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CHRONIC VIRAL HEPATITIS C: CLINICO-EPIDEMIOLOGICAL FEATURES, MODERN DIAGNOSIS AND TREATMENT METHODS, INTERRELATION WITH AUTOIMMUNE DISORDERS

Аuthors: M. D. Chemych, A. G. Lishnevska

Pages: 749–760

Abstract

         

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.

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