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Новая парадигма лечения хронического вирусного гепатита С у пациентовс хронической болезнью почек

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Аннотация

По данным литературы, инфекция, вызванная вирусом гепатита С (ВГС) у пациентов с хроническими болезнями почек (ХБП), ассоциируется с почти двукратным риском прогрессирования почечной недостаточности до терминальной стадии, может вызвать развитие острого почечного повреждения и вторичного нефритического синдрома. Для правильной лабораторной диагностики заболевания необходимо не только выявление антител против ВГС, но и обнаружение и количественное определение РНК вируса с помощью чувствительного анализа ПЦР с низким пределом детекции (≤15 МЕ/мл РНК). При отрицатель- ном первом тесте на ВГС у пациентов на гемодиализе следует рассмотреть его повторение каждые 6-12 месяцев с помощью ИФА. На данный момент наиболее эффективным и безопасным подходом к лечению ВГС-инфекции у пациентов с ХБП, в т.ч. у пациентов на диализе и реципиентов почки, является использование безинтерфероновых схем, основанных на противовирусных лекарственных средствах прямого действия. Долгосрочные наблюдения показывают, что при их использовании возможно окончательное излечение от ВГС более чем 99% пациентов. На сегодняшний день использование комбинации омбитасвир/паритапревир/ритонавир ++ дасабувир для лечения пациентов с выраженным снижением функции почек при генотипе 1а (с рибавирином) и 1b (без рибавирина) является основной схемой лечения ВГС-инфекции. Применение этой комбинации у реципиентов трансплантата почки также возможно, но требует существенной коррекции дозировок ингибиторов кальциневрина.

Об авторе

О. В. Калачик
9-я городская клиническая больница
Беларусь


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Для цитирования:


Калачик О.В. Новая парадигма лечения хронического вирусного гепатита С у пациентовс хронической болезнью почек. Рецепт. 2018;(3):364-378.

For citation:


Kalachyk A... The new treatment paradigm of chronic hepatitis C virus in patients with chronic kidney disease. Recipe. 2018;(3):364-378. (In Russ.)

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