STUDY OF THE EFFECTIVENESS OF ANTIVIRAL DRUGS IN THE LIVER DISEASES

Аннотация

The paper examines the literature data on factors affecting the process of fibrogenesis and cirrhosis in chronic viral hepatitis. It is shown that the course of fibrogenesis depends not only on the microorganism and the duration of the infection, but also on the genetic predisposition and characteristics of the macroorganism, the activity of the pathological process, the effects of hepatotoxic agents (primarily ethanol), etc. Keywords: chronic viral hepatitis, fibrosis, cirrhosis of the liver. Chronic viral hepatitis (HCG) is an urgent problem of modern healthcare. Currently, at least four pathotropic viruses are known to cause the development of chronic hepatitis and cirrhosis of the liver (CP) — B, C, D and G. From a practical point of view, the question of risk factors for the progression of fibrosis and the formation of cirrhosis of the liver in viral hepatitis deserves attention. Features of the microorganism. According to world statistics, the frequency of CP formation depends on the causes of liver damage, including in viral hepatitis from the type of hepatotropic virus. Thus, the frequency of CP formation in HBV monoinfection reaches 4% [I], whereas in HBV/HDV mixed infection it increases to 40% [2]. In HCV infection, CP, according to various authors, develops in 1.5 — 58% of cases [3, 4]. There are indications of the dependence of the formation of CP in HCG on the genotype of the hepatotropic virus. Thus, J. N. Kao et al. [5] provide data on the prevalence of the HBV genotype among patients with CP compared with asymptomatic carriers (60 and 23%, respectively). H. Sumi et al. [6] also believe that the HBV genotype is more associated with severe liver fibrosis (74/224 vs. 4/30 for genotypes B and C, respectively). At the same time, according to M. F. Yuen. et al. Выпуск журнала №-23 Часть–3_ Апрель –2025 299 MODERN EDUCATION AND DEVELOPMENT [7], in patients infected with the HBV genotype, higher levels of AlAT and bilirubin and lower levels of albumin were recorded, and, accordingly, higher mortality rates due to decompensation of liver function compared to individuals with HBV infection caused by geno type C. Brazilian researchers believe that infection, caused by hepatitis B virus with a mutation in the pre core region, it leads to an increase in the index of histological activity and the severity of liver fibrosis [8]. It is believed that patients with HCV having genotype 1b have the most unfavorable course of the disease, and CP is formed more often than with HCV caused by other genotypes of the pathogen. In contrast, there is an opinion that accelerated fibrosis progression is associated with not 1 HCV genotypes, in particular, with genotype 3 [9, 10]. However, other authors believe that the formation of CP does not depend on the HCV genotype [11]. In a study by M. Guido et al. [12] In children, the HCV gene type also did not correlate with the degree of liver fibrosis. There are indications that in chronic hepatitis D y patients with HDV genotype I, compared with patients with II, IV and unclassified HDV genotype, complete remission is less often recorded (15.2 vs. 40.2%) and unfavorable outcomes of the disease (liver cirrhosis and hepatocellular carcinoma) are more often noted (52.2 vs. 25%) [13]. The concentration (titer) of the pathogen in blood serum and tissues is considered as one of the factors that aggravate the course of hepatitis and lead to accelerated progression of liver fibrosis. According to D. K. Wong et al. [14] the titers of HBV DNA detected in liver tissue correlate with the concentration of HBV DNA in blood serum and with the degree of liver fibrosis. It is believed that a significant progression of fibrosis in HCV is associated with the concentration of HCV RNA in the blood serum exceeding 8 × 106 copies/ml [15]. At the same time, the negative HCV RNA status of the blood serum of y patients with HCV corresponds to the absence of progression of liver fibrosis [16]. According to other data, viral load is not associated with the progression of fibrosis. Thus, N. Saleem et al. [17] it is believed that the concentration of HCV RNA in the blood serum does not correlate with the activity of the pathological process, nor with the degree of liver fibrosis, nor with ca kim or another indicator of the Knodell histological activity index. The course and outcomes of mixed infections of various hepatotropic viruses Выпуск журнала №-23 Часть–3_ Апрель –2025 300 MODERN EDUCATION AND DEVELOPMENT depend on these viruses. Thus, E. Sagnelli et al. [18] it is believed that mixed HBV/HCV infection proceeds with more serious histological changes (including fibrosis) compared to monoinfection with one of these viruses. The histological activity index and the degree of liver fibrosis of y patients with HBV/HCV mixed infection exceeded those of y individuals with HCV mono infection (3.5-1.1 and 3.0 - 1.1 points versus 3.5 - 0.8 and 2.3 - 1.1 points, respectively). At the same time, according to S.