Experience in the treatment of chronic hepatitis С in HIV-infected patients in the Novgorod region

Chronic hepatitis C is a global problem for public health and society. There are more than 71 million patients with chronic hepatitis C in the world, approximately 400 thousand people die annually from causes associated with liver damage in viral hepatitis C. Against the background of an annual increase in the number of HIV-infected patients, the number of co-infected persons infected with 2 viruses at the same time increases annually. Both viruses have a synergistic interaction with each other, which makes the problem of combined infection super-urgent.
The aim of the study is to study the effectiveness of the applied treatment regimens for chronic hepatitis C in coinfected patients in the Novgorod region.
Materials and methods. The total number of patients was 104 people. The patients were monitored throughout the entire period of taking the drugs and 12 weeks after the end of therapy.
Results and discussion. Among the observed patients, men 60.6% were more often registered, these were patients of young reproductively active age. Pangenotypic therapy regimens were received by 33.7% of coinfected patients, 66.3% received genotype- specific therapy regimens. The virological response at the end of therapy in the general cohort of patients was achieved in 96.2% of patients. In the group of patients receiving pangenotype schemes, a virological response was registered in 100% of patients, and in the group of patients receiving genotype-specific schemes, in 94.2% of patients. Against the background of therapy, virological efficacy could not be achieved in 4 patients, and the exact causes of failure could not be established. These patients belonged to the group of patients receiving genotype-specific treatment regimens, therefore, the frequency of achieving SVR in this group of patients was 94.2%. SVR was registered in all patients (100%) in the following groups: patients receiving pangenotypic therapy regimens (n=35); patients with 1a, 2 and 3 virus genotype (n=42); patients with high degree of liver fibrosis (F3) or cirrhosis of the liver (n=43); patients with HCV/HCV (n=10); patients over 60 years of age (n=4). There were no clinically significant deviations of the main specific laboratory parameters during the study. On the contrary, there were improvements in the average values of liver enzymes after treatment after 12 weeks of follow-up. Also, no adverse events were reported during therapy.
Conclusion. Thus, the results of this study showed the high effectiveness of antiviral therapy and a good safety profile, both when using pan-genotype therapy regimens and genotype-specific regimens

1. Gill K., Ghazinian H., Manch R. et al. Hepatitis C virus as a systemic disease: reaching beyond the liver // Hepatol. Int. 2016. Vol. 10, No. 3. Р. 415–423. doi: 10.1007/s12072-015-9684-3; PMID: 26660706; PMCID: PMC4819925.

2. Nevola R., Acierno C., Pafundi P.C. et al. Chronic hepatitis C infection induces cardiovascular disease and type 2 diabetes: mechanisms and management // Minerva Med. 2021. Vol. 112, No. 2. Р. 188–200. doi: 10.23736/S0026-4806.20.07129-3; PMID: 33205641.

3. Okutan O., Ayten O. Hepatitis C and pulmonary fibrosis // Tuber. Toraks. 2017. Vol. 65, No. 2. Р. 131–137. doi: 10.5578/tt.35288; PMID: 28990892.

4. Hoofnagle J.H. Course and outcome of hepatitis C // Hepatology. 2002. Vol. 36, No. 1. Р. 21–29.

5. Di Bisceglie A.M. Natural history of hepatitis C: its impact on clinical management // Hepatology. 2000. Vol. 31. Р. 1014–1018.

6. WHO. Hepatitis C. Available at: https://www.who.int/news-room/fact-sheets/detail/hepatitis-c.

7. Shakhanina I.L., Osipova L.A. Economic losses from infectious diseases in Russia: values and trends. Epidemiology and infectious diseases, 2005, No. 4, рр. 19–21 (In Russ.)

8. On the state of sanitary and epidemiological welfare of the population in the Russian Federation in 2022: State report. Moscow: Federal Service for Supervision of Consumer Rights Protection and Human Welfare, 2023. 368 p. (In Russ.)

9. Viral Hepatitis Prevention Board. 2011. Available at: http://www.vhpb.org/files/html/Meetings_and_publications/Viral_Hepatitis_New-sletters/vhv19n1.pdf.

10. Pimenov N.N., Vdovin A.V., Komarova S.V., Mamonova N.A., Chulanov V.P., Pokrovsky V.I. Relevance and prospects of implementation in Russia of the Unified Federal Register of patients with viral hepatitis B and C. Therapeutic archive, 2013, Vol. 85, No. 11, рр. 4–9 (In Russ.)

11. The results of monitoring the procurement of drugs for the treatment of hepatitis C in Russia in 2022. Russia, July 2023. https://zdravresource.ru/wp-content/uploads/2023/08/analiz_zakupok_preparatov_dlya_lecheniya_vgs_v_rossijskoj_federaczii.pdf. (In Russ.)

12. Management of Hepatitis C and HIV Coinfection. WHO, 2006. 272 p.

13. Belyakov N.A., Boeva E.V., Zagdyn Z.M., Esaulenko E.V., Lioznov D.A., Simakina O.E. Epidemiology and course of infectious diseases against the background of the COVID pandemic Message 1. HIV infection, chronic hepatitis C and tuberculosis. Infection and immunity, 2022, Vol. 12, No. 4, C. 639–650 (In Russ.) doi: 10.15789/2220-7619-EAC-1958.

14. Costa-Rocha I.A.D., Silva L.D., Fonseca L. et al. Remodeling of immunological biomarkers in patients with chronic hepatitis C treated with directacting antiviral therapy // Antiviral Res. 2021. Vol. 190. Р. 105073. doi: 10.1016/j.antiviral.2021.105073; PMID: 33887350.

15. Priora M., Realmuto C., Parisi S. et al. Rheumatologic manifestations of hepatitis C in the era of direct-acting antiviral agents // Minerva Gastroenterol. Dietol. 2020. Vol. 66, No. 3. Р. 280–289. doi: 10.23736/S1121-421X.20.02680-X; PMID: 32218427.

16. Yushchuk N.D., Zairatiants O.V., Znoko O.O., Khripun A.I., Dudina K.R., Gudkova S.B., Klimova E.A., Krasnenkova S.F., Zhuravleva A.V., Orekhov O.O., Bely P.A. The burden of mortality from viral hepatitis B and C: assessment methodology and indicators in Moscow in 2015–2017. Infectious diseases: news, opinions, education, 2018, Vol. 7, No. 4, pp. 8–14 (In Russ.) doi: 10.24411/2305-3496-2018-14001.

17. Lo Re V. 3rd, Kallan M.J., Tate J.P., Localio A.R., Lim J.K., Goetz M.B., Klein M.B., Rimland D., Rodriguez-Barradas M.C., Butt A.A., Gibert C.L., Brown S.T., Park L., Dubrow R., Reddy K.R., Kostman J.R., Strom B.L., Justice A.C. Hepatic decompensation in antiretroviral-treated patients co-infected with HIV and hepatitis C virus compared with hepatitis C virus-monoinfected patients: a cohort study // Ann. Intern. Med. 2014. Mar 18. Vol. 160, No. 6. Р. 369–379. doi: 10.7326/M13-1829.

18. Lauer G.M., Walker B.D. Hepatitis C virus infection // N. Engl. J. Med. 2001. Vol. 345. Р. 41–52.

19. Massard J., Ratziu V., Thabut D. et al. Natural history and predictors of disease severity in chronic hepatitis C // J. Hepatol. 2006. Vol. 44 (1 Suppl.). Р. 19–S24.

20. Rassokhin V.V., Boeva E.V. Issues of epidemiology and pathogenesis of combined HCV and HIV infection. HIV infection and immunosuppression, 2020, Vol. 12, No. 1, pp. 32–46 (In Russ.) doi: http://dx.doi.org/10.22328/2077-9828-2020-12-1-32-46

21. Balagopal A., Philp F.H., Astemborski J. et al. Human immunodeficiency virus-related microbial translocation and progression of hepatitis C // Gastroenterology. 2008. Vol. 135. Р. 226–233.

22. Esaulenko E.V., Sukhoruk A.A., Ponyatishina M.V., Ganchenko R.A. Chronic viral hepatitis C in the North-Western Federal District. HIV infection and immunosuppression, 2017, Vol. 9, No. 2, pp. 74–81 (In Russ.) doi: 10.22328/2077-9828-2017-9-2-74-81.

23. Razavi H. et al. Hepatitis C virus prevalence and level of intervention required to achieve the WHO targets for elimination in the European Union by 2030: a modelling study. European Union HCV Collaborators // Lancet Gastroenterol. Hepatol. 2017. Vol. 2, No. 5. Р. 325–336. doi: 10.1016/S2468-1253(17)30045-6.