Вестник Витебского государственного медицинского университета (Aug 2022)
Liver cirrhosis: dispensary observation, the effectiveness of antiviral therapy
Abstract
Objectives. To analyze the natural course of liver cirrhosis caused by the hepatitis C virus (HCV) and to evaluate the effectiveness of the related therapy with direct-acting antivirals (DAAs). Material and methods. The natural course of HCV-related cirrhosis was analyzed in 132 dispensary patients, and the effectiveness of antiviral interferon-free therapy was evaluated in 85 of them. Results. The incidence of liver cirrhosis in HCV-infected patients (9.4%) significantly exceeded that in hepatitis B virus-infected patients (2.6%). Among the dispensary patients with HCV-related cirrhosis, 46.2% were correspondingly diagnosed on registration or during the first year of dispensary observation, and 31% developed cirrhosis during the first five years of follow-up observation. The average and median terms for cirrhosis development made up 4.6 and 3.0 years, respectively. The administration of DAAs to patients with HCV-related cirrhosis resulted in a sustained virologic response in 95.3% of all cases. The absence of the effect was mainly observed in patients with liver HCV-related cirrhosis of genotype 3a (11.1%), the proportion of which in Vitebsk region reaches 29.2% in patients with chronic hepatitis C and 37.12% in patients with HCV-related cirrhosis. The rapid tests employed for the detection of antibodies to the HCV during screening were found to be more suitable for the widespread use and cost-effective. Conclusions. The treatment of patients with HCV-related cirrhosis of all genotypes with DAAs elicited no sustained virologic response in 4.7% of all cases and in 11.1% of cases with genotype 3a. The rapid progression of liver fibrosis in patients under dispensary observation highlights the need to improve diagnostics and thus enable the efficient early detection of chronic hepatitis C and timely antiviral therapy prescription.
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