C hepatītu kā apdraudējumu Latvijas sabiedrībai līdz 2030. gadam iespējams padarīt par aizmirstamu pagātni, ja katru gadu ārstētu ap 3000 pacientu, bet šim nolūkam pārbaudītu jeb testētu daudz vairāk cilvēku nekā līdz šim. Zāles ir, tāpēc sekmes ir pašas sabiedrības gribēšanā.
Mērķi līdz 2030. gadam izskaust C hepatītu kā nopietnu draudu iedzīvotāju veselībai starptautiskā mērogā nospraudusi Pasaules Veselības organizācija (PVO), kura 28. jūliju noteikusi kā Pasaules hepatīta dienu.
Latvijā tagad C hepatītu iespējams izārstēt pilnībā apmēram 95% gadījumu, jo ir modernas efektīvas zāles, un šāds PVO mērķis ir reāli sasniedzams, paplašinot skrīninga apmērus, uzskata Rīgas Austrumu klīniskās universitātes slimnīcas (RAKUS) stacionāra “Latvijas Infektoloģijas centrs” (LIC) Aknu slimību nodaļas vadītāja un Latvijas Infektologu, hepatologu un HIV/AIDS speciālistu asociācijas (LIHHASA) viceprezidente, asoc. prof. Ieva Tolmane.
Ielaista C hepatīta riski
Kā infekcijas slimība C hepatīts ir hronisks iekaisums aknās, ko izraisa C hepatīta vīruss (HCV). Šis vīruss pēc akūtas inficēšanās ļoti bieži pāriet hroniskā procesā, bet organisms pats no vīrusa neatbrīvojas. Turpinās hronisks iekaisums, tiek bojātas aknu šūnas, vīruss vairojas, inficē nākamās šūnas, un ilgstošā laika periodā, aknās sāk izgulsnēties saistaudi, veidojas fibroze, kas pēc laika var novest līdz aknu cirozei, apraksta Ieva Tolmane.
“Ciroze jau ir slimība, kas ir neatgriezeniska un ko pilnībā izārstēt nevar. Cirozes gaitā aknās saaug saistaudi, un līdz ar to aknas nevar izpildīt savas funkcijas, bet aknas mums ir lielākā organisma laboratorija, tā gan sintezē ļoti daudzas organismam svarīgas lietas, gan izvada, gan metabolizē, pārstrādā, un, ja aknu funkcija ir ievērojami traucēta, tad no cirozes cilvēks var arī nomirt,” skaidro ārste.
Otrs smagu seku risks jebkuram cirozes pacientam ir aknu vēzis. Ja izveidojusies ciroze, tad pieaug arī aknu vēža risks, kas arī ir nopietns drauds turpmākajai dzīvei.
“C hepatīts pats par sevi nerada lielas problēmas cilvēkam, bieži vien to nemaz nejūt. Tas var noritēt bez jebkādiem simptomiem. Retākos gadījumos var būt neliels nogurums, izsitumi, miega traucējumi vai depresīvs noskaņojums, bet pārsvarā to nejūt. Ja šī slimība savlaicīgi nav atklāta, cilvēks to sajūt tikai tad, kad jau ir izveidojusies ciroze, turklāt ne sākuma stadijā, bet tad, kad aknas jau strādā slikti, un palīdzēt ir ļoti grūti. Tāpēc ir svarīgi C hepatītu diagnosticēt savlaicīgi, un mūsdienās tas ir labi ārstējams,” skaidro ārste.
Izārstējama hroniskā slimība
Slimība ir hroniska tad, ja tā turpinās ilgāk nekā sešus mēnešus, daudzos gadījumos visu atlikušo mūžu. Šajā ziņā mūsdienās C hepatīts ir viena no ļoti retajām hroniskajām slimībām, kuru iespējams izārstēt pilnībā – tā, ka izzūd C hepatīta vīruss, un cilvēks vairs nav infekcijas avots. Katrs izārstētais cilvēks ir ieguvums pats sev un arī sabiedrībai kopumā, un tāpēc PVO mērķis ir reāli sasniedzams, uzskata Ieva Tolmane.
“Agrāk tika izmantotas “smagas”, injicējamas zāles, ar daudzām blaknēm un zemāku efektivitāti, un ne visus varējām izārstēt. Kopš 2016.gada mēs ar ļoti labām, efektīvām zālēm izārstējam 95%-98% pacientu,” pauž ārste.
Taču tik sekmīgi rezultāti iespējami vien tad, ja C hepatīts ir konstatēts savlaicīgi – pirms aknu cirozes sākšanās. Bet līdz tam cilvēks parasti ir pie labas pašsajūtas, kamēr ciroze attīstās 10-15 gadu laikā. Vienīgais sekmīga iznākuma veids ir laikus pārbaudīties uz C hepatītu.
Problēmas atrisina skrīnings
“C hepatītu mēs varam izārstēt divu līdz trīs mēnešu laikā, atkarībā no stāvokļa un atbilstošās ārstēšanas shēmas, turklāt zāles ir pilnībā valsts apmaksātas un ļoti efektīvas, savukārt ārstēt mēs varam tikai tos, kuri ir diagnosticēti,” uzsver Ieva Tolmane.
Diemžēl ir daudz cilvēku, kas neiet pie ģimenes ārsta, jūtās labi, viņiem viss ir labi. Bet vienalga vismaz reizi gadā savu veselību pie ģimenes ārsta vajadzētu pārbaudīt. Un parasti ikgadējā izmeklējumā tests uz C hepatītu nav iekļauts, tāpēc, ja tas nekad nav darīts, vajag palūgt ģimenes ārstam to iekļaut vai arī izmantot kādu no citām pārbaudes iespējām.
Pārbaudīties uz C hepatītu patlaban iespējams četros veidos – nododot asinis kā donoram, jo visi donori tiek testēti uz B un C hepatītu un HIV infekciju, veikt testu HIV profilakses punktos, kas ir anonīmi un bez maksas visā Latvijā (vietas var atrast SPKC mājaslapā), ar ģimenes ārsta nosūtījumu un par maksu jebkurā laboratorijā, nododot anti-HCV testu. Ja anti-HCV tests ir pozitīvs, tas vēl nenozīmē, ka noteikti ir C hepatīts, tad nepieciešams apstiprināt pašu vīrusu, nododot asins analīzes. Ja atklāj C hepatītu, tad atliek to izārstēt, kas agrāk nebija tik vienkārši, bet šobrīd tas ir iespējams, uzsver ārste.
“Un ieteicams pārbaudīties pat tad, ja cilvēkam jau ir 70 vai 80 gadi, jo – mirt no cirozes – tā nav bauda. Tas nav tik mierīgi kā varbūt nomirt no infarkta. Mirt no cirozes ir ārkārtīgi smagi un ārkārtīgi grūti. Tā ir ļoti smaga slimība, ilgstoši mokoša un liels apgrūtinājums katram pacientam,” brīdina I. Tolmane.
Viņa uzskata, ka neatrisinātu jautājumu netrūkst arī dažādu riska grupu testēšanā. Piemēram, ieslodzījumu vietās skrīnings nav kā obligāts pasākums, tā ir katra brīva izvēle, un, nonākot ieslodzījuma vietā, nav noteikts, ka iemītnieks būtu jātestē, lai gan no infektologu viedokļa tas būtu jādara, bet tam jābūt valstiskam lēmumam ar regulējumu likumā.
“Esam testējuši psihoneiroloģisko slimnīcu pacientus, kur arī šī izplatība ir augstāka nekā sabiedrībā vispār. Arī sociālās aprūpes centros un patversmēs šī izplatība ir augstāka. Pārējā sabiedrībā, kur pacientu mazāk, viņus ir grūti atrast, tāpēc ir aicinājums katram cilvēkam, kurš ne reizi dzīvē nav pārbaudīts uz C hepatītu, veikt šo testu un tiem, kas kādreiz to izdarījuši, atkārtot ik pēc pieciem līdz desmit gadiem,” aicina I. Tolmane.
Dažādās iespējas inficēties
Profesore akcentē, ka C hepatīts nav kaut kāda “narkomānu slimība”, kas pārējiem varētu nebūt aktuāla. “Kad manai kolēģei vaicāja, kāds izskatās C hepatīta pacients, viņa teica, – pieejiet pie spoguļa un jūs ieraudzīsiet tipisku pacientu,” skaidro Ieva Tolmane. HCV izplatās ne tikai narkotiku lietotāju vidū, bet arī sabiedrībā kopumā, piemēram, dažādos kosmētikas procedūru kabinetos, tetovēšanas salonos, risks ir arī seksuālajās attiecībās, un arī medicīnā gadās savas vājās vietas, kur reti, bet mēdz notikt inficēšanās.
Saistībā ar izplatību profesore skaidro, ka attiecībā uz C hepatītu vienīgais epidemioloģiskais pētījums ir bijis 2008.gadā, un 2011.gadā tas ir nopublicēts. “Tur mums prevalence bija 1,7%, kas ir diezgan augsts rādītājs uz Eiropas Savienības fona. Toreizējās aplēsēs sanāca 38 000 inficēto Latvijā. Kāds skaitlis ir šobrīd, mēs skaidri nezinām, jo tādi pētījumi vēlāk nav bijuši,” komentē Ieva Tolmane.
PVO mērķis izskaust C hepatītu kā nopietnu draudu iedzīvotāju veselībai līdz 2030.gadam praksē nozīmē samazināt cirozes pacientu daudzumu, samazināt aknu vēža pacientu daudzumu, jo tās ir slimības, no kurām mirst. “Tas ir lielākais un galvenais mērķis. Un, protams, to mēs varam darīt ārstējot C hepatīta pacientus. Savukārt ārstēt mēs varam tikai tos, kuri mums ir diagnosticēti,” rezumē I. Tolmane.
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