gastro-jРоссийский журнал гастроэнтерологии, гепатологии, колопроктологииRussian Journal of Gastroenterology, Hepatology, Coloproctology1382-43762658-6673«Gastro» LLCgastro-j-1621Research ArticleЛЕКЦИИ И ОБЗОРЫLECTURES AND REVIEWSСовременные подходы к лечению больных хроническим гепатитом ВModern approaches to the treatment of patients with chronic hepatitis BГалимоваC. Ф.GalimovaS. F.МаевскаяМ. В.MayevskayaM. V.ИвашкинВ. Т.IvashkinV. T.2009050620091931320Copyright © Галимова C.Ф., Маевская М.В., Ивашкин В.Т., 20092009Галимова C.Ф., Маевская М.В., Ивашкин В.Т.Galimova S.F., Mayevskaya M.V., Ivashkin V.T.Данная работа распространяется под лицензией Creative Commons Attribution 4.0.This work is licensed under a Creative Commons Attribution 4.0 License.https://www.gastro-j.ru/jour/article/view/1621

Цель обзора. Представить современные рекомендации, позволяющие выбрать оптимальную схему противовирусной терапии для больного хроническим гепатитом В (ХГВ).Основные положения. Хроническая HBV­ин­фекция представляет большую эпидемиологическую и экономическую проблему во всем мире. Цирроз печени (ЦП) и гепатоцеллюлярная карцинома (ГЦК) HBV этиологии служат причинами более 1 млн смертей и 5–10% трансплантаций печени ежегодно. Понимание роли вирусной нагрузки в развитии ЦП и ГЦК и появление на фармацевтическом рынке новых препаратов позволило усовершенствовать рекомендации по ведению больных с хронической HBV­инфекцией. Главный критерий эффективности противовирусной терапии (ПВТ) – величина вирусной нагрузки. Мониторирование HBV DNA на 12, 24, 48­й неделях лечения дает возможность составить прогноз его эффективности и определить риск развития резистентности к аналогам нуклеозидов/нуклеотидов.В качестве кандидатов для проведения ПВТ рекомендуется рассматривать больных ХГВ с вирусной нагрузкой более 2000 МЕ/мл (»10 000 копий/мл) и/или повышением активности аланинаминотрансферазы (АлАТ), с признаками умеренных или тяжелых воспалительно­некротических изменений и/или фиброзом печени. Пациенты с ЦП рассматриваются в качестве кандидатов для ПВТ даже при нормальных значениях АлАТ независимо от величины вирусной нагрузки. Для больных с декомпенсированным ЦП препаратами выбора служат аналоги нуклеозидов/нуклеотидов. Новые аналоги нуклеозидов/нуклеотидов (телбивудин, энтекавир, тенофовир) обладают прямым противовирусным действием и хорошей переносимостью при длительном применении.Заключение. Современные международные рекомендации по ведению больных с HBV­инфекцией позволяют повысить эффективность лечения посредством рационального применения противовирусных препаратов, улучшить выживаемость, уменьшить летальность и риск развития ЦП и ГЦК, оптимизировать затраты на лечение.

The aim of review

The aim of review. To present up-to-date references, that allows to choose the optimal mode of antiviral therapy for patient with chronic hepatitis B (CHB).

Original positions

Original positions. Chronic HBV-infection represents a major epidemiologic and economic problem all over the world. Liver cirrhosis (LC) and hepatocellular carcinoma (HCC) related to HBV infection are the causes for over 1 million deaths and 5–10% of transplantations of liver per year. The comprehension of the role of viral load in development of LC and HCC and introduction to the pharmaceutical market of new agents allow to improve guidelines on management of patients with chronic HBV-infection. The main criterion of efficacy of antiviral therapy (AVT) – the level of viral load. Monitoring of HBV DNA on the 12, 24, 48-th weeks of treatment enables to predict its efficacy and risk of development of resistance to nucleoside/nucleotides analogues. It is recommended to consider patients with CHB with viral load of over 2000 МЕ/ml (≈10000 copies/ml) and/ or elevation of alanineaminotransferase (ALT) activity, with signs of moderate to severe inflammatory-necrotic changes and/or liver fibrosis as candidates for AVT. Patients with LC are considered as candidates for AVT even at normal ALT levels irrespective of level of viral load. For decompensated LC patients nucleoside/ nucleotides analogues are the drugs of choice. New analogues nucleoside/nucleotides (telbivudine, entecavir, tenofovir) have direct antiviral action and good tolerability at long application.

Conclusion

Conclusion. Modern international references on management of patients with HBV-infection allows to increase efficacy of treatment by of rational application of antiviral agents, to improve survival rate, to reduce mortality and risk of LC and HCC development, to optimize treatment cost.

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The authors declare that there are no conflicts of interest present.