The treatment of chronic hepatitis B virus infection at the University Hospital for Infectious Diseases "Dr. Fran Mihaljević" in Zagreb in the period from 2008 to 2017

Abstract

U razdoblju od 2008. do 2017. u Klinici za infektivne bolesti "Dr. Fran Mihaljević" u Zagrebu liječeno je 210 bolesnika s kroničnom HBV infekcijom koji su imali histološku i biokemijsku aktivnost bolesti. Stadij fibroze određivan je patohistološki i elastografski. Cirozu je već u početku imalo 14,5 % bolesnika. Iako je funkcionalno izlječenje bilo rijetko (5,5 % slučajeva) kod većine bolesnika postignuta je supresija virusne replikacije, usporavanje ili prekid razvoja fibroze, pa čak i regresija stadija fibroze za jedan stupanj po Metaviru u 16 % bolesnika. Zapaženo je smanjenje frekvencije pojave dekompenzirane ciroze i hepatocelularnog karcinoma za 2 do 3 puta u usporedbi s podacima kod neliječenih bolesnika. Bolesnici liječeni lamivudinom imali su visoku incidenciju razvoja rezistencije (32 % nakon 5 godina liječenja), te je terapija nastavljena tenofovirom uz većinom dobru podnošljivost i bez razvoja rezistencije. HBeAg nije se pokazao kao značajan prediktor težine i toka bolesti. Značajan je broj hematoloških i drugih imunosuprimiranih bolesnika (n = 24), koji terapiju primaju radi prevencije reaktivacije latentne HBV infekcije.A total of 210 patients with chronic HBV infection and histological and biochemical activity of disease were treated at the University Hospital for Infectious Diseases "Dr. Fran Mihaljević" in Zagreb in the period from 2008 to 2017. The fibrosis stage was determined histologically and by transient elastography, and cirrhosis was found initially in 14,5 % of the patients. Although functional recovery was rare (5.5 % of cases), the suppression of viral replication, slowing down or discontinuation of fibrosis progression was achieved in most of the treated. Even fibrosis regression by one stage in Metavir scale was achieved in 16 % of patients. There was also a decrease in the frequency of development of decompensated cirrhosis (2 patients) and hepatocellular carcinoma (2 patients) by 2 to 3 times in comparison to historical controls in nontreated patients. Patients treated with lamivudine had a high incidence of resistance development (32 % after 5 years). They continued therapy with tenofovir with good tolerability and no resistance development. HBeAg did not seem to be a significant predictor for the severity and the course of the disease. There is also a significant number of hematologic and other immunosuppressed patients (n = 24) receiving treatment to prevent the reactivation of latent HBV infection