THE ROLE OF MORPHOLOGICAL CHANGES OF LIVER IN THE PROGNOSTIFICATION OF INTERFERON THERAPY EFFECTIVENESS FOR PATIENTS WITH CHRONIC HEPATITIS TYPE C

Abstract

Objective: to determine the prognostic significance of morphological changes of liver to assess the effectiveness of interferon therapy in HCV patients with different viral genotypes. Subjects and methods. We compared the effectiveness of interferon therapy (IFN) (using different regimens - both monotherapy in different modes, and combined with ribavirin, due to a variety of treatment schemesб the evaluation of its effectiveness for patients with various histological changes was not carried out) in 88 patients with HCV who had underwent liver biopsy, followed by morphological examination of biopsy specimens. The evaluation of the biopsy results was performed in accordance with V. Serov and L. Severgin`s methods, with the detection of the degree of histological activity index (HAI) and histological stage of chronicity index (GSCI). The diagnosis of all the patients was verified by the detection of HCV RNA by polymerase chain reaction (PCR). Results and Discussion. Of the HCV patients with moderate histological activity, 68,8 % detected primary biochemical response, which was observed statistically significantly oftener than in the patients with low activity (37,5 %, χ 2 = 4,49, p = 0,034). Of the patients with 1b genotype HCV and moderate histological activity, 71,4 % detected the primary biochemical response, which was observed statistically significantly oftener than in the patients with low activity (27,8 %, χ 2 = 4,00, р = 0,046). No statistically significant differences in the effectiveness of interferon therapy in HCV patients with other HCV genotypes with different histological activity in different periods of treatment were revealed. The early biochemical response in the patients with severe fibrosis or cirrhosis was recorded in 25 %, which was statistically significantly less frequent than in the patients with moderate fibrosis (p = 0,037, 73,3 %). The primary biochemical response was observed in 12,5 % of the patients with severe fibrosis or cirrhosis, which was statistically significantly less frequent than in the patients with mild fibrosis (p = 0,024, 60%). None of the patients with severe fibrosis or cirrhosis detected a stable or long-term virological response, which was statistically significant less frequent than that of the patients without fibrosis (р = 0,024, 50 %) and moderate fibrosis (p = 0,02, 55,5 %). Conclusion. The presence of moderate histological activity in the patients with HCV with HCV genotype 1b is a significant prognostic factor to assess the primary viral response to antiviral therapy. None of the patients with severe fibrosis or cirrhosis revealed a stable or long-term viral response.