Вопросы вирусологии. 2021; 66: 331-339
Роль противовирусной терапии в лечении больных циррозом печени, ассоциированным с хронической HBV- и HCV-инфекцией
https://doi.org/10.36233/0507-4088-70Аннотация
Формирование цирроза печени (ЦП) служит неблагоприятным событием естественного течения её хронических заболеваний и может сопровождаться осложнениями, которые нередко становятся причиной фатального исхода. Изучение эффективности лекарственных средств (ЛС), влияющих на различные этиопатогенетические механизмы этого состояния, представляет собой одну из актуальных проблем современной гепатологии. Цель обзора – показать роль противовирусной терапии (ПВТ) в лечении ЦП, ассоциированного с хронической инфекцией, вызываемой вирусами гепатитов В (hepatitis B virus, HBV) и С (hepatitis C virus, HCV).
Для поиска научных статей использовались база данных PubMed, поисковая система Google Scholar, Кокрейновские систематические обзоры, электронная научная библиотека eLIBRARY.RU, а также пристатейные списки литературы. В соответствии с задачами работы отбирались публикации за период 2000–2021 гг. по поисковым запросам: «цирроз печени»; «фиброз печени»; «хроническая HBV-инфекция»; «хроническая HCV-инфекция»; «портальная гипертензия»; «лечение». Критерии включения ограничивались проблемой терапии ЦП, ассоциированного с хронической HBV- и HCV-инфекцией.
Текущие гайдлайны рекомендуют бессрочное лечение пациентов с HBV-ассоциированным ЦП аналогами нуклеозидов/нуклеотидов (АН/Н) независимо от сывороточных уровней ДНК HBV; стандартом же терапии HСV-ассоциированного ЦП стала современная концепция использования комбинаций противовирусных препаратов прямого действия. Исследования показали способность ПВТ ингибировать и реверсировать фибротические процессы, что, в свою очередь, может уменьшить выраженность портальной гипертензии (ПГ) и снизить риск связанных с ней осложнений, а также нормализовать печёночную функцию. Кроме того, отмечается, что осуществление перед ортотопической трансплантацией печени (ОТП) эрадикации HBV/ HCV повышает общую выживаемость в долгосрочной перспективе. Таким образом, обеспечение доступности препаратов для нуждающихся в данных лечебных мероприятиях будет способствовать не только профилактике ЦП, но также позволит улучшить качество и увеличить продолжительность жизни страдающих им пациентов.
Список литературы
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Problems of Virology. 2021; 66: 331-339
The role of antiviral therapy in the management of patients with liver cirrhosis associated with chronic HBV and HCV infection
https://doi.org/10.36233/0507-4088-70Abstract
The formation of the liver cirrhosis (LC) is an unfavorable event of the natural history of chronic liver diseases being accompanied by complications that often cause a fatal outcome. The study of the effectiveness of drugs that affect various etiopathogenetic mechanisms of this condition is an urgent problem of modern hepatology.
The aim of the review was to show the role of antiviral therapy (AVT) in the management of patients with LC associated with chronic HBV (hepatitis B virus) and HCV (hepatitis C virus) infection.
PubMed database, Google Scholar search engine, Cochrane Systematic Reviews, eLIBRARY.RU electronic scientific library, as well as the reference lists of articles were used to search for scientific articles. The relevant objectives of the review of the publications were identified for the period since 2000 up to 2021 by the search queries as following: «liver cirrhosis», «liver fibrosis», «chronic HBV infection», «chronic HCV infection», «portal hypertension», «treatment». The inclusion criteria were restricted to the management of patients with LC associated with chronic HBV and HCV infection.
Current guidelines recommend indefinite treatment of patients with HBV-associated LC with nucleos(t)ide analogues regardless of serum HBV DNA levels, while the modern concept of using direct-acting antiviral drug combinations has become the standard treatment for HCV-associated cirrhosis. Studies have shown the ability of AVT to inhibit and reverse fibrotic processes in LC associated with chronic HBV and HCV infection. It has also been reported that HBV/HCV eradication prior to orthotopic liver transplantation improves long-term overall survival.
This, in turn, can reduce the severity of portal hypertension and decrease the risk of associated complications, as well as normalize liver function. Thus, ensuring the availability of drugs for those in need of AVT will not only help prevent the development of LC, but also improve the quality of life and increase its expectancy of patients suffering from this disease.
References
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2. Feld J., Janssen H.L., Abbas Z., Elewaut A., Ferenci P., Isakov V., et al. Review Team. World Gastroenterology Organisation Global Guideline Hepatitis B: September 2015. J. Clin. Gastroenterol. 2016; 50(9): 691–703. https://doi.org/10.1097/MCG.0000000000000647
3. Cornberg M., Lok A.S., Terrault N.A., Zoulim F. 2019 EASL-AASLD HBV Treatment Endpoints Conference Faculty. Guidance for design and endpoints of clinical trials in chronic hepatitis B – Report from the 2019 EASL-AASLD HBV Treatment Endpoints Conference. J. Hepatol. 2020; 72(3): 539–57. https://doi.org/10.1002/hep.31030
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5. Liaw Y.F., Sung J.J., Chow W.C., Farrell G., Lee C.Z., Yuen H., et al., Cirrhosis Asian Lamivudine Multicentre Study Group. Lamivudine for patients with chronic hepatitis B and advanced liver disease. N. Engl. J. Med. 2004; 351(15): 1521–31. https://doi.org/10.1056/NEJMoa033364
6. Chang T.T., Liaw Y.F., Wu S.S., Schiff E., Han K.H., Lai C.L., et al. Long-term entecavir therapy results in the reversal of fibrosis/ cirrhosis and continued histological improvement in patients with chronic hepatitis B. Hepatology. 2010; 52(3): 886–93. https://doi.org/10.1002/hep.23785
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