Журнал «Актуальная инфектология» Том 7, №2, 2019
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Comparison of the efficiency of different treatment schemes of patients with chronic hepatitis in connection with HIV-infections (poster presentation)
Авторы: I.V. Rudan, V.D. Moskaliuk
Bukovinian State Medical University, Chernivtsi, Ukraine
Рубрики: Инфекционные заболевания
Разделы: Медицинские форумы
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Background. The purpose of the work is to establish the clinical, laboratory and immunological characteristics of HIV infection against the background of chronic hepatitis C (HCG) and/or B (HGV), as well as to compare the efficacy and safety of the interferon-free and non-interferon-type HCG therapy in HIV-infected patients.
Materials and methods. We examined 40 patients with HIV-monoinfection, 77 with combined HIV/HCG and another 18 with a combination of HBV-, HCV- and HIV-infections. Therapy for patients with HCG was performed using a triple interferon-like scheme (cofosbuvir 400 mg 1 time per day internally + pegylated interferon alfa-2a in a dose of 180 micrograms subcutaneously once a week + ribavirin in dosage depending on weight: 1000 or 1200 mg/day in persons < 75 kg or ≥ 75 kg, respectively), or a parenotypic combination of antiviral drugs of direct effect — cofosburir 400 mg and velpatsavir 100 mg 1 time per day internally. The duration of therapy in both circuits was 12 weeks.
Results and discussion. In HIV-monoinfection, dyspeptic syndrome was recorded at 2.9–3.3 times, while hepatosplenomegaly was 2.0–2.2 times less than when combined with HCV infection with HCG or with HCG and HCG (p < 0.001). Persons with an initial level of CD4+-lymphocytes < 350 cells/μl were more likely to be infected with HIV/HCV and HCV/HCV/HBV-co-infected patients in 2.2–2.6 times than in the HIV-monoinfected subjects (p < 0.01). The average strength and strong feedback between the parameters of CD4+-lymphocytes and the viral load (HF) of HIV were determined (in patients with HIV-infection only — r = –0.720, p < 0.05; with concomitant CSG — r = –0.763, p < 0.01; with a combination of HGV, CSF and HIV infection — r = –0.552, p < 0.05). This indicates the establishment of the pathological process and the balance between the immune system and the activity of the viral process. In the absence of concomitant viral hepatitis, the degree of liver fibrosis on the METAVIR F0 scale was significantly higher than in HIV/HCV and HIV/HCV/HBV co-infection, and there were no cases of liver cirrhosis at all. The ratio of HCV genotypes in our study was similar to other regions of Ukraine: dominated by 1b, every fourth to fifth patient was diagnosed with a 3a genotype, it was less likely to be identified, and only HCV genotype 2 was detected in single patients.
Conclusions. In the case of infection with 1b, the HCV genotype is not trivial in 1 month. ensure normalization of aminotransferase activity in 83.3 % of patients, and after 12 weeks — in all treated patients. Instead, the results of the viral kinetics of HCV in the process of antiviral therapy (HPT) lagged behind the dynamics of the syndrome of cytolysis. A steady-state virologic response (CDV) was achieved in 75.0 % of these patients, and in case of infection with HCV genotype 3a — in 2 of 3 people. In this case, the dynamics of activity of AlAT and ASAT in most cases was parallel to the viral kinetics of HCV. Only in the process of treating HCG with interferon-containing three-component regimen undesirable effects and side effects of therapy were noted: hyperthermia, general anemia, anorexia, weight loss, depression, decrease in the number of leukocytes and lymphocytes, and due to this decrease in the absolute amount of CD4+-lymphocytes in peripheral blood, while the percentage cells practically did not change. The syphosburir + velpatsavir therapy was found to be significantly more effective and safer: SST was found in 100.0 % of patients with HIV/HCG in the case of non-HCV genotype 3 and in 2 out of 3 patients infected with HCV genotype 3a. The concentration of aminotransferases, even in the absence of SVV, did not exceed the upper limit of the norm. These treatments have been well tolerated, only in isolated cases, noting moderate headache, fatigue and nausea, which could have been due to other causes.