Suvremeno liječenje kroničnih virusnih hepatitisa

master's thesis

• Title (english): Current treatment of chronic viral hepatitis
• Author: Ana Uroš
• Mentor: Lucija Virović Jukić (mentor)
• Committee member: Neven Ljubičić (predsjednik povjerenstva)
• Committee member: Jasenka Markeljević (član povjerenstva)
• Committee member: Lucija Virović Jukić (član povjerenstva)
• Granter: University of Zagreb; School of Medicine; (Department of Internal Medicine); Zagreb
• Defense date and country: 2020-07-17, Croatia
• Scientific / art field, discipline and subdiscipline: BIOMEDICINE AND HEALTHCARE; Clinical Medical Sciences; Internal Medicine

Abstract

Najčešći uzročnici kroničnih virusnih hepatitisa su virus hepatitisa B, virus hepatitisa C te virus hepatitisa D koji može dovesti do infekcije samo uz istovremenu infekciju virusom hepatitisa B. Klinička prezentacija kroničnih virusnih hepatitisa je slična i vrlo često infekcije prolaze asimptomatski ili uz prisutne blage i nespecifične simptome, te stoga infekcije često bivaju utvrđene ili slučajno u sklopu obrade zbog nekog drugog stanja ili kod osoba s već prisutnim posljedicama kroničnog hepatitisa u smislu razvoja ciroze jetre sa komplikacijama. Glavni cilj liječenja kroničnog hepatitisa je izlječenje. Razvojem novih, direktno djelujućih
protuvirusnih lijekova taj je cilj moguće ostvariti kod većine pacijenata s kroničnim hepatitisom C. Primjena direktno djelujućih protuvirusnih lijekova je potpuno promijenila terapiju kroničnog hepatitisa C omogućujući eradikaciju virusa u gotovo svih oboljelih uz ograničeno trajanje terapije i bez značajnih nuspojava koje su često otežavale donedavno korištenu interferonsku terapiju. Liječenje kroničnog hepatitisa B temelji se na primjeni interferona ili analoga nukleotida/nukleozida. Kod hepatitisa B nažalost često nije moguće postići potpuno izlječenje zbog perzistiranja kovalentno zatvorene kružne DNK (cccDNA) virusa koja mu omogućuje umnažanje unatoč primijenjenoj terapiji. Perzistencija cccDNA zahtijeva dugoročnu, najčešće doživotnu terapiju analozima nukleotida/nukleozida. Unatoč činjenici da ne postiže izlječenje u smislu eradikacije virusa, liječenjem kroničnog hepatitisa B moguće je ostvariti druge terapijske ciljeve, odnosno smanjiti i zaustaviti replikaciju virusa i spriječiti razvoj komplikacija bolesti u smislu ciroze i hepatocelularnog karcinoma. Terapija kroničnog hepatitisa D nije značajno napredovala u odnosu na terapije usmjerene protiv drugih uzročnika kroničnog virusnog hepatitisa i još uvijek se dominantno temelji na primjeni
interferona, i to s ograničenim uspjehom. Međutim, postoje obećavajuće naznake da će u budućnosti i ovim bolesnicima biti dostupne raznovrsnije i uspješnije terapijske opcije.

Abstract (english)

Chronic viral hepatitis is most commonly caused by hepatitis B virus, hepatitis C virus or hepatitis D virus which can cause infection only in the presence of hepatitis B infection. Patients infected with hepatitis viruses show similar presentations; they are often asymptomatic or present with only mild and nonspecific symptoms, and are therefore often diagnosed accidentally during diagnostic procedures for other conditions or in patients with already developed complications of advanced liver disease. The main goal of treatment is to eradicate the virus and cure the disease. With the recent development of new treatment options this goal is possible to achieve in most of patients infected with chronic hepatitis C.
The development of direct-acting antiviral drugs has completely changed the landscape of HCV treatment achieving viral eradication in almost all infected individuals with limited duration of treatment and without significant side-effects that represented significant burden during the interferon era. The therapy for chronic hepatitis B which is based on the use of
interferon or nucleotide/nucleoside analogues, unfortunately often cannot completely eradicate the virus and cure the disease due to persistence of covalently closed circular viral DNA (cccDNA) which enables replication of the virus despite the treatment. The persistence of cccDNA demands long-term, often lifelong therapy with nucleotide/nucleoside analogues.
Even though the therapy can't cure chronic hepatitis B, it can achieve other therapeutic goals like suppressing viral replication and preventing the development of complications like cirrhosis and hepatocellular carcinoma. The therapy for chronic hepatitis D hasn't advanced significantly compared with therapies for other causes of chronic viral hepatitis and is still mostly based on the use of interferon and with limited success. However, there are promising indications that more diverse and more successful therapeutic options will be available to patients with chronic hepatitis D in the future.

• Keywords: kronični virusni hepatitis; liječenje; direktno djelujući protuvirusni lijekovi; interferon; analozi nukleotida/nukleozida
• Keywords (english): chronic viral hepatitis; treatment; direct acting antiviral drugs; interferon; nucleotide/nucleoside analogues
• Language: croatian
• URN:NBN: urn:nbn:hr:105:948438
• Study programme: Title: Medicine; Study programme type: university; Study level: integrated undergraduate and graduate; Academic / professional title: doktor/doktorica medicine (doktor/doktorica medicine)
• Type of resource: Text
• File origin: Born digital
• Access conditions: Open access
• Created on: 2021-04-21 11:59:52