Hepatitis C: treatment in Germany

About 150 million people worldwide suffer from some form of liver disease. Every year, doctors register about 4 million requests with suspicion of this dangerous ailment. Treatment in Germany for hepatitis C in recent years has progressed far ahead of other countries. This became possible thanks to the development of a number of drugs, which in 80% of cases allow to achieve complete recovery of patients and do not have serious side effects.

Briefly about medicine in Germany

A distinctive feature of the treatment carried out in German clinics is minimally invasiveness. Before handing over the patient to the hands of surgeons, the attending physicians will try to cure him therapeutically.

The leading role in the process of all measures is assigned to preventive and rehabilitative measures. The principle of “disease is easier to prevent than to cure” is fully applied here. But if the illness has happened, in this country they will try to make sure that the patient regains his strength as soon as possible and returns to his usual way of life.

In general, medicine is divided into three levels here:

• primary - consultation of a doctor of family medicine;
• secondary - the help of a narrow specialist;
• tertiary - referral to narrowly focused clinics.

At the first stage, as a rule, 80% of those who apply are cured. The rest go to technically equipped clinics with experienced staff and high chances of recovery.

The entire health care system in the country is built on compulsory insurance. Every citizen has the opportunity to choose services in the private sector of German medicine or in the public. He will be able to use the services of the relevant clinics on the basis of monthly contributions, which depend on salary. Low-income members of society fall under the tutelage of the state, which compensates for these costs from the federal treasury.

Definition of hepatitis and its causes

Even in the recent past 30 years ago, a single name was used to designate different types of hepatitis - jaundice or Botkin's disease. Thanks to the advances in virology, new types of hepatitis viruses have been discovered.

Hepatitis C was diagnosed in 1989. It involves an inflammatory process in the liver that lasts a long period and leads to cell damage and dysfunction of this organ.

Infectionists distinguish 2 forms of the disease:

• acute - infection occurred no more than 6 months ago;
• chronic - more than six months have passed since the virus entered the body.

The virus is an RNA-containing formation in the form of a sphere, covered with an envelope. Genetic data is stored in one gene, which carries information about 6-11 genotypes.

Potential risk groups are:

• drug addicts who inject drugs;
• blood donors;
• those who are connected to a dialysis machine.

But we cannot exclude other segments of the population who may be carriers of hepatitis without even knowing it. Most often, infection occurs among men aged 25-39 years.

The transmission methods can be the most common:

• shaving with a joint razor;
• transfusion of already infected blood;
• dental procedures;
• manipulations in cosmetology, which may be associated with the risk of bleeding.

Transmission of infection by the fecal-oral route is also possible, but it is not as likely as with hepatitis E and A. If the mucous membrane of the gastrointestinal tract is damaged, oral infection is possible.

This disease is transmitted exclusively from humans, mainly through the blood. It is impossible to become infected with hepatitis through sexual contact. The probability of the latter exists only in HIV-positive patients who do not use contraceptives, and in the presence of a violation of the integrity of the mucous membrane. If the infection occurs in a pregnant woman, it is likely that the baby will also be infected.

If the virus entered the woman's body before pregnancy, the possibility of transmitting the disease to the fetus is reduced to 4%.

The incubation period is 2-24 weeks. In the acute form, the following symptoms are observed:

• headache;
• fatigue;
• sudden weight loss;
• anorexia;
• muscle pain;
• fever;
• pressing pain in the upper abdomen.

Such signs are observed in only 20% of patients. Most of the cases are asymptomatic, with a high risk of primary chronicity.

In the chronic form, the patient complains of:

• joint pain;
• itchy skin;
• vasculitis (vascular inflammation).

Acute hepatitis C leads to liver failure.

How is the diagnosis

To identify the disease, it is enough to take the patient's blood for analysis. The presence of the virus in the collected material can show a special test for the determination of HCV (hepatitis c virus) hepatitis C. This can take some time. This is due to the fact that some people who are already carriers of the virus do not have clear signs that the liver is inflamed.

Most often, an infection is detected by chance, during a routine or preventive examination by a gastroenterologist and a test to identify certain enzymes - transaminase.

Together with hepatitis C, the doctor often diagnoses cirrhosis. And since the development of the latter can take about 30 years after the patient was infected with the virus, it is very likely that the infection itself occurred long before the diagnosis was made.

To establish how much the disease has spread and what the degree of liver damage is, German specialists carry out the following types of diagnostics:

• blood biochemistry;
• CT;
• MRI;
• chromoendoscopy;
• echolocation;
• endoscopic examination with ultrasound.

To find out the degree of cell damage and the genotype of viruses, material is taken for a biopsy of the liver itself.

How is the disease treated?

Treatment of hepatitis B in Germany and hepatitis C in the standard way is carried out with a combination of ribavirin and alpha interferon. The course of treatment depends on the genotype, individual characteristics of the patient and the response of the body.

The duration of medication is on average 24-48, and in some cases 72 weeks.

Early diagnosis allows all procedures to be carried out at home. Severe forms require constant monitoring in a hospital setting. The complex effect on the disease gives a positive result in 95% of cases.

The treatment regimen is compiled on an individual basis based on the stage of the disease. Impact on the disease in the early stages is aimed at eliminating key symptoms, protecting the liver from further influence of the virus. The above immunocorrectors are prescribed exclusively for the acute form.

If the tried methods do not have the desired effect, gastroenterology uses a radical way to eliminate the disease - liver transplant.

New developments

The main disadvantage of the therapy described above is poor tolerance by the body. This is manifested in the development of anemia, heart failure, depression. Side effects are most often caused by interferon, which served as a reason and incentive for researchers and developers of new drugs to look for a more effective way.

In 2021, scientists at the Frankfurt University Hospital reported testing a new treatment regimen for hepatitis C.

The developed technique does not provide for the use of interferon. It consists in taking two types of drugs:

• an NS3 / 4F protease inhibitor, which is used by the virus to destroy proteins closely associated with the triggering of innate immunity in the body;
• inhibitor of polymerase involved in genome formation.

Both can be prescribed to patients in combination with ribavirin or separately. The latest developments in this area are the following drugs:

• Simeprevir - detoxifies the main reproductive enzyme HCV. Works well in a "triple therapy" setting, that is, in combination with two other drugs. It is prescribed individually, based on the stage of the disease.
• Sofosbuvir - allows you to completely abandon interferon, halves the course of treatment;
• Harvoni - contains two active ingredients, one of which is sofosbuvir. It is used for the treatment of genotype 1 Hepatitis C. It does not need additional use of interferon or other drugs.

A number of other drugs are in clinical trials or are in the approval phase.

How to go for treatment

To go through the process of treatment and rehabilitation abroad, it is necessary to perform a number of actions that will require not only additional costs, but also time and effort. A good option is to contact intermediaries - firms that organize travel for the purpose of medical tourism.

If you decide to tackle this issue yourself, then the sequence of stages will look like this:

1. Find a clinic that deals with the treatment of the disease you are interested in. Attention should be paid to the professorship, the location of the center and the cost of procedures. In some cases, it is more expedient to find a doctor of the required specialization and go to the institution where he works.
2. Write a letter to the clinic describing your problem. Attach to it anamnesis, copies of the diagnostic results. All documents must be accompanied by a translation into German or English.
3. After examining your appeal, the clinic will send you an answer and indicate the cost of treatment.
4. Next, you need to transfer funds to the specified account.
5. After receiving the payment, an invitation will be sent to you as the basis for opening a category C visa (the goal is to undergo treatment).

Only medical documents need to be prepared for the clinic, but obtaining a visa permit will require financial guarantees, confirmation of the availability of housing and insurance.

How much does treatment in German clinics cost?

When planning the budget for your trip to Germany, be sure to include some extra money for additional diagnostics. Not all clinics are satisfied with the results brought by patients from abroad. Most centers prefer to examine their ward using their own equipment. For convenience, the prices for diagnostics and treatment are given in the table in euros.

Please note that the cost of the course of therapy includes only the price of medicines, which is approximately 85% of the total amount. Diagnostics also includes an integrated approach to studying the problem. Additional expenses are not provided at this stage.

Where to contact

The main task of the patient, even at the stage of preparation, is the correct choice of the clinic. It should be ideally suited for its technical capabilities, qualifications of specialists, and location.

The leading medical institutions in Germany that specialize in the treatment of infectious diseases are:

• Oncological clinic for the treatment of liver cancer (Munich). Conducts interdisciplinary examination of patients, implements the latest developments in oncology, collaborates with the Munich Cancer Center. It is famous in Europe as the most progressive medical institution working in this direction.
• Center for the Treatment of Viral Diseases at the University Hospital in Dusseldorf. One of the most famous gastroenterology and hepatology clinics in the country.
• Clinic at the University Center for Hepatology and Gastroenterology in Freiburg. The hospital is located in the southern part of the country and is considered one of the most popular thermal spas.
• Center for Gastroenterology and Hepatology in Cologne. Specializes in liver cancer, viral hepatitis A, B, C, D.
• The Gastroenterology Center at the Charite Clinic Berlin. One of the largest clinics in Europe, which has gained fame not only for its unique operations, but also for its enormous research work.

Summarizing

Hepatitis of various types is one of the most common diseases in the world, which is treated therapeutically in the initial stages. Germany has achieved unprecedented results in this matter thanks to numerous studies carried out in the field of hematology, gastroenterology and oncology.

The process begins with the diagnosis of the disease. At this stage, all the necessary procedures are carried out, which allow not only to confirm the diagnosis, but also to establish the degree of organ damage, the type of hepatitis and designate the treatment regimen.

Thanks to innovative developments, patients in German clinics are now being treated with a new generation of drugs. They make it possible to increase the effectiveness of treatment and shorten its duration by several times.