E.V. ESAULENKO¹, A.A. SUKHORUK¹, O.A. GERASIMOVA²

¹Saint-Petersburg State Pediatric Medical University, 2 Litovskaya St., Saint-Petersburg, Russian Federation, 194100

²Russian Research Center for Radiology and Surgical Technologies, 70 Leningradskaya St., Pesochnyi settlement, Saint-Petersburg, Russian Federation, 197758

Esaulenko E.V. — D. Med. Sc., Professor, Head of the Department of Infectious Diseases in Adults and Epidemiology, tel. (812) 274-90-65, e-mail: infection-gpmu@mail.ru¹

Sukhoruk A.A. — postgraduate student of the Department of Infectious Diseases in Adults and Epidemiology, tel. (812) 274-90-65, e-mail: amaranta1981@mail.ru¹

Gerasimova O.A. — D. Med. Sc., Leading Researcher, tel. (812) 596-90-96, e-mail: ren321@mail.ru²

Comparative analysis was carried out of the effectiveness of antiviral therapy for chronic hepatitis C in patients with compensated cirrhosis and after liver transplantations. The study included 37 patients aged 49,2±8,2 years, divided into two groups: group 1 included 25 patients with liver cirrhosis (class A Child — Turcotte — Pugh) in the outcome of chronic hepatitis C, and group 2 — 12 patients after liver transplantation. Confirmation of the diagnosis of chronic hepatitis C was carried out by the detection of antibodies to hepatitis C virus at least 2 times with an interval of 6 months. Molecular biology and molecular genetic methods determined viral load and genotype. Cirrhotic stage of the disease was confirmed on the basis of the aggregate results of clinical, laboratory and instrumental examination. Antiviral therapy was performed using standard or prolonged preparations of interferon in combination with ribavirin. The main immunosuppressants were calcineurin inhibitors. The rapid and complete early virologic responses were recorded more often in group 2 (42% vs. 16 and 92% vs. 40, respectively; p<0,01). Sustained virologic response in both groups did not differ (32 and 42%, respectively, p>0.05). Patients, who were prescribed prolonged interferon, were more likely to achieve sustained virologic response. Thus, despite the greater frequency of achieving rapid and complete early virologic response in patients with recurrent HCV infection, in the future the treatment effectiveness is comparable to the efficiency with compensated cirrhosis. In case of planning antiviral therapy, the drugs of choice may be prolonged interferon.

Key words: chronic hepatitis C, liver cirrhosis, antiviral therapy, liver transplantation.

REFERENCES

1. Virusnye gepatity v Rossiyskoy Federatsii. Analiticheskiy obzor. 9-y vypusk, pod red. V.I. Pokrovskogo, A.B. Zhebruna [Viral hepatitis in the Russian Federation. Analytical Review. 9th Edition. Ed. V.I. Pokrovsky, A.B. Zhebrun]. Saint Petersburg: FBUN NIIEM imeni Pastera, 2013. 168 p.

2. Guidelines for the diagnosis and treatment of adult patients with hepatitis C. Ed. V.T. Ivashkina, N.D. Yushchuk, M.V. Majewski. Rossiyskiy zhurnal gastroenterologii, gepatologii, koloproktologii, 2013, vol. 23, no. 2, pp. 41-70 (in Russ.).

3. Shakhgil’dyan I.V., Yasinskiy A.A., Mikhaylov M.I. et al. Chronic hepatitis in the Russian Federation. Epidemiologiya i infektsionnye bolezni, 2008, no. 6, pp. 12-15 (in Russ.).

4. Bobrov A.N., Belyakin S.A., Plyusnin S.V. The etiological structure of liver cirrhosis as a result of fifteen years of observation. Vestnik Rossiyskoy Voenno-Meditsinskoy akademii, 2011, no. 1 (33), pp. 76-80 (in Russ.).

5. Esaulenko E.V. Hepatitis C: a look at the problem in the world. V mire virusnykh gepatitov, 2013, no. 4, pp. 14-19 (in Russ.).

6. World Health Organization. Guidelines for the screening, care and treatment of persons with hepatitis C infection. Edited by B. Smith, Y. Falk-Ytter. WHO, Switzerland, 2014. 123 p.

7. Gerasimova O.A. Non-surgical aspects of liver transplantation: an analysis of the waiting list RRCRST in 2000-2007. Vestnik transplantologii i iskusstvennykh organov, 2008, no. 5 (43), pp. 8-12 (in Russ.).

8. Agarwal K., Barnabas A. Treatment of chronic hepatitis C virus infection after liver transplantation. Digestive and Liver Disease, 2013, vol. 45, pp. 349-354.

9. Esaulenko E.V., Sukhoruk A.A., Gerasimova O.A. et al. Natural course of chronic hepatitis C after liver transplantation. Infektsionnye bolezni, 2014, vol. 12, no. 1, pp. 22-27 (in Russ.).

10. Alves de Mattos A., Zambam de Mattos A. Treatment of HCV infection in patient with cirrhosis. Annals of Hepatology, 2010, vol. 9, suppl. 1, pp. 80-83.

11. Fernandez-Rodriguez C.M., Alonso S., Martinez S.M. et al. Peginterferon plus ribavirin and sustained virological response in HCV-related cirrhosis: outcomes and factors predicting response. The American Journal of Gastroenterology, 2010, vol. 105, pp. 2164-2172.

12. Ponziani F.R., Annicchiarico E.B., Siciliano M. Treatment of hepatitis C in compensated cirrhotic patients is equally effective before and after liver transplantation. World J Gastroenterol., 2013, vol. 19, no. 21, pp. 3255-3262.

13. Federal Law of November 21, 2011 N 323-FZ «On the basis of health protection in the Russian Federation». Konsul’tant Plyus, available at: http://base.consultant.ru/cons/cgi/online.cgi?req=doc;base=LAW;n=156793 (accessed: 27.06.2014).

14. Bruno S., Shiffman M.L., Roberts S.K. et al. Efficacy and safety of peginterferon alfa-2a (40 KD) plus ribavirin in hepatitis C patients with advanced fibrosis and cirrhosis. Hepatology, 2010, vol. 51, pp. 388-397.

15. Bota S., Sporea I., Popescu A. et al. Response to standard of care antiviral treatment in patients with HCV liver cirrhosis – a Systematic Review. J. Gastrointestin. Liver Dis., 2011, vol. 20, no. 3, pp. 293-298.