Новая парадигма лечения хронического вирусного гепатита С у пациентовс хронической болезнью почек

Статья в Elpub

Рецепт. 2018; : 364-378

Новая парадигма лечения хронического вирусного гепатита С у пациентовс хронической болезнью почек

Аннотация

По данным литературы, инфекция, вызванная вирусом гепатита С (ВГС) у пациентов с хроническими болезнями почек (ХБП), ассоциируется с почти двукратным риском прогрессирования почечной недостаточности до терминальной стадии, может вызвать развитие острого почечного повреждения и вторичного нефритического синдрома. Для правильной лабораторной диагностики заболевания необходимо не только выявление антител против ВГС, но и обнаружение и количественное определение РНК вируса с помощью чувствительного анализа ПЦР с низким пределом детекции (≤15 МЕ/мл РНК). При отрицатель- ном первом тесте на ВГС у пациентов на гемодиализе следует рассмотреть его повторение каждые 6-12 месяцев с помощью ИФА. На данный момент наиболее эффективным и безопасным подходом к лечению ВГС-инфекции у пациентов с ХБП, в т.ч. у пациентов на диализе и реципиентов почки, является использование безинтерфероновых схем, основанных на противовирусных лекарственных средствах прямого действия. Долгосрочные наблюдения показывают, что при их использовании возможно окончательное излечение от ВГС более чем 99% пациентов. На сегодняшний день использование комбинации омбитасвир/паритапревир/ритонавир ++ дасабувир для лечения пациентов с выраженным снижением функции почек при генотипе 1а (с рибавирином) и 1b (без рибавирина) является основной схемой лечения ВГС-инфекции. Применение этой комбинации у реципиентов трансплантата почки также возможно, но требует существенной коррекции дозировок ингибиторов кальциневрина.

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Recipe. 2018; : 364-378

The new treatment paradigm of chronic hepatitis C virus in patients with chronic kidney disease

Kalachyk A. .

Abstract

By the literature review the hepatitis C virus infection in patients with chronic kidney diseases (CKD) associated with double-fold risk of renal insufficiency progression to terminal stage, can lead to the acute kidney injury and secondary nephritic syndrome.For the correct laboratory testing of HCV there is obligatory detection both the serum antibodies against virus and quantity investigation of virus RNA with the high sensitive PCR analysis with lowdetection limits (less than 15 ME/ml of RNA). In case of initial negative test for HCV in dialysis patients the analysis should be repeated every 6-12 months by ELISA.Currently the most effective and safe approach to the treatment of CKD patients (including dialysis and transplant recipients) with HCV infection is use of the interferon- free regimens based on the direct action antiviral agents. The long-lasting observations show that in case of usage of them more than 99% of patients can be cured.The combination of ombitasvir/paritaprevir/ritonavir plus dasabuvir for the treatment of patients with severe reduction of kidney function and infected by HCV genotype 1a (with ribavirin) or genotype 1b (without ribavirin) is the main regimen for the HCV treatment. Applying this combination also possible in renal transplant recipients, but the dosage of calcineurin inhibitors should be corrected substantially.

References