THE CLINICAL COURSE OF CHRONIC HEPATITIS B AND THE CHOICE OF ANTIVIRAL THERAPY FOR ITS TREATMENT ACCORDING TO THE MOLECULAR- GENETIC PROPERTIES OF THE PATHOGEN
Abstract
Background. The clinical course of chronic hepatitis B (CHB) as well as the efficacy of its antiviral therapy depend on the genetic properties of the virus.
Objective. To study the clinical and laboratory parameters of patients with CHB and their dependence on the molecular genetic properties of HBV in order to optimize the choice of antiviral therapy regimen.
Material and methods. The study included 231 patients with CHB. Routine hematological and biochemical tests, serum HBV DNA level, liver fibrosis stage were measured. Phylogenetic analysis of HBV was carried out in 90 patients.
Results. HBV DNA level above 2000 IU/ml was found in 68.8% of patients. Phylogenetic analysis revealed the circulation in Gomel region of HBV genotypes D (76.7%) and A (22.2%), genotype C being detected as well. Patients with genotype D had higher levels of aminotransferases and gamma-glutamiltransferase as well as higher liver fibrosis indices (p<0.05) as compared to those with genotype A; no differences in viral load were found. Antiviral treatment is indicated in 66.7% of patients with genotype D, and only in 35% of those with genotype A (p=0.01). Nucleos(t)ide analogues are optimal as initial antiviral therapy for 86.8% of patients with indications for treatment.
Conclusions. The determination of HBV viral load and genotype is important for predicting liver disease severity and choosing the optimal antiviral therapy regimen.
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