Читать книгу Pathy's Principles and Practice of Geriatric Medicine - Группа авторов - Страница 465

Chronic hepatitis C virus (HCV) and hepatitis B virus (HBV) infections account for 1 million deaths worldwide yearly, but this number should dramatically decrease with recent advances in treatment.¹⁰ Hepatitis B (an estimated 257 million people worldwide are hepatitis B surface antigen positive) should be tested for in all patients presenting with abnormal transaminases and in asymptomatic patients from high‐risk populations such as people born in high‐risk countries such as sub‐Saharan Africa, China, and Vietnam; former or current intravenous drug users; those on dialysis; and men who have sex with men. The screening tests for hepatitis B are surface antigen and antibody. Those found to have hepatitis B surface antigen should be screened with six‐month ultrasounds to look for hepatocellular carcinoma, which can occur more frequently than in other liver diseases in this condition in the absence of cirrhosis. People who have cirrhosis or persistently elevated transaminases and hepatitis B DNA levels should be given treatment with anti‐virals such as Tenofovir, which are oral and once‐daily and can prevent progression of and reverse fibrosis. Hepatitis C should also be tested for in anyone with abnormal liver tests or with a history of IV drug abuse or those who were born between 1945 and 1965 in the US, who have a 2.6% prevalence.¹¹ The screening test is a hepatitis C antibody test; if the hepatitis C antibody is positive, then the hepatitis C viral load should be determined to confirm infection. Over 15% of patients will be antibody‐positive but not have viral RNA, indicating previously resolved infection. Today, 96% of patients with hepatitis C can be cured with simple once‐daily oral medications taken for 8–12 weeks.¹² All patients with chronic hepatitis B and C need to be assessed for fibrosis.