MORPHOLOGICAL AND CLINICAL-BIOCHEMICAL RESPONSE TO STANDARD ANTIVIRAL THERAPY IN PATIENTS WITH CHRONIC HEPATITIS C
The objective: to analyze morphological and biochemical changes in patients with chronic hepatitis C (CHC) after a course of antiviral treatment with pegylated interferon and ribavirin.The work was carried out on the basis of the Infectious Disease Department at 5th Military Clinical Hospital of the RussianGuard of the Russian Federation in Ekaterinburg. The study was cohort, prospective, controlled, dynamic, with the inclusion of 243 patients with CHC. The proportion of men was 67.9% (165 people), women - 32.1% (78 people), with genotype 1 - 43.6% (106 people) with genotype 2 - 11.1% (27 people) and with genotype 3 - 45.3% (110 people). All patients with CHC received standard combination therapy - pegylated interferon alpha-2A 180 µg per week and ribavirin, the duration of treatment was 24 weeks at genotypes 2 and 3 and 48 weeks at 1 genotype of the virus. Prior to the administration of antiviral treatment, all patients underwent puncture liver biopsy and minimal fibrosis F0 was found in 1-51.0% (124 people), F2 - 26.7% (65 people), F3 - 11.5% (28 people) and F4 - 10.8% (26 people).Sustained viral response (SVR) was achieved in more than 2/3 of patients - 69.5% and not achieved in 30.5%. The group re- sponded to the treatment was dominated by patients with the "not-1" genotype of a HCV infection - 81.2%, with genotype 1 - 57.7 per cent. With minimal liver fibrosis (F0-1), SVR in patients with CHC was 80.6% and at the stage of moderate fibrosis (F2) - 73.8%, which is significantly higher than at the stage of severe liver fibrosis and cirrhosis (F3-4) - 38.9%. According to the results of repeated liver biopsy and fibroelastometry, a decrease in the stage of fibrosis and elasticity parameters was registered in patients with CHC at the stage ≤F2. Normalization of biochemical parameters was in all patients who achieved a SVR, as well as in the absence of a response at the stage of moderate fibrosis inclusive.Positive morphological dynamics after the course of antiviral treatment in patients with CHC occurs only at the stages of minimal and moderate liver fibrosis, while at the stages of severe liver fibrosis and cirrhosis, changes in the stage of the disease do not occur regardless of the viral response and virus genotype.