Aim. To determine the epidemiological features of the hepatitis B in the Russian Arctic. Materials and methods. We carried out a retrospective analysis of the incidence of hepatitis B (acute and chronic forms) in 9 Russian Arctic regions, 3 subarctic regions (Khanty-Mansiysk Autonomous Okrug, Magadan Region, Kamchatka Territory) and Russian Federation in 1999-2019. We also studied the prevalence of chronic hepatitis B and vaccination data against hepatitis B in these territories. Results. From 1999 to 2019 the incidence of acute hepatitis B in three subarctic regions decreased 166 times (from 66.5 to 0.4 per 100 thousand population), in the Arctic zone of 73 times (from 29.8 to 0.4 per 100 thousand population) and 77 times in Russia (from 43.8 to 0.6). The incidence of chronic hepatitis forms in the same period in the Arctic zone decreased by 16.3 times (from 140.1 to 16.3), 5.8 times in the subarctic regions (from 116.6 to 20.0) and 5.7 times in Russia (from 96.3 to 16.8). In 2018, the results of the prevalence of chronic hepatitis B in the Arctic zone (697.3) was higher than in Russia by 98% (352.1) and higher than in the subarctic regions by 67% (588.6). Timely coverage of hepatitis vaccination in children aged 12 months in the Russian Federation, the Arctic zone and the subarctic regions is maintained at a high level (more than 90%) from 2004 in 2019. Coverage of children by vaccination to 17 years inclusive and adults up to 35 years on these territories also exceeded 90%. Conclusion. Vaccination against hepatitis B in the Russian Federation led to a significant decrease in the incidence of this infection in the Russian Arctic. High prevalence of infection indicates the need to continue the program of mass vaccination and the timely introduction of the first dose of vaccine newborns. To reduce the risk of cirrhosis and liver cancer, it is necessary to increase the availability of diagnosis of the disease and its possible outcomes in the Arctic regions and timely provision of antiviral treatment of all patients.
Aim. Evaluate efficacy and safety of a combination of direct - acting antivirals narlaprevir/ritonavir with daclatasvir in patients with viral hepatitis C. Materials and methods. The study enrolled adult patients with HCV genotype 1b infection without demonstrated NS5A resistance - associated substitutions Y93C/H/N/S and/or L31F/M/V/I. Patients were treated with narlaprevir 200 mg QD, ritonavir 100 mg QD and daclatasvir 60 mg QD. Treatment duration was 12 weeks. Proportion of patients achieving sustained virological response 12 weeks after treatment (SVR12) was the primary efficacy endpoint. Results and discussion. In total, 105 (75.0%) patients were treatment with the study combination. Patients’ age varied from 21 to 69 years, the mean age being 43.2±10.9 years. There were slightly more women (55.2%), and 69 patients (65.7%) had comorbidities. SVR 12 was 89.5% (95% CI 82.0-94.7%). In 10 of 11 patients with treatment failures NS5A resistance - associated substitutions in residues 31 and/or 93 were found, as well as less clinically relevant substitutions L28M, P58S, R30Q, Q62K. Adverse events (AEs) were found in less than one half of patients (45 patients, or 42.9% in the safety population). Almost all recorded AEs were mild to moderate. Conclusion. Efficacy of treatment with a combination of narlaprevir/ritonavir and daclatasvir in treatment - naïve patients with HCV genotype 1b was close to 90%. This combination was found to be safe and well - tolerated.
Aim: to identify features of the clinical course of hepatitis A (HA) caused by viruses of different subtypes. Patients and methods: In the study there were included 195 patients with hepatitis A (130 males and 65 females) at the age from 15 to 72 years residing in the territories with various manifestations of the epidemic process of HA (Moscow, the Khabarovsk region, the Republic of Sakha (Yakutia), the Republic of Tajikistan and Ukraine). All patients were examined for the presence of Hepatitis A virus (HAV) RNA in blood, with following determination of the genotype of the virus by PCR. Biochemical blood tests (concentration of total and direct bilirubin, ALT activity) were performed from 2 to 9 times depending on the duration of hospital stay and severity of infection. The dynamics of biochemical indices was evaluated in accordance with the period of the disease: the first period -from the 1 st to 10 th day, the second -from 11 th to 20 th day, the third -from the 21 st day and later. Results: A direct moderate correlation (The Spearman correlation coefficient r = 0,3; p = 0,002) between the duration of jaundice and patients ’ age has been revealed. A significant relationship was observed in the group ofpatients with subtype IIIA (r = 0,4; p = 0,003) and was absent in patients with subtype IA. There were no statistically significant differences between the groups of patients with subtypes IA and IIIA, in dependence on the duration of hospitalization, the variant of the course ofprejaundice period, severity of the course disease, duration of the persistent jaundice and symptoms of intoxication. Absolute values and the dynamics of the reduction of total and direct bilirubin, as well as the dynamics of decrease of ALT activity in groups of patients with various subtypes were not differed significantly. Cholestatic forms of HA were observed only in patients with HAV isolates belonging to subtype IIIA. Conclusion: HAV subtype has no effect on the severity of the course of the disease neither major clinical symptoms and laboratory indices in patients from different age groups. A direct correlationship between the duration ofjaundice syndrome and age in patients with subtype IIIA may indicate a trend towards the formation of cholestatic forms of HA in patients with this subtype of the virus in older age groups.
The article describes results of the analysis of incidence rate of hepatitis A in Russia and 29 European countries over the period 2001 to 2008. The characteristic of hepatitis A outbreaks as well as molecular genetic diversity of hepatitis A virus in Russia and Europe has been compared. The authors analyze the state of herd immunity to hepatitis A virus in population of the territories of countries mentioned above. The results of seroprevalence study of hepatitis A virus among different age groups in Moscow are presented. The critical role of hepatitis A vaccination in the system of prevention and disease control measures is emphasized.
Introduction Changes in the levels of DNA of hepatitis B virus (HBV) infection and the quantitative content of the surface antigen (HBsAg) in acute hepatitis B, as well as the concomitant co-injection of other hepatitis viruses have been insufficiently studied so far. Materials and Methods In 21 patients with acute HBV monoinfection and 27 patients with co-infection of HBV + HCV and/ or HDV three to four serum samples were withdrawn with interval of 6-10 days and the dynamics of HBV viral load and concentration of HBsAg was examined. Results Logarithm of the concentration of DNA HBV was established to decrease from 4.0 ± 0.65 to 3.0 ± 0.59, to 2.5 ± 0.47, to 1.9 ± 0.65 (IU /ml, M ± s), the half-life of DNA HBV was increased from 1.6 days at baseline to 4 days to the end of the study. The decline of the HBsA concentration proceeded much slower: from 38 to 23, 12, 3.8 pg/ml. Half-life period of HBsAg accounted of 8 days at the beginning and 5.7 days at the end of the study, however, in 11 patients there was observed rapid elimination of HBsAg and disappearance of HBV DNA. Conclusion The fact of co-infection with hepatitis C virus (HCV) had no significant effect on the dynamics of HBV DNA and HBsAg levels. In patients infected with Hepatitis D virus (HDV) HBV viral load was significantly lower, and the concentration of HBsAg, by contrast, is significantly higher than in acute monoinfection with HBV. Thus, in acute hepatitis B DNA elimination occurs much faster than the elimination of HBsAg. In addition, in co-infection HDV inhibits replication of HBV, but at the same time stimulates the expression of HBsAg. The obtained data should be considered in the interpretation of laboratory tests in patients with acute hepatitis B, both in the earlier period, and at follow-up.
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