[Viral hepatitis delta. Is there the delta infection problem in the Russian Federation?].

Hepatitis delta (HD) is characterized by rapid progression to fibrosis, and development of hepatocellular carcinoma, and a high mortality rate. The article presents data on the epidemiology, diagnosis, treatment of HD. The views of the epidemiological, clinical and virological characteristics of HD-infection among population of the Russian Federation (RF) are limited due to absence of official HD registration and detection of antibodies to the HD virus (anti-HDV) in HBsAg-positive individuals. However, some areas of the country are characterized by a high HDV circulation (Republic Tyva (RT) - 46,5%, Republic Sakha (Yakutia) - 12,5%) according to our studies conducted in 6 regions of Russia. Clinical-epidemiological situation of HDV infection in RT can be considered as a model to create a program of optimize diagnosis, prevention and treatment of HDV-infection in the Russian Federation.

[Evaluation of the effect of mass vaccination against hepatitis B in the Russian Federation].

AIM: Evaluate the effect of mass vaccination against hepatitis B implemented within the framework of national project Health on the rate of development of unfavorable outcomes of infection and on average lifetime of the population of Russia. MATERIALS AND METHODS: Hepatitis B markers (HBsAg, anti-HBc, HBeAg, anti-HBe) were determined by enzyme immunoassayin 6211 blood serum samples from conditionally healthy population of 6 regions of the Russian Federation. Analysis of damage to health of the population caused by hepatitis B and favorable effect of mass vaccination against hepatitis B was performed by using mathematical model by Goldstein S.T. et al. (2005), that used results of detection of hepatitis B markers in discrete groups (women of childbearing age, children up to 5 years of age, adults aged 30 years and older). A formula developed by us was used to evaluate the effect of vaccination on the average lifespan of the population of the Russian Federation. RESULTS: The rate of HBsAg detection in the conditionally healthy population of the Tuva Republic was significantly higher (8.1%) than in other studied regions of the Russian Federation (p < 0.05): in Moscow Region--1.6%, in Rostov Region--1.6%, in Sverdlovsk Region--1.2%, Khabarosvk Region--2.0%, in Sakha (Yakutia) Republic--2.5%. The rate of detection of anti-HBc was significantly higher in the Tuva Republic and Sakha (Yakutia) Republic (46.2% and 42.3%, respectively); in other regions: Moscow Region--13.6%, Rostov Region--18.9%, Sverdlovsk Region--17.5%, Khabarovsk Region--21.0%. HBeAg in women of childbearing age was detected only in the Tuva Republic (0.4%). The mathematical analysis performed demonstrated that the level of coverage of vaccination of newborn children that in the studied regions is 96.1-99.6% may lead to the reduction of morbidity and mortality from hepatitis B and its outcomes by 91-95% that exceeds the similar parameter obtained by using our model, described in the literature for Africa, Asia and Europe. The calculated level of decrease of morbidity and mortality from hepatitis B and its outcomes may lead to the increase of average lifespan of the population of the Russian Federation by 1.44 - 4.08 months. CONCLUSION: The strategy of vaccination of newborn children against hepatitis B employed in the Russian Federation significantly reduces the risk of this disease and development of unfavorable outcomes of the disease especially in hyper endemic regions and promotes the increase of average lifespan of the population of Russia.

[Epidemiological and molecular biological analysis of causes of rise of hepatitis A incidence in Republic of Tuva in 2008].

AIM: Analysis of hepatitis A (HA) incidence in Tyva Republic in 2008 exploiting traditional epidemiological and molecular methods. MATERIALS AND METHODS: Epidemiological analysis of HA cases and contact persons in Erzinsky and Kyzyl regions of Tyva Republic was performed. Class M and G antibodies to HAV were determined in serum samples (n = 28), and HAV RNA--in stool samples (n = 16). Phylogenetic analysis of HAV RNA sequence was performed for VP1/2A region of the HAV genome with length 394 nucleotides. RESULTS: Cases of HA were registered during 3.5 months. Water supply sources did not have deviations from established standards. According to results of interviews, common food factor, which was able to cause the rise of HA incidence, was not determined. Signs of fecal contamination were revealed on environmental objects in preschool institutions and schools that demonstrate the low level of hygienic behaviour. It was shown that all cases of HA are related with different variants of the virus belonged to genotype IA that points to the absence of common source of infection. CONCLUSION: Results of epidemiological and genetic analysis of HAV demonstrate that observed rise in HA incidence in Tyva Republic are connected with phase of seasonal rise of HA incidence, which is characteristic for its perennial dynamics with active realization of contact route of virus transmission.

[Polyvirus hepatitides (prevalence, diagnosis, characteristics of virusological process)].

AIM: To ascertain prevalence of chronic hepatitides (CH) of polyvirus etiology and to characterize a course of such polyvirus CH. MATERIAL AND METHODS: A total of 15000 patients with chronic diseases of the liver (CDL) of different etiology were examined for markers of hepatotropic viruses, 312 patients with CH aged 18-59 years were examined clinically, biochemically, virusologically and morphologically. RESULTS: CH of polyvirus etiology are rather prevalent. A replicative form of HBV has a significant effect on the activity of the pathological process in mixed hepatitis. Incidence of chronic HBV and HCV infection rises with age. Viral hepatitis A in drug addicts runs an atypical course. CONCLUSION: Adequate epidemiological analysis, diagnosis and antiviral treatment, follow-up of CDL of mixed viral etiology, monitoring of drug addiction, healthy life style are able to reduce prevalence of mixed hepatitis.

[Gilbert's syndrome: a clinicogenetic trial].

AIM: To improve diagnosis of Gilbert's syndrome (GS) basing on functional and genetic methods of examination. MATERIAL AND METHODS: GS was diagnosed in 88 patients aged 15-72 years using clinical and genetic tests. RESULTS: Genotyping has detected changes in promotor part of the gene coding uridindiphosphateglucuroniltransferase. In homozygous carriers GS was characterized by a higher baseline level of bilirubin, distinct response to functional tests, frequent combination with essential tremor. In heterozygous patients GS often ran latently. CONCLUSION: Four variants of GS course were established: dispepsic, asthenovegetative, jaundice, latent. Low-caloric diet followed by fenobarbital raised sensitivity and specificity of the test. A clinical classification of GS is proposed. The detected disorders of antipirin pharmacokinetics allow prognosis of the risk of unwanted reactions to the drugs metabolized by monooxigenases of the liver.

[HCV infection in the elderly].

AIM: To investigate prevalence, clinical picture and course of hepatitis C virus (HCV) infection in elderly patients. MATERIAL AND METHODS: A total of 1045 patients aged 60- 74 years with chronic diseases of the liver (CDL) were examined for hepatitis. RESULTS: HCV monoinfection was detected in 210 (20.1%) patients. Alcohol-viral etiology of HCV was revealed in 22% cases. HCV RNA was identified in 117 (76%) out of 154 elderly patients. All the HCV infected patients had 1b genotype, high viremia. Pain and asthenic syndromes were main clinical manifestations of HCV infection. Most often the activity of HCV infection in the elderly patients was low (88.6%), progression was slow (94.7%). The latter was registered in 22.8% patients. HCV infection in the elderly entails higher inflammation activity and incidence of HCV RNA. CONCLUSION: Complex examination of elderly patients for early detection of HCV, early diagnosis and treatment slows down progression of CDL, reduces the rate of development of severe complications and lethality.

[Cytokines in primary biliary cirrhosis (diagnostic and prognostic value)]. / Tsitokiny pri pervichnom biliarnom tsirroze (diagnosticheskoe i prognosticheskoe znachenie).

AIM: To study concentrations of serum pro- and anti-inflammatory cytokines (CK), CK correlations with clinicobiochemical activity, diagnostic and prognostic implications in primary biliary cirrhosis (PBC). MATERIAL AND METHODS: Enzyme immunoassay has been used to study content of IL-1 beta, IL-4, IL-6, IL-8, TNF-alpha, INF-gamma in peripheral blood of 96 women aged 26 to 82 years (mean age 56.2 +/- 12.6 years) with PBC (kits "Protein Contour", "Cytokine", St-Petersburg). The control group consisted of 20 healthy women matched by age. RESULTS: PBC is associated with changes in serum CK content correlating with the disease activity and stage. Elevated levels of proinflammatory IL-6, TNF-alpha, INF-gamma and anti-inflammatory IL-4. CONCLUSION: Definition of the cytokine spectrum in PBC has made a prognostic significance as it allows judging about the disease activity, stage and prognosis.

[Primary biliary cirrhosis: 12-year experience in observation]. / Pervichnyi biliarnyi tsirroz: 12-letnii opyt nabliudeniia.

AIM: To ascertain initial signs of primary biliary cirrhosis (PBC), criteria of its early diagnosis, variants of the course, clinical picture and life quality of PBC patients. MATERIAL AND METHODS: 128 PBC patients were examined in the Central Research Institute of Gastroenterology from 1991 to 2002. Quality of life was assessed by SF-36 questionnaire adapted for patients with chronic cholestatic diseases of the liver. RESULTS: The patients complained of skin puritus (80%), jaundice (66%), fatigue (68.8%), weight loss (24.6%). The disease manifested with skin pruritus in 75.8%, jaundice--in 12.5% patients. Decompensated hepatic cirrhosis (Child-Pugh C) at first hospitalisation was diagnosed in 11.7% cases. The earliest and most significant biochemical markers of PBS were high activity of gammaglutamil-transpeptidase (GGTP) and alkaline phosphatase (AP). IgM level was high in 70.5% cases. Antimitochondrial antibodies were detected in 83.6% examinees. Overlapping with autoimmune hepatitis was seen in 9.4%. One-third of the patients had systemic symptoms. Quality of life deteriorated. CONCLUSION: PBC may be long asymptomatic. The absence of skin pruritus is not a sure sign of the disease absence. To detect PBC early, young and middle-aged women with unexplained weakness or skin pruritus should undergo a comprehensive examination including measurements of GGTP, AP, AMA, IgM, morphological investigation of liver tissue. PBC patients had low quality of life. This should be accounted for when treating patients, in determination of their working ability and for early referral for liver transplantation.