[HBV as one of the causes for development of cholelithiasis].

The aim of this study was to identify the influence of HBV on gall bladder and to establish necessity and terms of preventive measures. For this reason we have examined 58 patients, passed through cholecystectomy and 142 patients with B hepatitis. Patients of this group were followed up during 18 months. In the first group presence HBsAg in the gall bladder tissue was identified using immunoferment analysis and immunofluorescent testing. In all cases the blood was tested for specific markers (HBsAg, Anti-HB-cor antibodies of G and M classes). In the second group 75 patients were investigated prospectively. Observation using ultrasound was performed to find out the changes of gall bladder and bile. In this group preventive measures against gallstone formation were performed. 67 patients were investigated retrospectively and prevention was not performed among them. In 10 cases of cholecystectomy (17,2%) out of 58, HBsAg in the gall bladder tissue was identified both, with immunoferment analysis and immunofluorescent testing. The ultrasound examination revealed morpho-functional changes of gall bladder and bile in the acute stage of hepatitis B and also in following period. There were no cases of development of gallstones in the group where preventive measures using dietary fiber-rich food "Margi" were conducted, in the second group, where such measures have not been performed, gallstones developed in 5 patients (7,46%) out of 67, during 6-18 months after the acute B hepatitis. This results allow us to conclude, that cholecystopathogenic influence of HBV leads to the morpho-functional changes of gall bladder. This fact must be assessed as a risk factor for development of cholelithiasis and confirms necessity of early longlasting preventive measures.

Re-treatment of patients with hepatitis C who failed to respond (nonresponders) to previous treatment.

The aim of four-year follow up study was evaluation of re-treatment efficacy of antiviral therapy in patients with hepatitis C who failed to respond (non responders) to previous therapy. Study enrolled 29 patients, aged 21-59 with HCV infection (15 had HCV genotype 1, and 14 had HCV non-genotype1), who previously were treated with unmodified interferon alfa (conventional interferon) 2a or 2b 5 MIU TIW plus ribavirin (1000-1200 mg/day) and who failed under this therapy. Study subjects were randomized into two groups: in group I were included 17 patients--relapsers (patient in whom HCV RNA becomes undetectable on treatment and is undetectable at the end of therapy, but is detected again after discontinuation of treatment). Group II was composed of 12 patients: 4 were non responders (patient in whom HCV RNA levels remain stable on treatment), 4--partial responders (HCV RNA levels decline by >2 logs, but never become undetectable during treatment) and 4--breakthrough non responders (HCV RNA become undetectable during treatment, but before-treatment termination again become detectable). The diagnosis of HCV infection was made based on detection of HCV antibodies by ELISA and confirmed by RIBA. Detection of HCV RNA (qualitative) and HCV RNA Viral load--by Real time PCR technique (COBAS TaqMan Test). HCV genotypes were detected by INNO-Lipa method. In group I--rapid virological response (RVR) was observed in 10 (58%) patients, early viral response (EVR) in 12 patients (70%). Among them 9 (52%) patients remained HCV RNA undetectable by the end of treatment. After 6 months sustained viral response (SVR) was received in 7 (41%) patients from group I. In group II--RVR was observed in 5 (41%), EVR in 6 (50%) patients. Among them 5 (41%) patients remained HCV RNA undetectable by the end of treatment. After 6 months Sustained Viral Response was received in 3 (25%) patients. Re-treatment with pegylated interferon and ribavirin in patients with hepatitis C who failed to responds to previous treatment was effective in relapsers. Re-treatment in non responders, partial responders and breakthrough non responders was less effective (especially in non responders). Re-treatment effectiveness was higher in HCV genotype non 1 patients in comparison with HCV genotype 1. Thus re-treatment will be considered for relapsers. For making decision on re-treatment for other nonresponders, severity of disease (advance disease) should be considered.

[Side effects of the combined antiviral therapy in patients with chronic hepatitis C].

The aim of the study is to reveal and treat the side effects of the combined antiviral therapy - Peginterferon and Ribavirin in patients with chronic Hepatitis C. During 2004-2006 years, 40 patients in the ambulatory department of the Infectious Diseases Clinic of the State Medical University were investigated. All the patients were administered pegilated interferon and ribavirin after special procedures. The following side effects on the antiviral treatment were grouped: flu-like, cardiovascular, gastrointestinal, neuro-psychiatric, dermatological and hematological. Frequency, severity and duration of all unfavorable symptoms were independent of Hepatitis C genotype, though the adherence to the medications was better in younger age groups and the dose correction where required after the age 45.