Chronic viral hepatitis C is an urgent problem of modern medicine. The medical and social significance of hepatitis C is determined by a wide spread, a progressive increase in the incidence, a variety of clinical manifestations, a high probability of formation of chronic liver pathology and extrahepatic lesions. According to expert estimates, up to 1 billion people have been infected with the hepatitis C virus, and the number of patients with hepatitis C is about 200 million. Now there is a pandemic of hepatitis C, which is 4–5 times higher in scale and number of infected than HIV infection.
The purpose of this work is to analyze the literature data on the clinical and epidemiological features of the course of hepatitis C and on the basic principles of diagnosis and modern treatment of this disease. Considerable attention is paid to factors influencing the course and results of antiviral therapy (AVT) and on autoimmune abnormalities in patients with hepatitis C when developing scientific sources.
The causative agent of hepatitis C is the RNA virus, which belongs to the family Flaviviridae. The source of infection is patients with acute and chronic hepatitis C. The mechanism of transmission of infection is parenteral. Hepatitis C is characterized by a long, often perennial, asymptomatic course, which is why patients do not seek medical help. At this time, it is possible to detect a periodic increase in ALT activity, minor violations of liver biosynthesis without significant changes in the patient's condition. Therefore, the disease is often found in the stage of intensive morphological changes in the hepatic tissue, cirrhosis, less often – hepatocellular carcinoma. During the activation of the infectious process, the condition of the patient depends on the degree of hepatic insufficiency, in general similar to that in chronic hepatitis C: marked general weakness, significant weight loss, loss of appetite and other dyspeptic manifestations; Possible symptoms of hemorrhagic syndrome. Most patients have a cytopenic syndrome (anemia, leukopenia, thrombocytopenia). In women, there may be various violations of the menstrual cycle, infertility, in men – a violation of spermatogenesis.
Treatment according to the standards of care for patients with chronic HCV infection consists of interferon alfa-2а or alfa-2в (PEG-IFN) in combination with ribavirin for 24 or 48 weeks, depending on the genotype. In Europe in 2011 were allowed for the treatment of infection caused by the first genotype of the hepatitis C virus, telaprevir and bocepreviir. These drugs are direct-acting antiviral agents of the 1st generation; they belong to the group of protease inhibitors and are prescribed in combination with PegIFN and ribavirin. Patients are also prescribed non-interferon treatment of antiviral treatment.
The existence of prognostic factors for the efficacy of antiviral therapy in patients with chronic hepatitis C has been proved. Determination of the factors that can predict the effectiveness of treatment makes it possible to adjust antiviral therapy regimens, reduce the number and severity of unwanted side effects, improve quality of life and reduce the cost of treatment. Recently, it is said about the personalization of treatment, taking into account the characteristics of both the virus and the human body. Viral factors include the HCV genotype and the initial level of viral load. The main factors are interferon-lambda-3 (IL28B) polymorphism, liver damage (fibrosis and steatosis) and metabolic factors (body mass index, or insulin resistance).
The data of scientific researchers do not reject the fact about the possibility of the influence of viral hepatitis C on the triggering of autoimmune reactions. It was found that autoantibodies are detected in 55% of CHC patients.
Keywords: viral hepatitis C, antiviral therapy, autoimmune hepatitis.
- Costa JM, Munteunu М, Ten Ngo Y. [IL28b, ITPA, UGT1A1 and prognostic factors of treatment response in patients with chronic hepatitis C]. J. Gastoenterology and Clinic Biology. 2010;35(3):457–459.
- Chung-Feng H, Chia-Yen D, Jee-Fu H. [Linkage of the Hepatitis C Virus Genotype and Interleukin-28B Genetic Polimorphisms in Asian Patients. Hepatology. 2011;53(1):367–368.
- Maliy VP. [Viral hepatitis C]. Klinichna imunologia. Alergologia. Infektologia. 2014;4(73):11–16.
- Vinod K Dhawan. [Hepatitis C]. Medscape Medical News. 2014. Retrieved from: http://emedicine.medscape.com/article/177792-overview.
- Maev IV, Polunina EV, Polunina TE. [Chronic viral hepatitis C - etiology, pathogenesis, treatment]. Klinicheskaya medicina. 2009;11:12–17.
- Bogomolov PO, Koblov SV, Bueverov AO. [Pegylated interferon α2a in the treatment of chronic hepatitis C]. Rossiyskiy jurnal gastroenterologii, hepatologii, koloproktologii. 2012;22(5):64–68.
- Fedorchenko SV. Hronicheskaya HCV-infekcia [Chronic HCV infection]. Kyiv: VSI «Medicina» Publ. 2010:7–9.
- Andreychin M A. Virusni hepatiti [Viral hepatitis]. Ternopil:Ukrmedkniga Publ., 2001. 52 p.
- Romanchuk KU. Personalizacia pharmacoterapii ta prognozuvanna u hvorih na hronichniy hepatit C [Personalize pharmacotherapy and its prediction in patients with chronic hepatitis C]. Dyssertacia na zdobutta naukovogo stupena kandidata medichnyh nauk. 2016.
- Moroz LV, Romanchuk KU. [Prediction pharmacotherapy Chronic Hepatitis C in dependence from gene polymorphism Il28b]. Aktualnaya infektologia. 2014;3(4):39–41.
- Barclay L. [Obesity PrediC/Ts Poor Response to Hepatitis C Treatment]. Journal of Hepatology. 2003; 557 – 559, 639 – 644.
- Kobrin TI, Telegin DE. [Predicting efficacy of antiviral therapy in patients with chronic hepatitis C]. Infekciyni hvoroby. 2010;2(60):69–79.
- Castera L, Pinzani M. [Non-invasive assessment of liver ﬁbrosis: are we ready?]. Lancet. 2010;375:1419–20.
- Muir AJ, Arora S, Everson G. [A randomized phase 2b study of peginterferon lambda-1a for the treatment of chronic HCV infection]. J. Hepatol. 2014; 61:1238 – 1246.
- Tucker ME. [FDA approves 'game changer' hepatitis C drug sofosbuvir]. Medscape Medical News from WebMD. December 21, 2013. Retrived from: http:// www.medscape.com/viewarticle/817371.
- Pavlovska M, Galota V. [Progress in the treatment of hepatitis C PEG-Interferon]. Infekciyni hvoroby. 2001;4:62–65.
- Zeuzem S, Sarrazin C. [What is optimal treatment for naïve patients with chronic hepatitis C?]. Management of patients with viral hepatitis. France: Service d’Hépatologie Hôpital Beaujon University of Paris VII, 2007;1–6.
- Lukasiewicz E, Gorfine M, Freedman LS. [Prediction of nonSVR to Therapy with Pegylated Interferon-α2a and Ribavirin in Chronic Hepatitis C Genotype 1 Patients after 4, 8 and 12 Weeks of Treatment]. 2010, 17 (5): 345–351.
- Prokunina-Olsson L, Muchmore B, Tang W. [A variant upstream of IFNL3 (IL28B) creating a new interferon gene IFNL4 is associated with impaired clearance of hepatitis C virus]. Nat. Genet. 2013;45 (2):164–71.
- Asselah Т, Bieche I, Sabbagh A, Bedossa R, Moreau R, Valla D et al. [Gene expression and hepatitis C virus infection]. Gut. 2009;58:846–858.
- Ge D, Fellay J, Thompson AJ, Simon JS, Shianna KV, Urban TJ et al. [Genetic variation in IL28B predicts hepatitis C treatment-induced viral clearance]. Nature. 2009;461:399–401.
- Tarik A. [Genetic polymorphism and response to treatment in chronic hepatitis C: The future of personalized medicine]. Journal of Hepatology. 2010; 452–454.
- Nikitin IG. [Defeat schytovydnoy gland antiviral therapy on the background of chronic viral hepatytov]. Lechebnoe delo. 2007;1:69–74.
- Gutkowski K, Gutkowska D, Bilkiewicz T. [Interferon therapy in chronic viral hepatitis; an autoimmunity dilemma]. Przegl. Lek., 2007;64(3):148–152.
- Nemov VV, Popkova MI, Nikitina ZI, Martynova T G. [Autoimmunnye violations and methods s otsenki hepatitis aetiology razlychnoy]. 2009; 2 (7):139–141.
- Sundukova AN. Charakter autoimunnyh narusheniy I uroven citokinov vospalenia pri hronicheskom virusnom hepatite C. [The nature of autoimmune disorders and the level of cytokines of inflammation in chronic viral hepatitis C]. Dyssertacia na soiskanie nauchnoy stepeni kandidata medichnyh nauk. 2005.
- Aref S, Sleem T, El Menshawy N. [Antiplatelet antibodies contribute to thrombocytopenia associated with chronic hepatitis C virus infection]. Hematology. 2009;14: 277–281.
- Leuschner U. Autoimunniy hepatit. [Autoimmune Hepatitis]. Frankfurt-na-Maini Publ., 2008:7p.
- Stern S, Sayfu A, Oltcorn D. Ot simptoma k diagnosu. [From symptom to diagnosis]. M: Geotar-Media Publ., 2008. 816p.
- Peng M, Li Y, Zhang M, Jiang Y, Xu Y, Tian Y, et al. [Clinical features in different age groups of patients with autoimmune hepatitis]. Exp Ther Med. 2014;7:145–148.
- Hennes EM, Zeniya M, Czaja AJ, Pares A, Dalekos GN, Krawitt EL, et al. [Simplified criteria for the diagnosis of autoimmune hepatitis]. Hepatology. 2008;48:169–176.
- Abe M, Mashiba T, Zeniya M, Yamamoto K, Onji M, Tsubouchi H, et al. [Present status of autoimmune hepatitis in Japan: a nationwide survey]. J Gastroenterol. 2011;46:1136–1141.
- Schramm C, Wahl I, Weiler-Normann C, Voigt K, Wiegard C, Glaubke C, et al. [Health related quality of life, depression, and anxiety in patients with autoimmune hepatitis]. J Hepatol. 2014;60:618–624
- Takahashi H, Zeniya M. [Acute presentation of autoimmune hepatitis: Does it exist? A published work review]. Hepatol Res. 2011;41:498–504.
- Kozko VM, Anziferova NV, Solomennik GO, Yurko KV, Bondar OE, Vinokurova OM, Penko DB. [Diagnosis of fibrosis in peptic feces in chronic hepatitis C: chronicle of problems with perspective]. Hepatologia. 2015;1:27–33.
- Zvaginzeva TD, Chernobay AI. [Autoimmune Hepatitis]. Novosti mediciny i farmacii. 2013;6(450). Retrived from: http://www.mif-ua.com/archive/ article_print/35664.
- European Association for the Study of the Liver. EASL Clinical Practice Guidelines: management of chronic hepatitis B virus infection. J Hepatol 2012;57:167–185.
- EASL Recommendations on Treatment of Hepatitis C 2016. Journal of Hepatology. 2017;66:153–194.