، C و D معمولا نتیجه تماس با مایعات آلوده بدن هستند.
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دیدگاه های ارسال شده توسط شما، پس از تایید در سایت منتشر خواهد شد.
پیشگیری هپاتیت c
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پیشگیری هپاتیت c
People wait to receive free hepatitis testing and treatment at Lahore’s first dedicated Hepatitis Prevention and Treatment Clinic
nThe remaining 60–80% of persons will develop chronic HCV infection. Of those with chronic HCV infection, the risk of cirrhosis of the liver is between 15–30% within 20 years.
nHepatitis C is found worldwide. The most affected regions are WHO Eastern Mediterranean and European Regions, with the prevalence of 2.3% and 1.5% respectively. Prevalence of HCV infection in other WHO regions varies from 0.5% to 1.0%. Depending on the country, hepatitis C virus infection can be concentrated in certain populations (for example, among people who inject drugs) and/or in general populations. There are multiple strains (or genotypes) of the HCV virus and their distribution varies by region.
nThe hepatitis C virus is a bloodborne virus. It is most commonly transmitted through:
nHCV can also be transmitted sexually and can be passed from an infected mother to her baby; however these modes of transmission are much less common.
nHepatitis C is not spread through breast milk, food, water or by casual contact such as hugging, kissing and sharing food or drinks with an infected person.
nEstimates obtained from modelling suggest that worldwide, in 2015, there were 1.75 million new HCV infections (globally, 23.7 new HCV infections per 100 000 people).
nThe incubation period for hepatitis C is 2 weeks to 6 months. Following initial infection, approximately 80% of people do not exhibit any symptoms. Those who are acutely symptomatic may exhibit fever, fatigue, decreased appetite, nausea, vomiting, abdominal pain, dark urine, grey-coloured faeces, joint pain and jaundice (yellowing of skin and the whites of the eyes).
nDue to the fact that acute HCV infection is usually asymptomatic, few people are diagnosed during the acute phase. In those people who go on to develop chronic HCV infection, the infection is also often undiagnosed because the infection remains asymptomatic until decades after infection when symptoms develop secondary to serious liver damage.
nHCV infection is diagnosed in 2 steps:
nAfter a person has been diagnosed with chronic hepatitis C infection, they should have an assessment of the degree of liver damage (fibrosis and cirrhosis). This can be done by liver biopsy or through a variety of non-invasive tests.
nIn addition, these people should have a laboratory test to identify the genotype of the hepatitis C strain. There are 6 genotypes of the HCV and they respond differently to treatment. Furthermore, it is possible for a person to be infected with more than 1 genotype. The degree of liver damage and virus genotype are used to guide treatment decisions and management of the disease.
nEarly diagnosis can prevent health problems that may result from infection and prevent transmission of the virus. WHO recommends screening for people who may be at increased risk of infection.
nPopulations at increased risk of HCV infection include:
nAbout 2.3 million people of the estimated 36.7 million living with HIV globally have serological evidence of past or present HCV infection. Conversely, among all HIV-infected persons, the prevalence of anti-HCV was 6.2%. Liver diseases represent a major cause of morbidity and mortality among persons living with HIV.
nHepatitis C does not always require treatment as the immune response in some people will clear the infection, and some people with chronic infection do not develop liver damage. When treatment is necessary, the goal of hepatitis C treatment is cure. The cure rate depends on several factors including the strain of the virus and the type of treatment given.
nThe standard of care for hepatitis C is changing rapidly. Sofosbuvir, daclatasvir and the sofosbuvir/ledipasvir combination are part of the preferred regimens in the WHO guidelines, and can achieve cure rates above 95%. These medicines are much more effective, safer and better-tolerated than the older therapies. Therapy with DAAs can cure most persons with HCV infection and treatment is shorter (usually 12 weeks). WHO is currently updating its treatment guidelines to include pangenotypic DAA regimens and simplified laboratory monitoring. Meanwhile, there remains a very limited role for pegylated interferon and ribavirin in certain scenarios. Although the production cost of DAAs is low, these medicines remain very expensive in many high- and upper middle-income countries. Prices have dropped dramatically in some countries (primarily low-income) due to the introduction of generic versions of these medicines.
nAccess to HCV treatment is improving, but remains limited. In 2015, of the 71 million persons living with HCV infection globally, 20% (14 million) knew their diagnosis. 7.4% of those diagnosed (1.1 million) were started on treatment in 2015. In 2016, 1.76 million people were additionally treated in bringing the global coverage of hepatitis C curative treatment to 13%. Much needs to be done in order for the world to achieve the 80% treatment target by 2030.
nThere is no vaccine for hepatitis C, therefore prevention of HCV infection depends upon reducing the risk of exposure to the virus in health-care settings and in higher risk populations, for example, people who inject drugs, and through sexual contact.
nThe following list provides a limited example of primary prevention interventions recommended by WHO:
nFor people infected with the hepatitis C virus, WHO recommends:
nIn April 2016, WHO updated its “Guidelines for the screening, care and treatment of persons with chronic hepatitis C”. These guidelines complement existing WHO guidance on the prevention of transmission of bloodborne viruses, including HCV.n
nThey are intended for policy-makers, government officials, and others working in low- and middle-income countries who are developing programmes for the screening, care and treatment of people with HCV infection. These guidelines will help expand of treatment services to patients with HCV infection, as they provide key recommendations in these areas and discuss considerations for implementation.
nWorldwide, 7% of those diagnosed (1.1 million) were started on treatment in 2015. Of those started on treatment in 2015, about half received DAAs. Globally, over the years, the cumulative number of those placed on treatment reached 5.4 million persons in 2015. Most of the patients treated before 2015 received older treatments, primarily interferon-based therapies.
nIt is recommended that HCV serology testing be offered to individuals who are part of a population with high HCV prevalence or who have a history of HCV risk exposure/ behaviour.
nIt is suggested that following a positive HCV virus serological test another test (NAT for the detection of HCV RNA) be performed to diagnose chronic infection. NAT for HCV RNA should also be performed to assess whether to start treatment for hepatitis C.
nAn alcohol intake assessment is recommended for all persons with HCV virus infection followed by the offer of a behavioural alcohol reduction intervention for persons with moderate-to-high alcohol intake.
nIn resource-limited settings, the aminotransferase/platelet ratio index (APRI) or FIB4 tests should be used for the assessment of hepatic fibrosis rather than other non-invasive tests that require more resources such as elastography or fibrotest.
nAll adults and children with chronic HCV infection should be assessed for antiviral treatment.
nWHO recommends that all patients with hepatitis C be treated with DAA-based regimens, except for a few specific groups of people in whom interferon-based regimens can still be used (as an alternative regimen for patients with genotype 5 or 6 infection and those with genotype 3 HCV infection who also have cirrhosis).
nThese 2 first-generation DAAs, which are administered with pegylated interferon and ribavirin, were recommended in the 2014 guidelines. Evidence now shows that they result in more frequent adverse effects and less frequent cures compared with newer DAA-based regimens. Thus, these 2 medicines are no longer recommended by WHO.
nThe Guideline Development Group reviewed all the available data (over 200 studies) to determine which regimens were most effective and safest to treat each of the 6 different genotypes.
nIn May 2016, The World Health Assembly adopted the first “Global Health Sector Strategy on Viral Hepatitis, 2016-2021”. The strategy highlights the critical role of Universal Health Coverage and the targets of the strategy are aligned with those of the Sustainable Development Goals. The strategy has a vision of eliminating viral hepatitis as a public health problem and this is encapsulated in the global targets of reducing new viral hepatitis infections by 90% and reducing deaths due to viral hepatitis by 65% by 2030. Actions to be taken by countries and WHO Secretariat to reach these targets are outlined in the strategy.
nWHO is working in the following areas to support countries in moving towards achieving the global hepatitis goals under the Sustainable Development Agenda 2030:
nWHO published the Global Hepatitis Report, 2017, outlining the baseline for the drive towards elimination. The report sets out global statistics on viral hepatitis B and C, the rate of new infections, the prevalence of chronic infections and mortality caused by these two high-burden hepatitis viruses, as well as coverage of key interventions, all current as of the end of 2015. It is available online at the following link.
پیشگیری هپاتیت c
nWHO also organizes World Hepatitis Day on 28 July every year to increase awareness and understanding of viral hepatitis.
The remaining 60–80% of persons will develop chronic HCV infection. Of those with chronic HCV infection, the risk of cirrhosis of the liver is between 15–30% within 20 years.
Hepatitis C is found worldwide. The most affected regions are WHO Eastern Mediterranean and European Regions, with the prevalence of 2.3% and 1.5% respectively. Prevalence of HCV infection in other WHO regions varies from 0.5% to 1.0%. Depending on the country, hepatitis C virus infection can be concentrated in certain populations (for example, among people who inject drugs) and/or in general populations. There are multiple strains (or genotypes) of the HCV virus and their distribution varies by region.
The hepatitis C virus is a bloodborne virus. It is most commonly transmitted through:
HCV can also be transmitted sexually and can be passed from an infected mother to her baby; however these modes of transmission are much less common.
Hepatitis C is not spread through breast milk, food, water or by casual contact such as hugging, kissing and sharing food or drinks with an infected person.
Estimates obtained from modelling suggest that worldwide, in 2015, there were 1.75 million new HCV infections (globally, 23.7 new HCV infections per 100 000 people).
The incubation period for hepatitis C is 2 weeks to 6 months. Following initial infection, approximately 80% of people do not exhibit any symptoms. Those who are acutely symptomatic may exhibit fever, fatigue, decreased appetite, nausea, vomiting, abdominal pain, dark urine, grey-coloured faeces, joint pain and jaundice (yellowing of skin and the whites of the eyes).
Due to the fact that acute HCV infection is usually asymptomatic, few people are diagnosed during the acute phase. In those people who go on to develop chronic HCV infection, the infection is also often undiagnosed because the infection remains asymptomatic until decades after infection when symptoms develop secondary to serious liver damage.
HCV infection is diagnosed in 2 steps:
After a person has been diagnosed with chronic hepatitis C infection, they should have an assessment of the degree of liver damage (fibrosis and cirrhosis). This can be done by liver biopsy or through a variety of non-invasive tests.
In addition, these people should have a laboratory test to identify the genotype of the hepatitis C strain. There are 6 genotypes of the HCV and they respond differently to treatment. Furthermore, it is possible for a person to be infected with more than 1 genotype. The degree of liver damage and virus genotype are used to guide treatment decisions and management of the disease.
Early diagnosis can prevent health problems that may result from infection and prevent transmission of the virus. WHO recommends screening for people who may be at increased risk of infection.
Populations at increased risk of HCV infection include:
About 2.3 million people of the estimated 36.7 million living with HIV globally have serological evidence of past or present HCV infection. Conversely, among all HIV-infected persons, the prevalence of anti-HCV was 6.2%. Liver diseases represent a major cause of morbidity and mortality among persons living with HIV.
Hepatitis C does not always require treatment as the immune response in some people will clear the infection, and some people with chronic infection do not develop liver damage. When treatment is necessary, the goal of hepatitis C treatment is cure. The cure rate depends on several factors including the strain of the virus and the type of treatment given.
The standard of care for hepatitis C is changing rapidly. Sofosbuvir, daclatasvir and the sofosbuvir/ledipasvir combination are part of the preferred regimens in the WHO guidelines, and can achieve cure rates above 95%. These medicines are much more effective, safer and better-tolerated than the older therapies. Therapy with DAAs can cure most persons with HCV infection and treatment is shorter (usually 12 weeks). WHO is currently updating its treatment guidelines to include pangenotypic DAA regimens and simplified laboratory monitoring. Meanwhile, there remains a very limited role for pegylated interferon and ribavirin in certain scenarios. Although the production cost of DAAs is low, these medicines remain very expensive in many high- and upper middle-income countries. Prices have dropped dramatically in some countries (primarily low-income) due to the introduction of generic versions of these medicines.
Access to HCV treatment is improving, but remains limited. In 2015, of the 71 million persons living with HCV infection globally, 20% (14 million) knew their diagnosis. 7.4% of those diagnosed (1.1 million) were started on treatment in 2015. In 2016, 1.76 million people were additionally treated in bringing the global coverage of hepatitis C curative treatment to 13%. Much needs to be done in order for the world to achieve the 80% treatment target by 2030.
There is no vaccine for hepatitis C, therefore prevention of HCV infection depends upon reducing the risk of exposure to the virus in health-care settings and in higher risk populations, for example, people who inject drugs, and through sexual contact.
The following list provides a limited example of primary prevention interventions recommended by WHO:
For people infected with the hepatitis C virus, WHO recommends:
In April 2016, WHO updated its “Guidelines for the screening, care and treatment of persons with chronic hepatitis C”. These guidelines complement existing WHO guidance on the prevention of transmission of bloodborne viruses, including HCV.
They are intended for policy-makers, government officials, and others working in low- and middle-income countries who are developing programmes for the screening, care and treatment of people with HCV infection. These guidelines will help expand of treatment services to patients with HCV infection, as they provide key recommendations in these areas and discuss considerations for implementation.
Worldwide, 7% of those diagnosed (1.1 million) were started on treatment in 2015. Of those started on treatment in 2015, about half received DAAs. Globally, over the years, the cumulative number of those placed on treatment reached 5.4 million persons in 2015. Most of the patients treated before 2015 received older treatments, primarily interferon-based therapies.
It is recommended that HCV serology testing be offered to individuals who are part of a population with high HCV prevalence or who have a history of HCV risk exposure/ behaviour.
It is suggested that following a positive HCV virus serological test another test (NAT for the detection of HCV RNA) be performed to diagnose chronic infection. NAT for HCV RNA should also be performed to assess whether to start treatment for hepatitis C.
An alcohol intake assessment is recommended for all persons with HCV virus infection followed by the offer of a behavioural alcohol reduction intervention for persons with moderate-to-high alcohol intake.
In resource-limited settings, the aminotransferase/platelet ratio index (APRI) or FIB4 tests should be used for the assessment of hepatic fibrosis rather than other non-invasive tests that require more resources such as elastography or fibrotest.
All adults and children with chronic HCV infection should be assessed for antiviral treatment.
WHO recommends that all patients with hepatitis C be treated with DAA-based regimens, except for a few specific groups of people in whom interferon-based regimens can still be used (as an alternative regimen for patients with genotype 5 or 6 infection and those with genotype 3 HCV infection who also have cirrhosis).
These 2 first-generation DAAs, which are administered with pegylated interferon and ribavirin, were recommended in the 2014 guidelines. Evidence now shows that they result in more frequent adverse effects and less frequent cures compared with newer DAA-based regimens. Thus, these 2 medicines are no longer recommended by WHO.
The Guideline Development Group reviewed all the available data (over 200 studies) to determine which regimens were most effective and safest to treat each of the 6 different genotypes.
In May 2016, The World Health Assembly adopted the first “Global Health Sector Strategy on Viral Hepatitis, 2016-2021”. The strategy highlights the critical role of Universal Health Coverage and the targets of the strategy are aligned with those of the Sustainable Development Goals. The strategy has a vision of eliminating viral hepatitis as a public health problem and this is encapsulated in the global targets of reducing new viral hepatitis infections by 90% and reducing deaths due to viral hepatitis by 65% by 2030. Actions to be taken by countries and WHO Secretariat to reach these targets are outlined in the strategy.
WHO is working in the following areas to support countries in moving towards achieving the global hepatitis goals under the Sustainable Development Agenda 2030:
WHO published the Global Hepatitis Report, 2017, outlining the baseline for the drive towards elimination. The report sets out global statistics on viral hepatitis B and C, the rate of new infections, the prevalence of chronic infections and mortality caused by these two high-burden hepatitis viruses, as well as coverage of key interventions, all current as of the end of 2015. It is available online at the following link.
WHO also organizes World Hepatitis Day on 28 July every year to increase awareness and understanding of viral hepatitis.
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هپاتیت C
برای آشنایی با عوامل خطر و تشخیص اینکه یک فرد در معرض خطر قرار دارد یا خیر، ابتدا باید توضیح دهیم که برای امکان انتقال ویروس، عوامل زیر باید به طور همزمان وجود داشته باشند.
از آنجا که خون تنها مایع بدن نیست که می‌تواند حاوی ویروس هپاتیت C باشد، می‌بینید که این ویروس با بالاترین میزان تراکم یافت می‌شود؛ بنابراین، حتی مقدار کمی خون کافی است تا عفونت با این ویروس رخ دهد.
به علاوه، این ویروس می‌تواند از 16 ساعت تا حداکثر 4 روز در خون خشک شده روی هر سطحی در دمای اتاق زنده بماند.
با این وجود، در محیط‌های محدود، از قبیل داخل یک سرنگ، می‌تواند برای مدت طولانی‌تر زنده بماند.