| Sažetak | Hepatitis je upala jetre koja dovodi do oštećenja ili uništenja njezinih stanica (hepatocita), a može biti akutni i kronični.
Upalu jetre mogu uzrokovati različiti uzročnici kao što su bakterije, virusi, alkohol, toksini pa čak i lijekovi. Od virusnih
hepatitisa razlikujemo A, B, C, D, E... Svi ovi hepatitisi razlikuju se po načinima prijenosa, dužini inkubacije, težini
bolesti, mogućnosti prelaska u kroničnu upalu i razvoju teških komplikacija kao što su ciroza jetre i karcinom jetre.
Razlikuju se također i u postupcima liječenja.
Hepatitis C uzrokuje virus hepatitisa C (HCV). To je RNA virus, koji postoji u 6 glavnih varijacija označenih od 1 do
6, a to su tzv. genotipovi. Prenosi se inficiranom krvlju. Prema procjenama, u svijetu je oko 150 milijuna ljudi zaraženo
s HCV-om, a globalna prevalencija iznosi oko 2,2 %. Infekciju HCV-om možemo kategorizirati u dva stupnja. Prvi
stupanj predstavlja akutna, a drugi stupanj kronična infekcija. Akutni stadij predstavlja razdoblje prvih 6 mjeseci
infekcije, te može biti bez primjetnih simptoma. Manji broj ljudi inficiranih s HCV-om prirodno izbacuju virus iz tijela
tijekom prvih 6 mjeseci, dok u većine će doći do razvoja kronične infekcije. I kronična infekcija može biti bez
simptoma, i to dugo vremena. Često se događa da i kad se iskažu simptomi kao što su umor, depresija, nesanica,
problemi s kožom, bol i probavne smetnje, osobe ni ne pomisle na hepatitis, jer svim ovim simptomima mogu biti i
drugi uzroci. Hepatitis C ako se ne liječi može dovesti do ciroze jetre, karcinoma jetre i do smrti. Vrlo važno ga je i čim
prije dijagnosticirati, utvrditi genotip virusa, te procijeniti oštećenje jetre (kako bi se moglo započeti s adekvatnom
terapijom), a pri tome se koriste različite dijagnostičke metode. Liječenje se može provoditi interferonom, ribavirinom,
te direktnim antivirusnim lijekovima (DAA-ovima), tj. njihovim kombinacijama. Do 2011. godine, standard liječenja
je bila kombinacija pegiliranog interferona i ribavirina (tzv.dvojna terapija). Nakon toga, dvojna terapija proširena je
dodavanjem DAA-ova, te je omogućena primjena trojne terapije. Primjenom trojne terapije ostvareni su veliki pomaci
u postotku izlječenja, odnosno postizanju održivog virološkog odgovora (SVR-a), koji predstavlja osnovni cilj terapije.
Danas je dostupna i tzv. bezinterferonska terapija. Uvođenjem DAA-ova u terapiju omogućen je SVR i preko 90 %.
Vrlo važna je i adherencija bolesnika kod liječenja hepatitisa C, jer viša adherencija kod primijenjenog režima je
povezana s višim HCV virološkim odgovorom. |
| Sažetak (engleski) | Hepatitis is a liver inflammation that leads to damage or destruction of its cells (hepatocytes) and may be acute and
chronic. Liver inflammation can be caused by various agents such as bacteria, viruses, alcohol, toxins, and even drugs.
Viral hepatitis include hepatitis A, B, C, D E... All of these hepatitis differ by modes of transmission, incubation period,
severity of the disease, possibility of transition to chronic inflammation and development of severe complications such
as liver cirrhosis and liver cancer. They are also distinguished in treatment procedures.
Hepatitis C is caused by hepatitis C virus (HCV). It is an RNA virus, which exists in 6 major variants marked from 1 to
6, which are so-called genotypes. It is transmitted with infected blood. According to estimates, around 150 million people
in the world are infected with HCV and the global prevalence is about 2,2 %. HCV infection can be categorized in two
stages. The first stage is acute and the second stage is chronic infection. Acute stage is the period of the first 6 months
of infection and may be without noticeable symptoms. A smaller number of people infected with HCV naturally
discharge the virus from the body during the first 6 months, while most will develop chronic infection. Chronic infection
can be also without symptoms, for a long time. It is often the case that symptoms such as tiredness, depression, insomnia,
skin problems, pain and digestive disorders are felt and people do not even think about hepatitis, because all these
symptoms may have other causes. Hepatitis C if not treated can lead to cirrhosis of the liver, liver cancer and death. It is
very important to diagnose it as soon as possible, to identify the genotype of the virus, and to evaluate the liver damage
(so that it can be started with adequate therapy), using different diagnostic methods. Treatment can be performed with
interferon, ribavirin, and direct acting antivirals (DAAs), i.e. with their combinations. By 2011, the standard of treatment
was a combination of pegylated interferon and ribavirin (so-called dual therapy). Thereafter, the dual therapy was
extended by adding DAAs, and triple therapy was enabled. Using the triple therapy, there were great advances in the
percentage of cure, i.e. in the achievement of a sustained virological response (SVR), which is the main goal of the
therapy. Today, so-called interferon-free therapy is also available. By using DAAs in therapy, SVR rates over 90 % were
enabled. Adherence of patients with hepatitis C is also of great importance, as higher adherence in the administrated
regime is associated with higher HCV virological response. |
