Chronic hepatitis B virus infection: clinical characteristics and antiviral therapy
https://doi.org/10.51523/2708-6011.2022-19-2-10
Abstract
Objective. Based on the study of clinical and laboratory parameters, to identify groups of patients with chronic hepatitis B virus (HBV) infection who need antiviral therapy, and to evaluate the effectiveness of tenofovir treatment.
Materials and methods. The study group included 234 patients with various forms of chronic HBV infection. Сlinical data, blood laboratory parameters (biochemical blood test, complete blood count, coagulogram, serum HBV DNA level), liver fibrosis stage were studied.
Results. Currently, chronic HBV infection is more common in the age group of 30-39 years (35.5%), and is more prevalent in males (73.1%). Advanced liver fibrosis (stage F2 and higher) was found in 38.4% of patients, and liver cirrhosis – in 19.8%. Patients were predominantly HBeAg-negative (86.8%), they had lower serum aminotransferase levels (p=0.03) and DNA HBV viral load (p<0.001) as compared with HBeAg-positive ones. HBsAg-negative (occult) chronic HBV infection is detected in 1.3% patients and may occur with progressing liver disease.
Conclusion. The clinical and laboratory characteristics of the patients with chronic HBV infection have been presented, indications for antiviral therapy in 48.7% of the patients have been determined. Antiviral tenofovir therapy allows to achieve a biochemical and virological response in most patients, but due to its indefinite duration and high cost, the question of adherence to the therapy is crucial.
About the Authors
D. V. TserashkouBelarus
Dzmitry V. Tserashkou, Head of Infectious Department No.4
Gomel
V. M. Mitsura
Belarus
Viktar M. Mitsura, DMedSc, Associate Professor, Deputy Director for Research; Professor at the Department of Infectious Diseases
Gomel
References
1. Global Hepatitis Report 2017. Geneva: World Health Organization, 2017. [date of access 2021 July 16]. Available from: https://www.who.int/hepatitis/publications/global-hepatitisreport2017/en/
2. Fattovich G, Bortolotti F, Donato F. Natural history of chronic hepatitis B: Special emphasis on disease progression and prognostic factors. J Hepatol. 2008;48(2):335-352. DOI: https://doi.org/10.1016/j.jhep.2007.11.011
3. Bengsch B, Chang KM. Evolution in our understanding of hepatitis B virus virology and immunology. Clin Liver Dis. 2016;20(4):629-644. DOI: https://doi.org/10.1016/j.cld.2016.06.001
4. Lampertico P, Agarwal K, Berg T, Buti M, Janssen H, Papatheodoridis G, Zoulim F, Tacke F. EASL 2017 Clinical Practice Guidelines on the management of hepatitis B virus infection. J Hepatol. 2017;67(2):370-398. DOI: https://doi.org/10.1016/j.jhep.2017.03.021
5. Bertoletti A, Kennedy PT. The immune tolerant phase of chronic HBV infection: new perspectives on an old concept. Cell Mol Immunol. 2015;12(3):258-263. DOI: https://doi.org/10.1038/cmi.2014.79
6. Croagh CM, Lubel JS. Natural history of chronic hepatitis B: phases in a complex relationship. World J. Gastroenterol. 2014;20(30):10395-10404. DOI: https://doi.org/10.3748/wjg.v20.i30.10395
7. Invernizzi F, Viganò M, Grossi G, Lampertico P. The prognosis and management of inactive HBV carriers. Liver Int. 2016;36(S1):100-104. DOI: https://doi.org/10.1111/liv.13006
8. Raimondo G., Locarnini S, Pollicino T, Levrero M, Zoulim F, Lok AS, et al. Update of the statements on biology and clinical impact of occult hepatitis B virus infection. J Hepatol. 2019;71(2):397-408. DOI: https://doi.org/10.1016/j.jhep.2019.03.034
9. Terrault NA, Lok AS, McMahon BJ, Chang KM, Hwang JP, Jonas MM, Brown Jr RS, Bzowej NH, Wong JB. Update on prevention, diagnosis, and treatment of chronic hepatitis B: AASLD 2018 Hepatitis B Guidance. Hepatology. 2018;67(4):1560-1599. DOI: https://doi.org/10.1002/hep.29800
10. Sarin SK, Kumar M, Lau GK, Abbas Z, Chan HLY, Chen CJ, et al. Asian-Pacific clinical practice guidelines on the management of hepatitis B: a 2015 update. Hepatol Int. 2016;10(1):1-98. DOI: https://doi.org/10.1007/s12072-015-9675-4
11. Lok AS, McMahon BJ, Brown RS, Wong JB, Ahmed AT, Farah W, et al. Antiviral therapy for chronic hepatitis B viral infection in adults: a systematic review and meta-analysis. Hepatology. 2016;63(1):284-306. DOI: https://doi.org/10.1002/hep.28280
12. Tereshkov DV, Mitsura VM, Gasich EL, Zhavoronok SV. Clinical characteristics of chronic hepatitis B virus infection and possibilities of antiviral therapy. Medical Journal. 2020;(2):73-79. (in Russ.).
13. Con D, Goodwin T, Majeed A, Roberts S, Kemp W. Comparison of 48 week efficacy of tenofovir vs entecavir for patients with chronic hepatitis B: A network meta analysis. J Viral Hepat. 2021;28(1):40-50. DOI: https://doi.org/10.1111/jvh.13400
14. Viganò M, Grossi G, Loglio A, Lampertico P. Treatment of hepatitis B: Is there still a role for interferon? Liver Int. 2018;38(S1):79-83. DOI: https://doi.org/10.1111/liv.13635
Review
For citations:
Tserashkou D.V., Mitsura V.M. Chronic hepatitis B virus infection: clinical characteristics and antiviral therapy. Health and Ecology Issues. 2022;19(2):82-89. (In Russ.) https://doi.org/10.51523/2708-6011.2022-19-2-10