Uticaj stabilnog virusološkog odgovora na tok i ishod bolesti kod pacijenata sa teškom fibrozom ili cirozom jetre uzrokovanom hroničnom hepatitis C virusnom infekcijom

Abstract

Hepatitis C virus (HCV) je, globalno posmatrano, najčešći uzročnik hroničnog virusnog hepatitisa sa dugogodišnjim progresivnim tokom, varijabilnom kliničkom slikom i često nepredvidivim ishodom. Naša drţava spada u grupu zemalja sa intermedijernom zastupljenošću HCV infekcije, tj. prevalencijom od 0,19% meĎu dobrovoljnim davaocima krvi i procenjenom prevalencijom od 1,13% na nivou Srbije. U našoj zemlji postoji višedecenijsko iskustvo u dijagnostici i lečenju pacijenata sa HCV infekcijom, ali osim kliničkih opservacija, nema objavljenih podataka o dugoročnom ishodu kod ovih pacijenata. U terapijskom i prognostičkom smislu najzahtevniju grupu predstavljaju pacijenti kod kojih se HCV infekcija otkrije u fazi uznapredovalog oštećenja jetre (fibroze ili ciroze), najčešće zbog višedecenijskog asimptomatskog toka bolesti, ali i zbog neadekvatnih mera skrininga, posebno u populacijama pod povećanim rizikom. U ovoj grupi pacijenata, čak i nakon terapijskog uspeha i postizanja nedetektibilne viremije (bez obzira na vrstu korišćenog terapijskog protokola), postoji rizik od nastanka nepovoljnih ishoda-uključujući virusološki i biohemijski relaps, dekompenzaciju jetre i pojave hepatocelularnog karcinoma (HCC). Višedecenijsko iskustvo u primeni kombinovane antivirusne terapije pegilovanim interferonom (PEG-IFN) i ribavirinom je pokazalo da postizanje stabilnog virusološkog odgovora (SVR) značajno redukuje morbiditet i mortalitet u grupi pacijenata sa teškim preterapijskim oštećenjem jetre. Pored toga, kliničke opservacije i literaturni podaci stranih autora govore u prilog potrebi za nastavkom praćenja ove grupe pacijenata i redovnim skriningom na HCC, čak i u slučaju odrţavanja nedetektibilne viremije i/ili regresije fibroze. Multikauzalna priroda, individualan tok bolesti i često nepredvidiv dugoročni ishod u ovoj grupi pacijenata, čak i nakon trajne supresije viremije, a u odsustvu preporuka o duţini praćenja i bilo kakvih publikovanih podataka u našoj zemlji, predmet su posebnog interesovanja autora i ove studije...

Hepatitis C virus (HCV) is the most common worldwide cause of chronic viral hepatitis with a long-term progression, variable clinical presentation and outcome. Serbia is a country with an intermediary prevalence of HCV infection, estimated around 0,19% among blood donors and aproximately 1,13% in the general population of Serbia. In spite of two decades of diagnostic and therapeutic experiences with clinical observances, there are no published data concerning long-term prognosis and outcome in these patients. Patients with baseline liver fibrosis and cirrhosis present the most challenging group of patients, and are mostly underdiagnosed due to the asymptomatic nature of the disease and insufficient screening, especially in certain groups of patients. In this particular group, even after treatment success and HCV supression, remains a risk of unfavourable outcomes including virological and biochemical relapse, adverse clinical outcomes and hepatocellular carcinoma (HCC). Although sustained virological response (SVR) undoubtedly reduces liver-related morbidity and mortality in patients with severe baseline liver damage, clinical observance and published data show that these patients need continuous monitoring and HCC screening in spite of HCV supression and/or fibrosis regression. AIM: Main purpose of this study was to examine reliability and durability of SVR, as a predictor of treatment success and long-term outcome in patients with HCV related severe baseline liver injury. PATIENTS AND METHODS: A cohort study included 325 patients with HCV related severe baseline liver injury, who completed treatment protocol with pegylated interferon and ribavirin from January 2003. until November 2011. at the Hepatology department of the Clinic for Infectious And Tropical Diseases, Clinical Center of Serbia. After treatment completion, patients were followed and endpoints were December 2015, death outcome or the date of the last checkup. Inclusion criteria included: chronic hepatitis C infection with elevated liver enzymes, age 18-65 years, baseline severe fibrosis or cirrhosis (METAVIR>F2), a completion of treatment protocol and informed consent...