Anti-HCV blood test what it is and what to do

Hepatitis C is a disease caused by the HCV virus. The infection is transmitted through blood and sexually. The causative agent of the disease affects liver cells, in advanced cases, cirrhosis occurs. Pathology is manifested by the following symptoms:

  • weakness and fatigue;
  • pathological proliferation of liver tissue;
  • bloating and enlarged spleen;
  • skin and whites of the eyes turn yellow.

Such pronounced symptoms can occur 14 days after the virus enters the body. But often the incubation period is delayed up to six months. Hepatitis is an insidious disease, for a long time the patient may not have any complaints. During this period, the virus manages to infect most of the liver cells.

To identify the disease as early as possible, doctors give a referral for a blood test Anti hcv total. What does this study provide for diagnosis? It allows you to accurately determine the presence of the virus long before the onset of the first symptoms of hepatitis C. This makes it possible to prescribe therapy as soon as possible, before the disease has not yet begun to destroy the liver.

In addition to a blood test for Anti hcv total, there are other methods for diagnosing hepatitis. What kind of research is this and how accurate they are, we will consider further.

The doctor may suspect hepatitis in terms of analysis of the biochemical composition of the blood. In sick people, the values ​​of bilirubin and liver enzymes (AST and ALT) are several times higher than normal. But this does not always mean hepatitis. The same data can be observed with severe intoxications. Therefore, a biochemistry test alone is not enough for an accurate diagnosis of the disease. With any deviations in hepatic indices, the doctor always prescribes additional diagnostics, including an antibody test.

To detect hepatitis in the early stages, a blood test by the method of poly-dimensional chain reaction (PCR) helps. Currently, this is the most accurate analysis, which is based on the determination of the RNA of the causative agent of the disease. This diagnostic method allows you to calculate the viral load, that is, the concentration of infection in the blood plasma.

Sometimes PCR does not detect RNA of the virus, despite the fact that specific immunoglobulins are detected in the antibody assay. This happens in patients who have had hepatitis in the past.

The danger of hepatitis C is that the disease is often completely asymptomatic, and its first signs appear several months after infection. Also in medical practice, there are cases when patients are not aware of the presence of the disease for several years.

In most cases, the disease is detected by chance during a general blood test. If pathogenic bodies are present in the serum, many indicators will be abnormal. Despite the fact that the symptoms of hepatitis are very lubricated, doctors warn that there are some symptoms by the presence of which it is possible to suspect the presence of a disease:

  • general weakness, poor performance;
  • discomfort and pain in the right hypochondrium;
  • lack of appetite;
  • soreness in the muscles and joints.

These symptoms are common and may indicate the presence of other diseases, but if they occur, it is strongly recommended that you consult with your doctor in any case.

An uncertain result of an enzyme immunoassay is the presence in the biomaterial of a small amount of antibodies to the pathogen, in which it is impossible to refute or confirm infection with the infection. Doubtful data orient the hepatologist to further monitor the patient.

Reasons for the vague anti-HVC test result:

  1. early stage of hepatitis;
  2. insufficient sensitivity of the test system;
  3. non-compliance with the rules for the collection of biomaterial.

The data of the medical literature on the presence of genetic material in the blood with weakly positive ELISA are contradictory. To confirm the infection, additional tests are performed.

It is possible that false-positive ELISA results for rheumatoid factor in the blood of patients suffering from systemic lupus erythematosus, Sjogren’s syndrome, rheumatoid arthritis or parasitic infections.

Virus Detection Methods

The disease itself is caused by the HCV virus. The virus enters the liver, causes an inflammatory process in it, and thereby kills hepatocytes.

Hepatitis C liver

The liver grows in size, the enzymes in the blood increase. But noticeable signs of the disease do not appear, and a person infected with hepatitis C virus becomes a carrier. Without realizing the presence of a serious infectious disease, the carrier becomes dangerous in the event of direct contact with other people’s blood.

Hepatitis C virus (hcv) is a small chain of RNA inside the viral envelope, which uses the genetic material of liver cells for its reproduction. Their direct contact leads to:

  • The launch of the inflammatory process in the liver;
  • Destruction of hepatic cells (cytolysis);
  • The launch of immune mechanisms with the synthesis of specific antibodies;
  • Autoimmune aggression of immune complexes against inflamed hepatocytes.

Hepatitis C virus, entering the body, causes a very slow immune response, which leaves it unnoticed for a long time. The disease is often detected only at the stage of cirrhosis, although all the time the viral particles and their corresponding antibodies circulate in the blood. All well-known methods for diagnosing hcv infection are based on this. These include:

  1. Serological tests in the laboratory;
  2. PCR diagnostics (polymerase chain reaction);
  3. Rapid tests to determine the disease at home.

Important to remember. Diagnosis of viral hepatitis C is quite complicated. This is due to the high mutating ability of the pathogen. In a short time, it is able to acquire new antigenic properties, which makes it practically invisible to immune cells and serological diagnostic tests.

AHCV blood test shows the presence of antibodies to hepatitis C virus in the serum. Many patients mistakenly believe that this study is a check for the presence of a disease, but in fact this is not entirely true. The analysis does not show the presence of the disease itself, but only indicates whether the body has encountered this virus.

When infected with hepatitis C, antibodies are actively produced in the body – proteins of the immune system designed to combat pathogenic virus cells. The production of antibodies (Ab, At, Hcvab) does not begin immediately, but 5-6 months after infection. It is because of this feature that there are often cases when the patient is already sick, but a blood test gives a negative result for the presence of hepatitis C.

Doctors also warn patients that antibodies may be present in the blood serum for some time after treatment. Because of this feature, this study cannot be attributed to accurate diagnostic methods. To identify the overall clinical picture, the patient is prescribed additional tests and an examination to determine the presence of hepatitis.

Hepatitis C virus has the following features:

  • able to multiply in monocytes, macrophages, neutrophils and b-lymphocytes;
  • hepatitis virus contains an RNA molecule that carries genetic information and proteins that interact with the body;
  • Compared with other pathogens, HCV is considered one of the more dangerous because it has several different types and is prone to mutations. Because of this feature, it is difficult for the body and immunity to resist the virus;
  • today there are 6 known HCV genotypes and a large number of subtypes that differ in susceptibility to drugs and a further prognosis for patients;
  • hepatitis C virus is transmitted primarily by injection. There is also an increased likelihood of infection by blood transfusion and transplantation of its components. Sexual transmission of the virus is unlikely.

Also, the virus can be transmitted from an infected mother to the fetus. The probability of transmission of the virus in this way is low, but it still exists.

When an antibody test is prescribed

First of all, infectious disease specialists prescribe this analysis to patients with signs of liver damage in order to determine the type of disease. This study is also indicated for hepatitis patients undergoing treatment to determine the effectiveness of treatment.

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In addition, the study is prescribed to people who have an increased risk of infection:

  • persons who received a blood transfusion prior to a mandatory donor study for hepatitis C;
  • children born to infected mothers;
  • HIV infected
  • hemodialysis patients;
  • medical professionals;
  • patients before surgery;
  • patients with abnormalities in a biochemical blood test for bilirubin and liver enzymes;
  • people who have used (or have used in the past) injectable drugs.

Hepatitis C virus (HCV) is a single-chain hepatotropic virus that copies itself primarily in liver cells. It has high mutagenicity, which is due to the many options for the course of hepatitis C. There are 6 main genotypes and hundreds of subtypes of HCV, which are characterized by different forecasts of the course and effectiveness of antiviral therapy.

For the initial detection of a viral disease, a screening examination is carried out, which includes:

Enzyme-linked immunosorbent assay is a laboratory detection of low molecular weight compounds in a biomaterial based on an antigen-antibody reaction. When infected with a virus, the immune system synthesizes antibodies (anti-HVC). Therefore, their presence in 70% of cases indicates infection.

ELISA for anti-HVC – an analysis that is included in a screening examination of people susceptible to viral hepatitis.

What is the analysis for antibodies to HCV:

  1. primary detection of HCV infection;
  2. detection of a previous disease;
  3. differential diagnosis of hepatitis.

An analysis of HCV infection markers is performed for signs of liver damage:

  • nausea;
  • pain in the right hypochondrium;
  • yellowing of the skin;
  • decreased appetite;
  • bitterness in the mouth;
  • upset stool.

Indications for analysis on anti-HCV:

  1. screening examination;
  2. increased levels of hepatic transaminases;
  3. high risk of contracting HCV infection.

IFA is recommended for all people at risk:

  • living together with patients with hepatitis;
  • recipients and blood donors;
  • health workers in contact with the blood of patients.

Timely diagnosis and therapy reduce the likelihood of irreversible changes in the liver, increase the chances of recovery.

Possible indications for research

Anyone can get tested for HCV infection. Special indications for this are not necessary, except for the person’s desire to undergo this blood test. But there is a category of persons who are subject to mandatory research. These include:

  • Blood donors;
  • People who underwent a transfusion of blood, its components or preparations based on it;
  • Increased levels of hepatic transaminases (AlAT, AsAT), especially after previous surgical interventions, childbirth and other medical procedures;
  • Suspicion of viral hepatitis C or the need to exclude this diagnosis;
  • Negative tests for viral hepatitis B in the presence of symptoms of liver inflammation;
  • Monitoring the effectiveness of the treatment of HCV infection and resolving issues related to the tactics of further treatment.

Most often, a study is done if the doctor suspects that the person is infected with hepatitis. An anti HCV total blood test is a screening test. It is carried out for all patients who need inpatient care, women bearing a child, and people who are being examined. Also, the doctor can prescribe a patient examination in the presence of the following complaints:

  • persistent nausea, accompanied by bouts of vomiting;
  • weakness of the body, muscle aches;
  • lack of appetite;
  • low hemoglobin content;
  • controversial general blood count;
  • increased ESR (erythrocyte sedimentation rate);
  • increased bilirubin;
  • the presence of urobilin in urine;
  • destructive changes in the structure of the liver, detected during ultrasound.

Such a study is periodically performed for patients who are at risk. Since hepatitis C is transmitted sexually or through blood, the following categories of citizens fall into the risk group:

  • promiscuous people;
  • persons using drugs (by injection);
  • people who like to get tattoos and piercings;
  • patients who are often given a blood transfusion. Also, the analysis is done to citizens who underwent organ transplantation;
  • children born to an infected woman.

Doctors warn that people at risk should have a blood test done at least every six months. This is due to the fact that the hepatitis virus is prone to permanent mutations, because of which its symptoms can be blurred or will constantly change. At the same time, a person will not guess about the presence of the disease, and the virus will slowly destroy the liver.

If a patient is prescribed a hepatitis test, the doctor must explain what the analysis is and how to prepare for it. Blood sampling is carried out only on an empty stomach, while the patient will have to abandon the consumption of any medications several days before taking the biomaterial.

If these simple rules are ignored, the transcript of the analysis will be unreliable and a repeat study will be required. How long it takes to decrypt depends on the type of laboratory, but usually a form with the results is issued 3-5 days after taking the biomaterial. Blood is taken only from a vein.

  • negative. The result means that the body has never encountered hepatitis C virus. But experts warn that such a reaction may occur if less than 6 months have passed since the infection;
  • positive. This answer means that the patient has already had hepatitis or is currently infected with it;
  • identified anti-HCV IgG. The result confirms the presence of a chronic form of hepatitis;
  • identified anti-HCV IgM. Identification of the acute form of the disease;
  • detection of anti-HCV IgG and anti-HCV IgM in the blood. This result indicates an exacerbation of the chronic form of hepatitis.

If a Core Ag nucleocapsid protein is detected in the patient’s blood, this also confirms the presence of the virus in the blood. The production of this protein can be activated several days after infection, even before the start of antibody production.

Anti hcv total blood count: what is it?

In a person infected with hepatitis C virus, special protein compounds (immunoglobulins or antibodies) are formed in the body. So the immune system responds to the pathogen proteins (antigens). If the pathology proceeds secretly, then antibodies begin to form 90 days after infection. In acute manifestations of hepatitis, antibodies appear 14 days after the onset of the first signs of the disease.

The study of Anti hcv total on antibodies to hepatitis C virus antigens helps to detect immunoglobulins. In this case, it is possible to identify the disease at an early stage. For analysis, blood is taken from a vein. Then, by enzyme immunoassay, it is determined whether there are immunoglobulins against the HCV virus in the test material. In a sick person, antibodies of class M and G are present in the blood. During the analysis, their total number is determined. The accuracy of the study is about 90%.

But antibodies to the virus are also found in the blood of patients who have had hepatitis in the past. They remain after the illness.

In patients with an acute form of the disease, immunoglobulins M are found in the blood. Antibodies G are usually determined during chronic hepatitis or in patients at the recovery stage.

The interpretation of the results depends on the correctness of blood donation, therefore, preparation for analysis begins 24 hours before the manipulation and contains some restriction measures:

  • the exclusion from the diet of foods with a high content of carbohydrates, fats, sodium salt, spices, namely sweet, smoked, spicy, salted, fried and fatty foods;
  • limit sports and other heavy physical activity;
  • prevent exposure to physical and chemical factors (do not sunbathe on the beach and tanning beds, cancel physiotherapy procedures, do not overheat and do not overcool);
  • reduce the impact of biological factors (do not drink alcohol, psychostimulants, biological supplements, medicines, if possible according to vital indicators, for 24 hours).
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In order to avoid the dubious result of the analysis, it is necessary to prevent absorption of other compounds (proteins, fats, carbohydrates, nicotine, chemicals) into the systemic bloodstream, therefore:

  • blood is given strictly on an empty stomach;
  • eating 8 hours before the test;
  • You can drink a glass of clean water without gas;
  • one hour before the analysis is supposed not to smoke;
  • if possible, take pharmaceuticals after blood donation.

If the result of the Anti-HCV-total analysis is positive, then, since the system has a high degree of sensitivity, this indicator reliably means that antibodies to the disease are present in the blood.

Since normal immunoglobulins to HCV are absent, this means that:

  • patient infected (carrier), HCV diagnosis;
  • a person has an acute or chronic form of hepatitis C (the diagnosis is confirmed);
  • suffered a disease in the past (convalescence stage).

With a positive analysis, the patient is prescribed a complete comprehensive examination to select treatment tactics and identify the stage of the disease and possibly associated complications.

Features of PCR diagnostics

If a virus is suspected in the blood, each person can independently conduct a preliminary diagnosis for the presence of antibodies using rapid tests. Special test systems can be purchased at each pharmacy chain; they are equipped with everything necessary for analysis.

Although the test does not help determine the exact amount of HCV in the blood, it will in any case help confirm or refute the suspected diagnosis. To get a reliable result, you must carefully read the attached instructions and strictly adhere to it during testing.

The result of the express test will be ready in 8-10 minutes. Decryption is carried out only after this time

Typically, the diagnosis is carried out according to this algorithm of actions:

  1. First you need to open the sterile container.
  2. Next, process the ring finger with an antiseptic wipe.
  3. Now you need to pierce a small pillow of the ring finger with a scarf and pick up a few drops of blood with a pipette.
  4. Transfer blood to the recess on the test plate and add a couple drops of the reagent to the material, which is supplied.

If 1 strip appears on the screen, this indicates the absence of pathogenic cells in the blood. If 2 strips are visible, the result is positive. In such a situation, you should immediately contact your doctor.

A laboratory blood test for hcv involves the detection of antibodies (immunoglobulins) of classes M and G to the antigenic components of the hepatitis C virus. For this, enzyme-linked immunosorbent assays (ELISA) and radioimmunoassay (RIA) are used. Laboratory methods for detecting antibodies are considered the most reliable, since they allow the use of several antigenic complexes of the most common types of hepatitis C virus as reagents.

For the study, about 20 milliliters of venous blood are collected from the peripheral vein. It is centrifuged and defended to obtain a plasma (liquid transparent part). Form elements and sediment are removed. To exclude false-positive results, it is better to take blood in the morning before eating. A few days before, it is desirable to exclude the use of medications, especially those that affect the state of the immune system.

The results of the analysis can be presented as follows:

  1. Hcv is negative. This means that no antibodies to hepatitis C virus were detected in the body. No disease;
  2. HCV – Positive. This indicates the presence in the blood samples of antibodies to hepatitis C virus. A person has either been ill with this disease, or is currently suffering from an acute or chronic form thereof;
  3. Detected anti-hcv IgG. In this case, you should think about chronic viral hepatitis C;
  4. Detected anti-hcv IgM. Its isolated presence indicates an acute process, and a combination with anti-hcv IgG indicates an exacerbation of a chronic one.

HCV rapid testing is the first step in detecting a disease

Anyone can do a hcv blood test on their own. This was made possible thanks to the creation of special test systems for the rapid diagnosis of viral hepatitis C. Their effectiveness is inferior to laboratory serological methods, but is excellent for tentative determination of a possible infection in a short time.

Polymerase chain reaction is the most modern way to detect the genetic material of any cells. With regard to viral hepatitis C, the method allows you to detect RNA molecules of viral particles. This can be done with a qualitative and quantitative method. The first method may turn out to be uninformative if the number of viral particles in the test blood does not reach a threshold value. The second method allows you to accurately indicate the number of detected viral chains of RNA and is more sensitive.

The analysis can be represented by the following results:

  1. Hcv RNA was not detected. This means that there are no viral particles in the test blood;
  2. Hcv RNA detected. This indicates infection with hepatitis C;
  3. A quantitative hcv PCR test is performed to assess the degree of infection of the patient’s blood and the activity of virus reproduction in the body. High is considered a viral load of blood from 600 to 700 IU / ml. Indicators above this figure are called very high, below it – a low viral load of blood.

A hcv blood test for the diagnosis of viral hepatitis C is the only informative, accessible and harmless method for verifying the diagnosis. Correct interpretation and combination of different methods of its implementation minimize the number of diagnostic errors.

How to pass the analysis

This study does not require complicated preparation. However, some guidelines must be followed before performing an Anti hcv total blood test. What are these rules?

  1. Investigations always take place in the morning on an empty stomach. You can only drink clean water.
  2. The day before blood donation, spicy, fatty, sweet, salty foods and alcohol are excluded from the diet.
  3. Do not smoke a few hours before the test.
  4. If the patient is taking any medications, a doctor should be warned about this.

Positive result

A positive Anti hcv total blood test in most cases indicates infection with hepatitis. Sometimes this may indicate a previous illness, then the doctor must be warned that the patient had hepatitis in the past.

With this result, additional studies are prescribed. There are 6 genotypes of the virus, and the treatment of each of them has its own specifics. Therefore, for the correct choice of the method of therapy, an analysis is carried out for the genotype of the pathogen.

There are extremely rare cases when a person is not sick, but the Anti hcv total blood test is positive. What does this mean? This occurs with serious malfunctions in the immune system. A false positive result of the analysis can be with the following pathologies:

  • autoimmune diseases;
  • tumors;
  • infectious diseases.

However, the analysis gives distorted results in exceptional cases. And usually the presence of antibodies indicates infection with the hepatitis virus. The treatment regimen for the disease depends on the genotype of the microorganism, but there are general principles of therapy:

  • prescribing antiviral drugs with the active components Sofosbuvir and Daclatasvir, as well as interferon-based drugs;
  • taking hepatoprotectors, for example, Essentiale, Phosphoglyph, Karsil, Silimar;
  • regular use of immunomodulators such as “Zadaxin”, “Timogen”;
  • following a diet that restricts salty, spicy, greasy, and fried foods.

If the result of the antibody test turned out to be positive, the doctor diagnosed hepatitis C, then do not despair. This is not a sentence. With modern methods of diagnosis and treatment, the prognosis of the disease is favorable in 95% of cases.

With positive or doubtful serological analysis data, they resort to a molecular biological study of the blood – polymerase chain reaction (PCR). This test for hepatitis C viral RNA is confirmatory.

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Qualitative PCR – a laboratory study in which the pathogen genetic material is determined. 1.5 weeks after hepatitis C infection, viral particles – ribonucleic acid (RNA) – are detected in the blood. To eliminate the risk of a false negative result, ultra-sensitive test systems of 150-1 * 10 ^ 8 IU / ml are used.

Interpretation of PCR data:

  1. not detected – no virus in the blood;
  2. detected – there is infection with hepatitis.

If the fact of HCV infection is confirmed, 2 more analyzes are performed:

  • quantitative PCR – determine the level of viral load;
  • genotyping – specify the genotype and subtype of the hepatitis pathogen.

Adequate treatment with PPD drugs leads to the destruction of HCV in 96-100% of cases. The chances of recovery increase with the timely detection of HCV infection. Therefore, if you suspect hepatitis, you must immediately undergo a screening examination.

Doctors warn patients that a positive result for hepatitis does not always indicate the presence of the disease. As practice shows, quite often the analysis results are false. A false clinical result may be the result of the following factors: improper processing and incorrect storage of the collected biomaterial, analysis in different laboratories, and the inclusion of third-party components in the studied biomaterial.

Also, the likelihood of a false result increases if the patient ignored medical recommendations before giving the blood. If the study showed the presence of antibodies to hepatitis C virus, additional tests are prescribed for the patient, one of which is an RNA PCR test.

This is one of the most accurate and sensitive tests, with which you can determine the presence of the virus in the blood in the early stages and accurately determine its genotype. With the help of this study, you can confirm or refute the initial diagnosis. Experts warn that for successful therapy it is necessary to determine the genotype of the virus. If you prescribe treatment without taking into account the type of pathogen, the therapy will be ineffective.

Normal value

There are no quantitative guidelines for this study. There are only 2 options for Anti hcv total analysis indicators – positive and negative. The results of the study are usually ready in a week, as the data sometimes require calculations and additional checks. A form with indicators must be presented to the attending physician. Only a physician will be able to correctly interpret the analysis data.

What is a positive Anti hcv total blood count? This means that antibodies to hepatitis C virus are present in the patient’s blood. Most often this result indicates a disease, but there are exceptions to this rule.

If the Anti hcv total blood count is negative, this indicates the absence of antibodies to hepatitis C. But this does not always mean that the person is healthy.

For HCV analysis, blood is given on an empty stomach. If the result is positive, a biochemical blood test will be prescribed to clarify the level of liver enzymes. An ELISA blood test for HCV is almost the only method that today diagnoses hepatitis C virus infection by 90%.

Upon receipt of a positive HCV test result, further investigation of the virus genotype follows. Six types are currently known and diagnosed. Each has its own treatment method. Therefore, genotyping is necessary to prescribe the right therapy

The cause of a false-positive ELISA result can be acute infectious processes in the body, the presence of oncology or autoimmune diseases.

A blood test for HCV determines the level of viral load. The norm of the HCV blood test is negative, that is, the absence of antibodies to hepatitis C. With a positive result, the norms for determining the viral load are as follows: 2 * 106 copies / ml – low viral load, 2 * 106 copies / ml – high viral load. PCR analysis allows you to detect hepatitis RNA in the blood. And today it is the most accurate method for diagnosing hepatitis C.

Negative result

This indicator means that at the moment the patient does not produce immunoglobulins against hepatitis C virus proteins. Most often this means that the person is not sick. But it’s too early to calm down, the absence of antibodies does not mean that there was no infection. If the patient has symptoms from the liver, then the doctor will prescribe additional studies. A negative result can be observed in sick people in the following cases:

  1. A person is infected with hepatitis, but too little time has passed since the infection, antibodies have not yet been developed.
  2. There is a seronegative form of hepatitis C in which immunoglobulins are not produced.

Therefore, if the patient is concerned about the liver, then the examination must be continued even with negative results of the analysis. Perhaps the doctor will prescribe a PCR diagnosis that will accurately show the presence of the virus.

If the Anti-HCV-total test result is negative, what does this mean? Deciphering the result “negatively” when detecting antibodies to hepatitis C:

  1. No virus was found in the blood; the patient is healthy.
  2. Not enough time from the moment of infection (incubation period).
  3. Seronegative variant of the course of viral hepatitis C.
  4. Low antibody titer (viral load below the threshold norm of the test analyzer), in which case the result is called false negative.

Conclusion

As practice shows, hepatitis C is more often found in an advanced stage, when the treatment of the disease is as problematic as possible. This is due to the fact that the disease is almost asymptomatic and most patients carry it on their feet.

That is why, in order to be able to timely detect the disease and start treatment on time, it is necessary to periodically donate blood to HCV. An analysis is recommended at least once a year. Only in this case is there a chance to timely detect this insidious disease.

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Svetlana Borszavich

General practitioner, cardiologist, with active work in therapy, gastroenterology, cardiology, rheumatology, immunology with allergology.
Fluent in general clinical methods for the diagnosis and treatment of heart disease, as well as electrocardiography, echocardiography, monitoring of cholera on an ECG and daily monitoring of blood pressure.
The treatment complex developed by the author significantly helps with cerebrovascular injuries and metabolic disorders in the brain and vascular diseases: hypertension and complications caused by diabetes.
The author is a member of the European Society of Therapists, a regular participant in scientific conferences and congresses in the field of cardiology and general medicine. She has repeatedly participated in a research program at a private university in Japan in the field of reconstructive medicine.

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