Prof. Dr. Krasimir Antonov: Hepatitis C slumbers for decades, but strikes suddenly

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Prof. Dr. Krasimir Antonov: Hepatitis C slumbers for decades, but strikes suddenly
Prof. Dr. Krasimir Antonov: Hepatitis C slumbers for decades, but strikes suddenly

“The revolutionary treatment, which has already helped hundreds of Bulgarians get rid of hepatitis C, has been applied in our country for two years. Modern interferon-free therapy gives excellent results. About 90% of patients are successfully treated. The point is to diagnose them in time. In 2016, just over 400 people were treated for hepatitis C - the most seriously ill. The balance sheet for 2017 indicates that there are already more than 500 people receiving treatment, because all infected people have the right to this

“The silent killer” - the hepatitis C virus is known by this nickname, because it can live in our body for tens of years, without a single symptom. It mainly attacks the liver, but it has the ability to affect other organs as well. It can affect the kidneys, thyroid gland, pancreas or even the cerebral cortex, complicating the serious condition of patients with other serious diagnoses", the famous hepatologist and gastroenterologist Prof. Dr. Krasimir Antonov, head of the "Diagnostics, treatment and follow-up of patients with viral hepatitis, porphyrias and liver pathology during transplantation" at the hospital "St. Ivan Rilski" in Sofia.

- Prof. Antonov, I met your patient, infected unknown how and when with viral hepatitis C, experienced the horror of the infection, the ineffective treatment, but got a chance to enter the pilot program for interferon-free therapy, with which in 3 months you have eradicated the virus, for which I congratulate you. Can Bulgarian patients with hepatitis C still rely on this revolutionary new therapy?

- Of course, they can rely on the new therapy that was introduced from March 1, 2016. It is definitely a revolution in the treatment of hepatitis C infection, because it achieves a cure of up to 100%, completely clearing the virus. Since January 1, 2017, in our country we can treat patients with all degrees of liver damage, something that we could not do in the past due to our limited financial capabilities. The sooner the disease is detected, the sooner the therapy begins, the effect is that the disease quickly disappears and that the liver completely recovers. Screening programs in this regard are very important, because this is the only way we can eliminate hepatitis C from the face of the earth by 2030.

The positive, if there is anything positive at all about this disease, is that it is more difficult to transmit - exclusively and only through blood. Research in the US shows that the main risk group for the spread of hepatitis C is intravenous drug users due to the use of shared syringes.

But in Bulgaria the statistics show otherwise. The main part of the sick - approximately 100,000 people - are representatives of the elderly population - over 40-50 years old, in which the infection happened sometime in the past - 20-30 years ago., when he alth services were at another level. Usually, the "guilty" was some medical intervention - blood transfusion or surgery, as well as dental treatment. In young patients, the infection is indeed transmitted through the use of drugs, but they are not the main contingent of patients.

How many people are diagnosed with the disease each year? How many are sick in our country?

- In practice, people who have been repeatedly treated by other methods and by other specialists go to our clinical centers. As a number, I can say about our center that annually we include about 200-300 people in the new therapy for the treatment of hepatitis C. Otherwise, I think that the sick in our country exceed 100,000 people. Over 90% of patients do not know that they are infected with hepatitis C. And this is the purpose of screening - to detect and treat them

Apart from the liver, what other organs does hepatitis C affect?

- The infection affects the whole organism. The virus can cause damage to the pancreas, thyroid gland, kidneys. It can cause vasculitis, it can underlie a disease like lymphomas because it is a blood disease. It affects the central nervous system, it affects the whole organism. Modern treatment is able to cover this type of patient and the results are very good.

Now it remains to find the patients in time…

- However, the lack of symptoms in chronic viral hepatitis and the insufficient awareness of patients lead to the late diagnosis and untimely treatment of these diseases. Regarding chronic viral hepatitis, I would not say that the Bulgarian is diagnosed in time. Unfortunately, our experience shows that our patients are elderly, with advanced liver diseases, which means that we clearly missed timely diagnosis in these patients

People need to be informed about these diseases, GPs too, and we as specialists need to establish the link between the frontline and specialist care. It is necessary for each of us to take responsibility for our he alth and be active when it comes to early diagnosis of such serious diseases as viral hepatitis.

Are you happy with the new hepatitis C therapy?

- Of course, I am very pleased. The complete cure rate is over 95%. Only one patient did not have such a response, because the therapy had to be temporarily stopped due to manifested renal failure. Subsequently, it was not understood where this deficiency came from, but already his therapy was compromised. Only in this one case do we have a failure.

The number of patients with permission from the He alth Insurance Fund for treatment with the new therapy is increasing, because no patients were cured with the previous one, with interferon. Few patients responded to possibly successful therapy, ie. the contraindications for interferon were so great that we practically treated he althy people. And now we treat people with a very severe clinical picture, even those with liver cancer. Therefore, the number of patients is actually very large, exceeding the expectations of the he alth authorities. However, now the he alth authorities know about them and they will be cured 100%.

Violetta: In 3 months I was cured with the new medication

The neighbors were afraid to talk to me even through the fence of our yard

On a warm day, we are sitting with friends having a beer in our neighborhood cafe. We share with laughter what happened to us in the last 2-3 days. However, one of us continues to be so thoughtful - our new friend Violetta. We think it's because of the beautiful blonde girl playing on the makeshift playground next to us - her granddaughter Daria. When I asked her why she was so tense, I could see a tear fall from her eye. An hour later I already knew - she had overcome a life-threatening illness with incredible efforts

I tentatively named her Violetta, because she explained to me how much she loves flowers and with what love she takes care of them. Here is her story.

I found out by accident that I have hepatitis C. After a lot of stress due to a serious accident with the death of a long-time friend, my husband developed diabetes. In the fifth year since the onset of his illness, two years ago, he entered the hospital for infusions because the illness had damaged the sensation in his legs. At the time, a patient organization was campaigning against hepatitis. His attending physician suggests that her patients get a free hepatitis test right now, and he agrees. The day after that, he already knew that there were elevated values in the blood test. Then I had to do some research. This is how our nightmare began - our family collapsed after my husband's accusations that I had cheated on him with someone who was sick and thus infected him. We said a lot of hard words and I just needed support and healing.

Then the tears started

We lived in a small town, close to Sofia. I was working in a bank. I took a week off because I didn't want my colleagues to see me so confused and weak. I walked the streets, not knowing if I was dreaming or if everything that was happening to me was reality. However, reality hit me two days later. The results came in from our national lab - I had hepatitis C. Hell broke loose and swallowed me. The shock was complete, I didn't know what to do. My personal doctor started to prepare the documents for treatment, and first I had to go to Sofia to a virologist-gastroenterologist, and I read almost everything I could find on the Internet. There was therapy, I could be cured. That's how I found the best doctor for me - Prof. Krasimir Antonov.

There were indications at least a year earlier that I was infected

For two years I have been thinking about how I got infected. I've had no blood transfusions, no tattoos, never even considered, let alone used, drugs. I haven't had a tooth pulled, nor have I had any complicated dental interventions, apart from a stone cleaning and two fillings. Some time ago a heavy object fell on my feet and since then something has happened to my nails. And because I can't handle them alone, I went for a pedicure at least once a month, visiting my daughter and son-in-law in Sofia. I don't want to blame these people and this guild at all, but I actually had one of my fingers cut twice.

An indication that I was sick with hepatitis C was also my general condition, which I personally attributed to worries about my husband's he alth. I often complained of headaches accompanied by vomiting. I lost a lot of weight, I had no appetite. I didn't have the strength to do anything - I could barely cope with my housework, and at the bank I sat down in front of the computer in the morning and got up at the end of the working day. But I didn't go to the doctor, which I count as my most fatal and gross mistake.

Don't tell about your condition, our society is too conservative

This is what the jeep advised me. Very worried, however, I shared my problem with a friend from the bank. Two hours later I was fired, even though I still had a valid sick leave. I shut myself up at home, but in unknown ways and the neighbors had already found out about my illness. They were afraid to talk to me even through the fence of the yard of our house.

My husband went to live with his sister nearby in a village, my son from the gate of the yard forbade me to go to his house and see my grandson. He also said that he will never forgive me for infecting his father and for putting his family under the threat of infection… It hurt me a lot - both from their words and from their gestures.

In the beginning my treatment was a nightmare

I cried, I drank my medicine, they gave me the injections and I prayed around the clock that I would get well and be able to continue my life. Some long days began in reading about hepatitis C. Cruel and difficult to tolerate interferon therapy. It worked almost like chemotherapy for me. Terrible side effects… nightmares… In some cases the therapy works, the body accepts it with more or less complications, but it didn't work for me. I was completely wrecked, heart, anemic, hormones out of whack. I lived around the clock in pain, in terror, keeping the house sterile.

But you know - in all this impasse, I was grateful that I found out just in time that I was sick. Because I could know when I already have liver cancer or liver cirrhosis.

In my fight against the disease, I was not alone after all

I am grateful to the daughter, and especially to the son-in-law, who did not stop being interested in new developments in the treatment of hepatitis C.

That's how I came to the new therapy. In the middle of 2016, I was included in the program of the He alth Insurance Fund. No more injections, no more fear for my life, no more fear of infecting my children and grandchildren and random people. Although I knew that hepatitis C was only transmitted through blood, my worries never went away. In just 3 months with the new pills, the dangerous virus was eradicated from my body. Retests then proved it.

Explore Yourself

I have been a he althy person for half a year, but, in truth, very restless. I live in Sofia, with my daughter, son-in-law and granddaughter.

Instead of being calm and happy, I am terrified that the child might get infected with hepatitis. Because this silent contagion is not only the C variant - the disease of dirty hands is lurking everywhere. You have no idea how many wet wipes I use on her just by going out…

My girlfriends here, as well as yourself, are amazed at my cleanliness. They also wonder when I use every convenient moment to tell them something about this huge threat to our lives - about hepatitis and its varieties. They also wonder why I am not working at the age of 55, why I live with my child, they wonder where my husband is.

Yes, just to say that we are not divorced yet, that he is now he althy too, that he still lives with his sister, that our boy still hasn't forgiven me…

Do your research, I say to you and to your readers. Examine yourself, because nothing should threaten your life and he alth. Doctors call hepatitis C the "silent killer." Yes, it is because it has been damaging you for years without warning you in any way…

I pray that everyone living with Hepatitis C will have the opportunity to undergo such successful treatment as I did…

We part with Willy with a smile and a promise to meet and talk again. Wet wipes wiped the dust from the granddaughter's hands, but according to Violeta, they cannot remove the memory of the experience, the horror of the diagnosis, the broken family.

So that there are no more such human dramas, a drop of blood in the laboratory will give us the certainty that we are he althy. Explore yourself!

How does the disease damage?

Hepatitis A is what is known as jaundice or "dirty hands disease". It is transmitted through the oral-fecal route, it is acute and a person recovers in any case

Hepatitis B is transmitted through blood and sexual contact, in the majority of people it is acute. In about 20% of those infected, hepatitis B becomes chronic, when the treatment is long, difficult and not always successful. There are cases in which hepatitis B runs without symptoms and directly becomes chronic, which is why so many people do not know that they are sick. There is a vaccine for hepatitis A and B.

Hepatitis C is blood-borne, not sexually transmitted. Infection can occur during any blood manipulation - surgery, blood transfusion, dental intervention, visit to a beautician or manicurist. Particularly risky are drug use due to the use of shared needles, tattooing, piercing and, as crazy as it sounds, visiting the dentist with direct contact with contaminated instruments.

Only 10% of those infected with hepatitis C manage to fight the virus on their own, in the rest it becomes chronic. And here there are no symptoms, except when the liver damage has already progressed too far. In some of the infected, the virus "sleeps", i.e. they are carriers without the disease actually harming them. Others, however, develop severe liver damage leading to cirrhosis and/or cancer within 20-30 years.

The good news is that, unlike hepatitis B, the treatment of hepatitis C gives quite good results - about 50% success rate for genotypes 1 and 4 and 90% for genotypes 2 and 3. Sofia now has an office for free and anonymous counseling and testing for hepatitis C. The center was created on the initiative of the patient association "HepActive" and the association "He alth Without Borders". Quick and free tests can be done at the "Sexual He alth Center" on "Tsar Samuil" Street. The examination for hepatitis C is not included in the annual preventive package and is not paid by the Fund.

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