EFFECTIVENESS OF DIRECT-ACTING ANTIVIRAL DRUG THERAPY IN PATIENTS WITH CHRONIC VIRAL HEPATITIS C

All over the world hepatitis C is a global medical and social health problem, along with HIV infection, tuberculosis, hepatitis B, etc. According to the latest WHO estimates, the overall number of patients with chronic hepatitis C (CHC) in 2015 amounted to 71 million people (1 % of the world’s population). In Russia there are 5 million such patients. The largest number of people registered with CHC diagnosed in the Russian Federation is registered and lives in the Volga Federal District – 23.3 % (143,477 people). The incidence in the city of Ulyanovsk is very high (81.7 per 100 thousand of the population), and tends to grow steadily. The aim of this paper is to determine the effectiveness of 3D therapy in real clinical practice. Materials and Methods. Clinical charts of 151 patients with hepatitis C who underwent 8- and 12-week 3D and 3D+ ribavirin therapy (3 people) were analyzed. After therapy, the biochemical and virological responses were studied. The density of the liver tissue was determined on the FibriScanCompact 530 (Echosens, France). Results. There was a 100 % rate of sustained virological response to 8- and 12-week 3D therapy in complex groups of patients (extrahepatic manifestations, severe comorbid pathology, patients without previous responce to therapy). Triple therapy (Vikeira Pak) reduced the need for retreatment. Evaluation of interactions of direct antiviral drugs (3D scheme) in combination with ribavirin and without it was carried out with the most frequently prescribed drugs in the cohort of our patients. The 3D therapy regimen had a good safety profile: none of the patients cancelled treatment due to adverse events. Key words: chronic viral hepatitis C, 3D therapy, ombitasvir + paritaprevir + ritonavir, sustained virological response, genotype 1. Гепатит С является глобальной медико-социальной проблемой здравоохранения во всем мире наряду с такими заболеваниями, как ВИЧ-инфекция, туберкулез, гепатит В и ряд других инфекционных болезней. Согласно последним оценкам ВОЗ число больных хроническим гепатитом С (ХГС) в мире в 2015 г. составило 71 млн чел. (1 % населения Земли), из них 5 млн проживает в России. Наибольшее число лиц, состоящих на учете с диагнозом ХГС в РФ, зарегистрировано и проживает в Приволжском федеральном округе – 23,3 % (143 477 чел.). Заболеваемость в г. Ульяновске очень высока, составляет 81,7 на 100 тыс. населения и имеет тенденцию к неуклонному росту. Цель работы – определение эффективности 3D-терапии в реальной клинической практике. Материалы и методы. Проанализированы истории болезни 151 пациента с диагнозом «гепатит С». Все больные прошли курсы терапии 3D и 3D+рибавирин (3 чел.) в режиме 8 и 12 нед. Изучены биохимический, вирусологический ответы, после проведенного курса терапии определена плотность печеночной ткани на аппарате FibriScanCompact 530 (Echosens, Франция). Результаты. Доказана 100 % частота устойчивого вирусологического ответа на 8- и 12-недельные курсы 3D-терапии у сложных групп пациентов (с внепеченочными проявлениями, с тяжелой коморбидной патологией, у пациентов, ранее не отвечавших на терапию). Выбор трехкомпонентной терапии препаратом «Викейра Пак» обоснован возможностью снижения потребности в повторных курсах терапии. Оценка лекарственных взаимодействий препаратов прямого противовирусного действия схемы 3D в сочетании с рибавирином и без него производилась с наиболее часто назначаемыми препаратами в когорте наблюдаемых нами пациентов. Схема 3D-терапии имеет хороший профиль безопасности, ни один из пациентов не прекратил лечение в связи с нежелательными явлениями. Ключевые слова: хронический вирусный гепатит С, 3D-терапия, омбитасфир+паритапревир+ритонавир, устойчивый вирусологический ответ, генотип 1.

Toxoplasmosis and liver disease: literature review and clinical observation

Toxoplasmosis is a widespread ubiquatorial disease. A distinctive feature of this parasitosis is the predominance of latent forms. As a rule, in people with intact immune systems, the disease is asymptomatic. Severe cases of toxoplasmosis are usually associated with immunodeficiencies. At the same time, in cases of a manifest course in immunocompetent persons, toxoplasmosis is characterized by a polymorphism of clinical manifestations with damage to almost all organs and systems. In addition to the widely reported lesions of the eyes, brain, and intrauterine infection (IUI) associated with T. gondii, there are reports of damage to the liver, heart, lungs, and even multisystem cases of visceral toxoplasmosis. The article describes a clinical observation of toxoplasma hepatitis in a child with chronic viral hepatitis C. This clinical observation demonstrates the possibility of liver damage in the structure of toxoplasmosis and confirms the significance of this parasitosis among the population of patients with liver diseases.

Ifluence of seasonity on vitamin D level in patients with HCV infection and healthy people

According to WHO, about 150-200 million people are currently infected with the HCV virus worldwide. Recently, in the professional literature, the number of publications on the role of vitamin D in patients with viral hepatitis C has increased as vitamin D metabolism occurs with the participation of the liver and its deficiency is associated with an increased risk of infectious diseases. The aim of this study was to investigate the effect of seasonal factor on vitamin D (25 hydroxycalciferol) levels in patients with chronic viral hepatitis C and healthy subjects. The study involved 100 patients in the registry of patients with chronic viral hepatitis in the Dnipropetrovsk region. The prevalence and deficiency of vitamin D in patients with chronic viral hepatitis C and conditionally healthy subjects at different times of the year were determined, which showed the presence or absence of a seasonal effect on serum 25(OH)D level. Patients were divided into two groups, depending on the time of the year (autumn-winter and spring-summer), in which the level of 25 (OH) D was determined. The serum was metabolised by vitamin D, which is synthesized by the liver – 25 hydroxycalciferol (25 (OH) D), an indicator of the supply of vitamin D to the human body. Vitamin D levels were evaluated according to the M.F. Holick classification. According to the level of vitamin D patients were divided into 3 groups (patients with normal level, insufficient (suboptimal) level and vitamin D deficiency). The results of the study showed no effect of seasonal factor on the level of 25 (OH) D in the serum of patients with chronic viral hepatitis C. Vitamin D levels are controlled by the time of the year: in spring and summer this indicator is normal, in autumn and winter – seasonal decrease in vitamin D.

Chronic viral hepatitis C. Approach to therapy

The problem of chronic viral hepatitis C currently remains relevant due to the high incidence, frequent outcomes in liver cirrhosis, high disability of the population, and expensive treatment. The article discusses timely approaches to the treatment of chronic viral hepatitis C, using interferon-free therapy regimens.

Machine Learning Model for Diagnosing the Stage of Liver Fibrosis in Patients With Chronic Viral Hepatitis C

Aim. The purpose of the work was the development of a machine learning model for diagnosing the stage of liver fibrosis in patients with chronic viral hepatitis C according to the data of routine clinical examination. Materials and methods. A total of 1240 patients with chronic viral hepatitis C was examined. A set of data obtained from 689 patients balancing by the stage of liver fibrosis was used for developing and testing machine learning models. 9 routine clinical parameters were selected as the most important predictors for determining the likelihood of liver fibrosis the 3–4 stages presence: age, height, weight and body mass index of the patient, the number of platelets in the clinical blood test, levels of alanine transaminase, aspartate transaminase, gamma-glutamyltransferase, and total bilirubin in a biochemical blood test. Results. The accuracy of the developed method for determining the 3–4 stages of liver fibrosis in patients with chronic viral hepatitis C in comparison with the «gold standard» of diagnosis (liver biopsy) was 80.56% (95% CI: 69.53–88.94%), sensitivity — 66.67%, specificity — 94.44%. Conclusion. The developed method is an alternative to more expensive and geographically inaccessible studies. The method does not require the purchase of additional equipment or software, as well as additional laboratory tests, when used in real clinical practice. The introduction of the method into clinical practice can help to solve the problem of low material and territorial availability of diagnostic tests and allow determining the stage of liver fibrosis in patients with chronic viral hepatitis C.

POSSIBILITIES OF BIORREGULATION IN COMPLEX THERAPY OF CHRONIC PANCREATITIS IN COMORBIDITY WITH CHRONIC VIRAL HEPATITIS C

Key words: chronicpancreatitis, chronicviralhepatitis C, bioregulatorydrugs, Momordica compositum, Hepel, functional and structuralstate of the pancreas. Topicality. Insufficient development of primary and secondary prevention of chronic pancreatitis (CP), which occurs on the background of chronic viral hepatitis C (CVHC), requires a deeper study of the mechanism of its development and the establishment of clinical and pathogenetic features, which should be taken into account rehabilitation. One of such approaches to complex treatment of CP on the background of CVHC is the inclusion of drugs of bioregulatory therapy, which motivated thestudy. The aim is to investigate the parameters of the functional and structural state of the pancreas in chronic pancreatitis on the background of chronic viral hepatitis C, as well as their dynamics under the influence of complex therapy with the inclusion of bioregulatory drugs (BRD). Materials and methods. 106 patients with CP without exacerbation in combinationwith CVHC in the remission phase and without it were examined. The main group of the study included 72 patients with CP in the phase of unstable remission with concomitant CVHC in the latent stage. Patients with CP and concomitant CVHC were divided into two groups according to correction programs. It should be noted that patients in the study contingent of etiological antiviral therapy for CVHC infection for various reasons were not treated (refusal of antiviral treatment due to allergic history, personal intolerance, financial insolvency, etc.). Group I (36 patients) received only conventional treatment (CT). Group II (36 patients), in addition to CT, received additional BRD Momordica compositum for 1 amp. in / m 3 times a week for one month) and Hepel 1 tab. sublingually 3 times a day for 15-20 minutes before meals or after 1 hour after meals for one month. Results. After treatment an improvement in the structure of the pancreas and liver was observed, as evidenced by a decrease in the severity of Echoelastography and ultrasound. The score of ultrasound soft ware in the first group decreased by 28.6 %, and in the second group – decreased by 57.1 %; the rate of Echoelastography of the pancreas by 4.8% and 26.1 %, respectively, and the Echoelastography of the liver – by 15.3 % and 30.7 %, respectively. They also noted an improvement in the results of the coprogram and an increase in the level of fecal elastase-1: inthefirst group – by 23.8 %, and in the secondgroup – by 52.7 %. Discussion. Positive dynamics wasobserved in both groups, but in patients of group I after treatment it was less significant thaningroup II, where additionally a patient with CP on the background of CVHC received complex BRD (p <0.05). This proved a statistically significant higher efficacy of treatment using a complex bioregulatory corrector ofexocrine insufficiency (Momordica Compositum) and a complex bioregulatory hepatotropic drug (Hepeel) for one month. Conclusions: 1. Concomitant CVHC in the latent stage worsened the structural and functional state of the pancreas in CP, as well as the structural state of the liver according to EHR (p<0,05); 2. The use of complex bioregulatory therapy in addition to the conventional treatment of CP on the background of latent CVHC contributed to a statistically significant increase in its effectiveness in relation to conventional treatment: the level of fecal elastase-1 increased by 52.7% (p <0.05) compared to 23.8 %, pancreatic rigidity decreased by 26.1 % vs. 4.8 % (p <0.05), liver rigidity decreased by 30.7 % vs. 15.3 % (p <0.05).