Uticaj stabilnog virusološkog odgovora na tok i ishod bolesti kod pacijenata sa teškom fibrozom ili cirozom jetre uzrokovanom hroničnom hepatitis C virusnom infekcijom
Impact of sustained virological response on the outcome and prognosis in patients with severe fibrosis and cirrhosis caused by chronic hepatitis C infection
Author
Jordović, JelenaMentor
Delić, DraganCommittee members
Simonović-Babić, JasminaBojović, Ksenija
Katanić, Nataša
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Show full item recordAbstract
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 vi...remije (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 sustai...ned
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...