Остановка Гепатит СPart 2: Medical issues
2.0.1 How do I find good medical care for hepatitis?
It is very important to find a health practitioner who is familiar with this illness. The symptoms of hepatitis can be mimicked by other illnesses, such as autoimmune illnesses, cancer, chronic fatigue syndrome, lupus, arthritis, etc... If you in fact have another illness that is not properly diagnosed, you may be losing out on getting treatment that might be effective for you.
It is still an uphill struggle to find a doctor who is experienced in diagnosing and treating hepatitis C. A hepatologist specializes in diseases of the liver, and is the best choice, followed by a gastroenterologist (a digestive disease specialist), or an infectious disease specialist. If there is a hepatitis support group nearby, it could be an excellent resource for identifying local doctors who may be familiar with hepatitis.
You can also contact the American Liver Foundation (ALF), the HEP project in Seattle, the Hepatitis C Support Project in San Francisco, HepCBC in Victoria, British Columbia, or a host of other hepatitis C organizations for a list of doctors near you who are experienced in treating Hep C. If there are no hepatitis specialists in your area, you may want to go out-of-town, and your local hepatitis C organization may be able to help you. For a list of hepatitis C organizations in your area see Part 12.of the FAQ.
If your own doctor is sympathetic but doesn’t have a lot of experience with Hep C, you might gather
together some medical articles on
hepatitis and hepatitis treatments and encourage your doctor to study
them. You can also give him or her a copy of the FAQ.
See Appendix D for a list of Hepatologists and Gastroenterologists in Canada.
2.0.2 What is the difference between a gastroenterologist and a hepatologist?
A hepatologist specializes in treating liver disease. A gastroenterologist specializes in the gut. Hepatologists are more likely to be on top of the latest information concerning treatment of hepatitis C. Unfortunately, hepatologists are few and far between, especially in Canada.
2.1.0 How is it diagnosed?
There are 4 major blood tests for HCV.
- The EIA-3 test detects antibodies to the virus.
- The RIBA test is the confirmatory test for HCV antibodies.
- The PCR test or TMA, which measure the amount of virus circulating in a person’s blood stream.
- The RT-PCR, or Real Time Reverse Transcription-PCR, which determines the genotype of the virus.
While the newer HCV antibody tests are better than before, false positive results still occur. Further testing should be used to confirm the antibody test. A new TMA test may now be available in your area. With this test, almost all people with chronic HCV will test positive.
Abnormal liver function tests (LFTs) suggest chronic disease, but there is no correlation between the level of the liver function tests and how severe the disease is. Many physicians (especially primary care physicians) still assume that people with low LFT’s do not have severe disease, and this has led to complications and even death because of misdiagnosis. Studies show that testing for enzyme level elevation is not an accurate diagnostic for the presence of hepatitis C (Digestive Disease Week 2000).
Before 1990 doctors could diagnose HCV only by ruling out other possibilities (thus the old name for HCV was “non-A, non-B hepatitis”).
Hepatitis C antibodies may not develop for two to six months after infection, so not all patients who go to the doctor with possible hepatitis C infection can be diagnosed immediately with blood tests. Diagnosis may have to exclude other possible reasons for symptoms such as HAV, HBV, cytomegalovirus, Epstein-Barre virus infection, as well as non-viral liver problems such as fatty liver, or alcohol or drug-related diseases.
Follow-up blood tests are very important in order to determine if the disease has become chronic. The blood tests for antibodies are usually repeated three and six months after the original diagnosis.
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