Monitoring of patients with chronic hepatitis B without liver cirrhosis while determining the tactics of treatment

Abstract

Aim. The purpose of the work is to reveal the features of CHB without liver cirrhosis when assessing the need for the appointment of antiviral therapy for the implementation of the State Target Program; to compare the criteria for monitoring CHB patients without cirrhosis in existing international recommendations.

Material and methods. When assessing the features of the course of CHB in 286 patients without cirrhosis, the recommendations of NICE (2013) and WHO (2015) were taken into account to determine the need for antiviral treatment, which is the basis of the clinical protocol in Ukraine. The work analyzes the international guidelines for monitoring CHB patients without cirrhosis: the American Association for the Study of the Liver Diseases (2016), the European Association for the Study of the Liver (2012), the National institute for Health and Care Excellence (2013), World Health Organization (2015).

Results. In the work, we analyzed the features of the course of CHB without cirrhosis using criteria for the distribution of patients depending on the indications for antiviral treatment, which are set out in the clinical protocol in Ukraine and are based on the international recommendations of NICE (2013) and WHO (2015). It is shown that 8.0 % (23 of 286) of patients require priority antiviral treatment according to laboratory criteria. The course of CHB in these patients is characterized by more frequent astheno-vegetative manifestations, more pronounced cytolytic syndrome and more frequent detection of HBeAg. Among 38.1 % (109 of 286) patients with CHB without cirrhosis with a low viral load <2000 IU / ml, which is not recommended for antiviral drugs, one third has cytolytic syndrome (34.3 %), one tenth is HBeAg-positive (10.5 %), and one fourth has liver fibrosis of F 2–3 stages (27.3 %), which requires an improvement in the monitoring of these patients.

The analysis of international recommendations showed complex and different approaches to monitoring CHB patients without cirrhosis of the liver when deciding on the appointment of antiviral treatment. The AASLD recommendations (2016) differ from the others in the mandatory determination of the patient's HBeAg status and the clearly established norm of ALT. The EASL (2012) recommendations do not require mandatory determination of HBeAg status, with the main criterion being the amount of HBV-DNA in the blood. NICE recommendations (2013) determine the mandatory identification of a combination of factors in addressing this issue, taking into account the patient's age, viral load, the severity of the cytolytic syndrome. WHO recommendations (2015) are the most adapted for countries with limited resources.

Conclusion. When using the recommendations of NICE 2013 and WHO 2015 among 38.1 % of CHB patients without cirrhosis with a low viral load <2000 IU/ml, which is not recommended for antiviral therapy, 34.3 % have cytolytic syndrome, 10.5 % are HBeAg-positive, and 27.3 % have liver fibrosis F 2–3 stages, which makes it necessary to improve monitoring of these patients. Monitoring CHB patients without cirrhosis in determining the need for antiviral treatment in the world remains a complex issue and has no unambiguous approaches to the solution, as evidenced by the existence of several international clinical recommendations: AASLD 2016, EASL 2012, NICE 2013, WHO 2015.