gastro-jРоссийский журнал гастроэнтерологии, гепатологии, колопроктологииRussian Journal of Gastroenterology, Hepatology, Coloproctology1382-43762658-6673«Gastro» LLC10.22416/1382-4376-2023-33-1-84-124gastro-j-807Research ArticleКЛИНИЧЕСКИЕ РЕКОМЕНДАЦИИCLINICAL GUIDELINESКлинические рекомендации Российского общества по изучению печени, Российской гастроэнтерологической ассоциации, Национального научного общества инфекционистов по диагностике и лечению хронического вирусного гепатита СClinical Practice Guidelines of the Russian Society for the Study of the Liver, the Russian Gastroenterological Association, the National Scientific Society of Infectious Disease Specialists for the Diagnosis and Treatment of Chronic Hepatitis Chttps://orcid.org/0000-0002-6815-6015ИвашкинВ. Т.IvashkinV. T.

Ивашкин Владимир Трофимович — доктор медицинских наук, академик РАН, профессор, заведующий кафедрой пропедевтики внутренних болезней, гастроэнтерологии и гепатологии, директор клиники пропедевтики внутренних болезней, гастроэнтерологии и гепатологии им. В.Х. Василенко

119435, г. Москва, ул. Погодинская, д. 1, стр. 1

Vladimir T. Ivashkin — Dr. Sci. (Med.), RAS Academician, Prof., Head of the Department of Propaedeutics of Internal Diseases, Gastroenterology and Hepatology, Director of the Clinic for Propaedeutics of Internal Diseases, Gastroenterology and Hepatology

119435, Moscow, Pogodinskaya str., 1, building 1

ivashkin_v_t@staff.sechenov.ruЧулановВ. П.ChulanovV. P.

Чуланов Владимир Петрович – профессор, доктор медицинских наук, заместитель директора по научной работе и инновационному развитию

127473, г. Москва, ул. Достоевского, д. 4, корп. 2

Vladimir P. Chulanov – Dr. Sci. (Med.), Prof., Deputy Director for Research and Innovative Development

127473, Moscow, Dostoevsky str., 4, building 2

chulanov_v_p_1@staff.sechenov.ruМамоноваН. А.MamonovaN. A.

Мамонова Нина Алексеевна – гастроэнтеролог, гепатолог, терапевт

127473, г. Москва, ул. Достоевского, д. 4, корп. 2

Nina A. Mamonova – gastroenterologist, hepatologist, internis

127473, Moscow, Dostoevsky str., 4, building 2

nina.mamonova@mail.ruhttps://orcid.org/0000-0001-8913-140XМаевскаяМ. В.MaevskayaM. V.

Маевская Марина Викторовна — доктор медицинских наук, профессор

119435, г. Москва, ул. Погодинская, д. 1, стр. 1

Marina V. Maevskaya — Dr. Sci. (Med.), Prof.

119435, Moscow, Pogodinskaya str., 1, building 1

mvmaevskaya@me.comhttps://orcid.org/0000-0001-5939-1032ЖарковаМ. С.ZharkovaM. S.

Жаркова Мария Сергеевна — кандидат медицинских наук, заведующая отделением гепатологии Клиники пропедевтики внутренних болезней, гастроэнтерологии, гепатологии им. В.Х. Василенко

119435, г. Москва, ул. Погодинская, д. 1, стр. 1

Maria S. Zharkova — Cand. Sci. (Med.), Head of the Department of Hepatology, Clinic of Propaedeutics of Internal Diseases, Gastroenterology and Hepatology

119435, Moscow, Pogodinskaya str., 1, building 1

zharkovamaria@mail.ruhttps://orcid.org/0000-0002-0532-9126ТихоновИ. Н.TikhonovI. N.

Тихонов Игорь Николаевич — ассистент кафедры пропедевтики внутренних болезней, гастроэнтерологии и гепатологии, врач-гастроэнтеролог отделения гепатологии клиники пропедевтики внутренних болезней, гастроэнтерологии и гепатологии им. В.Х. Василенко

119435, г. Москва, ул. Погодинская, д. 1, стр. 1

Igor N. Tikhonov – Assist. Prof.,  Department of Propaedeutics of Internal Diseases, Gastroenterology and Hepatology, gastroenterologist of the Department of Hepatology of the Clinic of Propaedeutics of Internal Diseases, Gastroenterology and Hepatology

119435, Moscow, Pogodinskaya str., 1, building 1

antihbs@gmail.comhttps://orcid.org/0000-0003-2346-1216БогомоловП. О.BogomolovP. O.

Богомолов Павел Олегович — кандидат медицинских наук, руководитель отделения гепатологии

129110, г. Москва, ул. Щепкина, д. 61/2

Pavel O. Bogomolov — Cand. Sci. (Med.), Head of the Department of Hepatology

129110, Moscow, Shchepkina str., 61/2

Bpo73@list.ruВолчковаЕ. В.VolchkovaE. V.

Волчкова Елена Васильевна – доктор медицинских наук, профессор, заведующая кафедрой инфекционных болезней

119435, г. Москва, ул. Погодинская, д. 1, стр. 1

Elena V. Volchkova – Dr. Sci. (Med.), Prof., Head of the Department of Infectious Diseases

119435, Moscow, Pogodinskaya str., 1, building 1

volchkova_e_v@staff.sechenov.ruДмитриевА. С.DmitrievA. S.

Дмитриев Александр Сергеевич – кандидат медицинских наук, врач-инфекционист, руководитель Центра эпидемически значимых инфекционных болезней

127473, г. Москва, ул. Достоевского, д. 4, корп. 2

Alexander S. Dmitriev – Cand. Sci. (Med.), infectious disease specialist, Head of the Center for Epidemiologically Significant Infectious Diseases

127473, Moscow, Dostoevsky str., 4, building 2

https://orcid.org/0000-0002-4965-596XЗнойкоО. О.ZnojkoO. O.

Знойко Ольга Олеговна — доктор медицинских наук, доцент, профессор кафедры инфекционных болезней и эпидемиологии

127473, г. Москва, ул. Делегатская, 20, стр. 1

Olga O. Znojko — Dr. Sci. (Med.), Prof., Department of Infectious Diseases and Epidemiology

127473, Moscow, Delegatskaya str., 20, building 1

olgaznoyko@yandex.ruhttps://orcid.org/0000-0003-4319-8144КлимоваЕ. А.KlimovaE. A.

Климова Елена Анатольевна — доктор медицинских наук, доцент, профессор кафедры инфекционных болезней и эпидемиологии

127473, г. Москва, ул. Делегатская, 20, стр. 1

Elena A. Klimova — Dr. Sci. (Med.), Prof., Department of Infectious Diseases and Epidemiology

127473, Moscow, Delegatskaya str., 20, building 1

elena_klimova_@mail.ruКозловК. В.KozlovK. V.

Козлов Константин Вадимович – доктор медицинских наук, доцент кафедры инфекционных болезней (с курсом медицинской паразитологии и тропических заболеваний)

194044, г. Санкт-Петербург, ул. Академика Лебедева, д. 6

Konstantin V. Kozlov – Dr. Sci. (Med.), Assoc. Prof., Department of Infectious Diseases

194044, St. Petersburg, Academika Lebedeva str., 6

kosttiak@mail.ruКравченкоИ. Э.KravchenkoI. E.

Кравченко Ирина Эдуардовна – доктор медицинских наук, профессор кафедры инфекционных болезней

420012, г. Казань, ул.Бутлерова, д. 49

Irina E. Kravchenko – Dr. Sci. (Med.), Prof., Department of Infectious Diseases

420012, Kazan, Butlerova str., 49

МалинниковаЕ. Ю.MalinnikovaE. Yu.

Малинникова Елена Юрьевна – доктор медицинских наук, профессор, заведующая кафедрой вирусологии

125993, г. Москва, ул. Баррикадная, д. 2/1, стр. 1

Elena Yu. Malinnikova – Dr. Sci. (Med.), Prof., Head of the Department of Virology

125993, Moscow, Barrikadnaya str., 2/1, building 1

malinacgb@mail.ruhttps://orcid.org/0000-0001-7513-1636МасленниковР. В.MaslennikovR. V.

Масленников Роман Вячеславович — кандидат медицинских наук, ассистент кафедры пропедевтики внутренних болезней, гастроэнтерологии и гепатологии; врач общей практики

119435, г. Москва, ул. Погодинская, д. 1, стр. 1

Roman V. Maslennikov — Cand. Sci. (Med.), Assist. Prof., Department of Propaedeutics of Internal Diseases, Gastroenterology and Hepatology; general practitioner, Consulting and Diagnostic Center No. 2 of the Moscow Health Department

119435, Moscow, Pogodinskaya str., 1, building 1

mmmm00@yandex.ruМихайловМ. И.MikhailovM. I.

Михайлов Михаил Иванович – доктор медицинских наук, профессор, член-корреспондент РАН, заведующий лабораторией вирусных гепатитов

195067, г. Санкт-Петербург, Пискаревский пер., д. 47

Mikhail I. Mikhailov – Dr. Sci. (Med.), Prof., RAS Corresponding Member, Head of the Laboratory of Viral Hepatitis

195067, St. Petersburg, Piskarevsky per., 47

michmich2@yandex.ruhttps://orcid.org/0000-0001-9633-4328НовакК. Е.NovakK. E.

Новак Ксения Егоровна – кандидат медицинских наук, доцент кафедры инфекционных болезней взрослых и эпидемиологии

194100, г. Санкт-Петербург, ул. Литовская, д. 2

Ksenia E. Novak – Cand. Sci. (Med.), Assoc. Prof., Department of Infectious Diseases of Adults and Epidemiology

194100, St. Petersburg, Litovskaya str., 2

kseniya.novak@mail.ruhttps://orcid.org/0000-0003-1699-0881НикитинИ. Г.NikitinI. G.

Никитин Игорь Геннадьевич — доктор медицинских наук, профессор, заведующий кафедрой госпитальной терапии № 2 лечебного факультета; директор ФГАУ НМИЦ «Лечебно-реабилитационный центр»

117997, г. Москва, ул. Островитянова, д. 1

Igor G. Nikitin — Dr. Sci. (Med.), Prof., Head of the Department of Hospital Therapy No. 2

117997, Moscow, Ostrovityanova str., 1

igor.nikitin.64@mail.ruhttps://orcid.org/0000-0001-8391-5211СюткинВ. Е.SyutkinV. E.

Сюткин Владимир Евгеньевич — доктор медицинских наук, ведущий научный сотрудник отделения трансплантации печени, профессор кафедры хирургии с курсами онкохирургии, эндоскопии, хирургической патологии, клинической трансплантологии и органного донорства

129010, г. Москва, Большая Сухаревская площадь, 3;

123098, Москва, ул. Маршала Новикова, д. 23

Vladimir E. Syutkin — Dr. Sci. (Med.), Leading Researcher, Department of Liver Transplantation; Prof., Department of Surgery with courses in oncosurgery, endoscopy, surgical pathology, clinical transplantology and organ donation

129010, Moscow, Bolshaya Sukharevskaya square, 3;

123098, Moscow, Marshala Novikova str., 23.

vladsyutkin@gmail.comЭсауленкоЕ. В.EsaulenkoE. V.

Эсауленко Елена Владимировна – доктор медицинских наук, профессор, заведующая кафедрой инфекционных болезней взрослых и эпидемиологии

194100, г. Санкт-Петербург, ул. Литовская, д.2

Elena V. Esaulenko – Dr. Sci. (Med.), Prof., Head of the Department of Adult Infectious Diseases and Epidemiology

194100, St. Petersburg, Lithuanian str., 2

https://orcid.org/0000-0002-1395-9566ШептулинА. А.SheptulinA. A.

Шептулин Аркадий Александрович — доктор медицинских наук, профессор кафедры пропедевтики внутренних болезней, гастроэнтерологии и гепатологии Института клинической медицины им. Н.В. Склифосовского

119435, г. Москва, ул. Погодинская ул., д. 1, стр. 1

Arkady A. Sheptulin — Dr. Sci. (Med.), Prof., Department of Propaedeutics of Internal Diseases, Gastroenterology and Hepatology

119435, Moscow, Pogodinskaya str., 1, building 1

sheptulin_a_a@staff.sechenov.ruШироковаЕ. Н.ShirokovaE. N.

Широкова Елена Николаевна — доктор медицинских наук, профессор кафедры пропедевтики внутренних болезней, гастроэнтерологии и гепатологии

119435, г. Москва, ул. Погодинская, д. 1, стр. 1

Elena N. Shirokova — Dr. Sci. (Med.), Prof., Department of Propaedeutics of Internal Diseases, Gastroenterology and Hepatology

119435, Moscow, Pogodinskaya str., 1, building 1

elshirokova@yandex.ruhttps://orcid.org/0000-0003-1928-4747ЮщукН. Д.YushchukN. D.

Ющук Николай Дмитриевич — академик РАН, доктор медицинских наук, профессор, президент ФГБОУ ВО «Московский государственный медико-стоматологический университет имени А.И. Евдокимова».

127473, г. Москва, ул. Делегатская, д. 20, стр. 1

Nikolai D. Yushchuk – RAS Academician, Dr. Sci. (Med.), Prof., President

127473, Moscow, Delegatskaya str., 20, building 1

prof.uyshuk@gmail.comФГАОУ ВО «Первый Московский государственный университет им. И.М. Сеченова» (Сеченовский Университет) Министерства здравоохранения Российской ФедерацииРоссияSechenov First Moscow State Medical University (Sechenov University)Russian FederationФГБУ «Национальный исследовательский медицинский центр фтизиопульмонологии и инфекционных заболеваний» Министерства здравоохранения Российской ФедерацииРоссияCenter for Epidemiologically Significant Infectious Diseases, National Medical Research Center for Phthisiopulmonology and Infectious DiseasesRussian FederationГБУЗ МО «Московский областной научно-исследовательский клинический институт им. М.Ф. Владимирского» Министерства здравоохранения Российской ФедерацииРоссияM.F. Vladimirsky Moscow Regional Research Clinical InstituteRussian FederationФГБОУ ВО «Московский государственный медико-стоматологический университет им. А.И. Евдокимова» Министерства здравоохранения Российской ФедерацииРоссияMoscow State University of Medicine and DentistryRussian FederationФГБВОУ ВПО «Военно-медицинская академия им. С.М. Кирова» Министерства обороны РоссииРоссияKirov Military Medical AcademyRussian FederationФГБОУ ВО «Казанский государственный медицинский университет» Министерства здравоохранения Российской ФедерацииРоссияKazan State Medical UniversityRussian FederationФГБОУ ДПО «Российская медицинская академия непрерывного профессионального образования» Министерства здравоохранения Российской ФедерацииРоссияDepartment of Virology, Russian Medical Academy of Continuing Professional EducationRussian FederationФГБОУ ВО «Северо-Западный государственный медицинский университет имени И.И. Мечникова» Министерства здравоохранения Российской ФедерацииРоссияNorth-Western State Medical University named after I.I. MechnikovRussian FederationФГБОУ ВО «Санкт-Петербургский государственный педиатрический медицинский университет» Министерства здравоохранения Российской ФедерацииРоссияSaint-Petersburg State UniversityRussian FederationФГАОУ ВО «Российский национальный исследовательский университет им. Н.И. Пирогова» Министерства здравоохранения Российской ФедерацииРоссияPirogov Russian National Research UniversityRussian FederationГБУЗ «Научно-исследовательский институт скорой помощи им. Н.В. Склифосовского Департамента здравоохранения города Москвы» Министерства здравоохранения Российской Федерации; ФГБУ «Государственный научный центр Российской Федерации – Федеральный медицинский биофизический центр им. А.И. Бурназяна» Федерального медико-биологического агентстваРоссияSklifosovsky Clinical and Research Institute for Emergency Medicine; Russian State Research Center — Burnazyan Federal Medical Biophysical CenterRussian Federation20230406202333184124Copyright © Ивашкин В.Т., Чуланов В.П., Мамонова Н.А., Маевская М.В., Жаркова М.С., Тихонов И.Н., Богомолов П.О., Волчкова Е.В., Дмитриев А.С., Знойко О.О., Климова Е.А., Козлов К.В., Кравченко И.Э., Малинникова Е.Ю., Масленников Р.В., Михайлов М.И., Новак К.Е., Никитин И.Г., Сюткин В.Е., Эсауленко Е.В., Шептулин А.А., Широкова Е.Н., Ющук Н.Д., 20232023Ивашкин В.Т., Чуланов В.П., Мамонова Н.А., Маевская М.В., Жаркова М.С., Тихонов И.Н., Богомолов П.О., Волчкова Е.В., Дмитриев А.С., Знойко О.О., Климова Е.А., Козлов К.В., Кравченко И.Э., Малинникова Е.Ю., Масленников Р.В., Михайлов М.И., Новак К.Е., Никитин И.Г., Сюткин В.Е., Эсауленко Е.В., Шептулин А.А., Широкова Е.Н., Ющук Н.Д.Ivashkin V.T., Chulanov V.P., Mamonova N.A., Maevskaya M.V., Zharkova M.S., Tikhonov I.N., Bogomolov P.O., Volchkova E.V., Dmitriev A.S., Znojko O.O., Klimova E.A., Kozlov K.V., Kravchenko I.E., Malinnikova E.Y., Maslennikov R.V., Mikhailov M.I., Novak K.E., Nikitin I.G., Syutkin V.E., Esaulenko E.V., Sheptulin A.A., Shirokova E.N., Yushchuk N.D.This work is licensed under a Creative Commons Attribution 4.0 License.https://www.gastro-j.ru/jour/article/view/807Цель исследования

Цель исследования: в клинических рекомендациях, предназначенных для врачей-терапевтов, врачей общей практики, гастроэнтерологов, инфекционистов, представлены современные положения по диагностике и лечению хронического гепатита С.

Основное содержание

Основное содержание. Хронический вирусный гепатит С — социально значимая инфекция, заболеваемость которой в Российской федерации остается высокой. За последние 10 лет достигнуты большие успехи в лечении гепатита С — появились препараты с прямым противовирусным действием. Спектр их эффективности позволяет достичь устойчивого вирусологического ответа более чем в 90 % случаев, даже в группах, которые ранее не рассматривались как кандидаты на терапию или были трудными для излечения: пациенты, получающие заместительную почечную терапию, после трансплантации печени и других органов, на стадии декомпенсированного цирроза печени, с коинфекцией ВИЧ и др. Из рекомендаций исключены препараты интерферонов ввиду их низкой эффективности и широкого спектра нежелательных явлений. Расширены показания к назначению лечения, а именно — факт подтверждения репликации вируса. Сокращены сроки диспансерного наблюдения пациентов без цирроза печени (до 12 недель после окончания терапии). Также в данных рекомендациях представлены подходы к активному скринингу гепатита в группах риска, профилактические и реабилитационные мероприятия после окончания лечения.

Заключение

Заключение. Достигнуты большие успехи в лечении хронического вирусного гепатита С. В большинстве случаев эрадикация вирусной HCV-инфекции — реальная задача даже у пациентов на стадии цирроза печени, с нарушением функции почек, коинфекцией ВИЧ, после трансплантации печени и других органов.

Аim

Аim: diagnosis and treatment algorithms in the clinical recommendations intended for general practitioners, gastroenterologists, infectious disease specialists, hepatologists on the of chronic hepatitis C are presented.

Summary

Summary. Chronic viral hepatitis C is a socially significant infection, the incidence of which in the Russian Federation remains significantly high. Over the past 10 years, great progress has been made in the treatment of hepatitis C — direct acting antiviral drugs have appeared. The spectrum of their effectiveness allows to achieve a sustained virological response in more than 90 % of cases, even in groups that were not previously considered even as candidates for therapy or were difficult to treat — patients receiving renal replacement therapy, after liver transplantation (or other organs), at the stage of decompensated liver cirrhosis, HIV co-infected, etc. Interferons are excluded from the recommendations due to their low effectiveness and a wide range of adverse events. The indications for the treatment have been expanded, namely, the fact of confirmation of viral replication. The terms of dispensary observation of patients without cirrhosis of the liver have been reduced (up to 12 weeks after the end of therapy). Also, these recommendations present approaches to active screening of hepatitis in risk groups, preventive and rehabilitation measures after the end of treatment.

Conclusion

Conclusion. Great success has been achieved in the treatment of chronic hepatitis C. In most cases, eradication of viral HCV infection is a real task even in patients at the stage of cirrhosis of the liver, with impaired renal function, HIV co-infection, after solid organs transplantation.

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