Epidemiology and Infectious DiseasesEpidemiology and Infectious DiseasesЭпидемиология и инфекционные болезни3034-20073034-2015Eco-Vector4083610.17816/EID40836ArticlesСтатьиResearch ArticleMedical social factors affecting the effectiveness of the treatment of viral hepatitis patientsМедико-социальные факторы, влияющие на эффективность лечения больных вирусным гепатитом СRadutoO. IРадутоОльга Ивановна

доктор мед. наук, проф., член Национального научного общества инфекционистов

olga@r-l-g.ruCentral Research Institute of Epidemiology of the Federal Service on Customers' Rights Protection and Human Well-being Surveillance«Центральный НИИ эпидемиологии» Роспотребнадзора15102014195VOL 19, NO5 (2014)ТОМ 19, №5 (2014)323623072020Copyright ©; 2014, Eco-vectorCopyright ©; 2014, ООО "Эко-вектор"2014Eco-vectorООО "Эко-вектор"https://rjeid.com/1560-9529/article/view/40836

There was performed the analysis of modern epidemiological, social and financial aspects of the hepatitis C treatment. There was considered the influence of some factors on the efficacy of the treatment efficacy, in particular, the genetic status of patients, stage of the disease, the development of side effects and patient compliance with the treatment regimen. Social factors were shown to include also the patient's race, language barriers, being in prison, availability of the treatment. The effectiveness of treatment for this group ofpatients is also influenced by the gender, young age, the presence of mental illness in the patient, drug and alcohol abuse. Financial constraints contribute to the reducing the commitment of the drugs intaking, the deterioration of the health status of viral hepatitis C and B patients, respectively, higher total health expenditure for the health care. There was made a conclusion about the necessity of the work on the formation of the adherence of this category of patients to the treatment, the patient and doctor must work together to make a treatment decision, after careful discussion of the need to comply treatment and risks of side effects, as well as re-infection.

Выполнен анализ современных эпидемиологических, социальных и финансовых аспектов лечения вирусного гепатита C. Рассмотрено влияние на эффективность терапии ряда факторов, в частности генетического статуса больных, стадии заболевания, развития побочных эффектов, а также соблюдение пациентами режима терапии. Показано, что к социальным факторам относятся раса больного, языковые барьеры, нахождение в местах лишения свободы, возможность доступа к лечению. На эффективность лечения данного контингента больных влияют также пол, молодой возраст, наличие психических заболеваний у пациента, употребление алкоголя и наркотиков. Финансовые ограничения способствуют снижению приверженности к приему препаратов, ухудшению состояния здоровья больных вирусным гепатитом С и соответственно более высоким общим расходам на здравоохранение. Сделан вывод о необходимости работы по формированию приверженности данной категории пациентов к лечению, больной и врач должны совместно принимать решение о проведении лечения после тщательного обсуждения необходимости соблюдения режима лечения и рисков побочных эффектов, а также повторного заражения.

viral hepatitis Csocial factorsinjecting drug addictsantiviral drugstreatment complianceвирусный гепатит Cсоциальные факторыпотребители инъекционных наркотиковпротивовирусные препаратыприверженность к лечениюAverhoff F.M., Glass N., Holtzman D. Global burden of hepatitis C: considerations for healthcare providers in the United States. Clin. Infect. Dis. 2012; 55 (Suppl. 1): 10-5.Barreiro P., Vispo E., Labarga P., Soriano V. Management and treatment of chronic hepatitis C in HIV patients. Semin. Liver Dis. 2012; 32 (2): 138-46.Louie K.S., St Laurent S., Forssen U. et al. The high comorbidity burden of the hepatitis C virus infected population in the United States. BMC Infect. Dis. 2012; 12: art. 86.Islam M.M., Topp L., Conigrave K.M. et al. Linkage into specialist hepatitis C treatment services of injecting drug users attending a needle syringe program-based primary healthcare centre. J. Subst. Abuse Treat. 2012; 43 (4): 440-5.Talwani R., Gilliam B.L., Rizza S.A. et al. Current status of treatment for chronic hepatitis C virus infection. Drugs Today. 2012; 48 (3): 219-31.Michielsen P., Ho E., Francque S. Does antiviral therapy reduce the risk of hepatocellular carcinoma in patients with chronic hepatitis C? Minerva Gastroenterol. Dietol. 2012; 58 (1) : 65-79.McHutchison J.G., Everson G.T., Gordon S.C. et al. Telaprevir with peginterferon and ribavirin for chronic HCV genotype 1 infection. N. Engl. J. Med. 2009; 360 (18): 1827-38.McHutchison J.G., Manns M.P., Muir A.J. et al. Telaprevir for previously treated chronic HCV infection. N. Engl. J. Med. 2012; 362 (14): 1292-303.Poordad F., Khungar V. Emerging therapeutic options in hepatitis C virus infection. Am. J. Manag. Care. 2011; 17 (Suppl. 4): 123-30.Gidding H.F., Law M.G., Amin J. et al. Hepatitis C treatment outcomes in Australian clinics. Med. J. Austral. 2012; 196 (10): 633-7.Dore G.J., Hellard M., Matthews G. et al. Effective treatment of injecting drug users with recently acquired Hepatitis C virus infection. Gastroenterology. 2010; 138 (1). 123.Yee H.S., Chang M.F., Pocha C. et al. Update on the management and treatment of hepatitis C virus infection: recommendations from the Department of Veterans Affairs Hepatitis C Resource Center Program and the National Hepatitis C Program Office. Am. J. Gastroenterol. 2012; 107 (5). 669-89.National Institutes of Health Consensus Development Conference statement: Management of Hepatitis C. Hepatology. 2002; 36 (5): 3-20.Mecenate F., Pellicelli A., Barbaro G. et al. Short versus standard treatment with pegylated interferon alfa-2A plus ribavirin in patients with hepatitis C virus genotype 2 or 3: the cleo trial. BMC Gastroenterol. 2012; 10, art. 21.Chayama K., Takahashi S., Toyota J. et al. Dual therapy with the nonstructural protein 5A inhibitor, daclatasvir, and the nonstructural protein 3 protease inhibitor, asunaprevir,in hepatitis C virus genotype 1b-infected null responders. Hepatology. 2012; 55 (3): 742-48.Negro F., Alberti A. The global health burden of hepatitis C virus infection. Liver Int. 2011; 31 (2): 1-3.Bonkovsky H.L., Snow K.K., Malet P.F. et al. Health related quality of life in patients with chronic hepatitis C and advanced fibrosis. J. Hepatol. 2007; 46 (3). 420-31.Snow K.K., Bonkovsky H.L., Fontana R.L. et al. Changes in quality of life and sexual health are associated with low-dose peginterferon therapy and disease progression in patients with chronic hepatitis C. Aliment. Pharmacol. Ther. 2010; 31 (7): 719-34.Huckans M., Mitchell A., Pavawalla S. et al. The influence of antiviral therapy on psychiatric symptoms among patients with hepatitis C and schizophrenia. Antiviral Ther. 2010; 15 (1): 111-9.Brown R.S. Recent advances in hepatitis C: highlights from the 2010 AASLD meeting. Gastroenterol. Hepatol. 2011; 7 (1, Suppl.1): 6-13.Ge D., Fellay J., Thompson A. et al. Genetic variation in IL28B predicts hepatitis C treatment-induced viral clearance. Nature. 2009; 461 (7262). 399-401.Srivastava S., Bertagnolli M., Lewis J. Sustained virological response rate to pegylated interferon plus ribavirin for chronic hepatitis C in African Americans: results in treatment-naive patients in a university liver clinic. J. Nat. Med. Assoc. 2005; 97 (12); 1703-7.Teuber G., Schafer A., Rimpel J. et al. Deterioration of health-related quality of life and fatigue in patients with chronic hepatitis C: association with demographic factors, inflammatory activity, and degree of fibrosis. J. Hepatol. 2008; 49 (6): 923-9.Danoff A., Khan O., Wan D. et al. Sexual dysfunction is highly prevalent among men with chronic hepatitis C virus infection and negatively impacts health-related quality of life. Am. J. Gastroenterol. 2006. 101 (6). 1235-43.Zickmund S., Ho E.Y., Masuda M. et al. They treated me like a leper’ Stigmatization and the quality of life of patients with hepatitis. C. J. Gen. Int. Med. 2003; 18 (10): 835-44.Hartwell D., Jones J., Baxter L., Shepherd J. Shortened peginterferon and ribavirin treatment for chronic hepatitis C. Int. J. Technol. Assessm. Hlth Care. 2012; 28 (4): 398-406.Broers B., Helbling B., Francois A. et al. Barriers to interferon-а therapy are higher in intravenous drug users than in other patients with acute hepatitis C. J. Hepatol. 2005; 42 (3): 323-8.Cooper C.L., Giordano C., Mackie D., Mills E. Equitable access to HCV care in HIV-HCV co-infection can be achieved despite barriers to health care provision. J. Ther. Clin. Risk Manag. 2010; 26 (6). 207-12.Fox R.K., Currie S.L., Evans J. et al. Hepatitis C virus infection among prisoners in the California State correctional system. Clin. Infect. Dis. 2005; 41(2): 177-86.Радуто О.И. Теоретические и практические проблемы управления социальным здоровьем населения в трансформационный период: Монография. М.: РУДН; 2008.Allwright S., Bradley F., Long J. et al. Prevalence of antibodies to hepatitis B, hepatitis C, and HIV and risk factors in Irish prisoners: results of a national cross sectional survey. Br. Med. J. 2000; 321 (7253): 78-2.Ruiz J.D., Molitor F., Sun R. et al. Prevalence and correlates of hepatitis c virus infection among inmates entering the California correctional system. West. J. Med. 1999; 170 (3): 156-60.Sanyal C., Ingram L., Sketris I. et al. Coping strategies used by patients infected with hepatitis C virus who are facing medication costs. Can. J. Hosp. Pharm. 2011; 64(2): 131-40.Piasecki B.A., Lewis J.D., Reddy K.R. et al. Influence of alcohol use, race, and viral coinfections on spontaneous HCV clearance in a US veteran population. Hepatology. 2004; 40 (4): 892-9.Serra M.A., Escudero A., Rodriguez R. et al. Effect of hepatitis C virus infection and abstinence from alcohol on survival in patients with alcoholic cirrhosis. J. Clin. Gastroenterol. 2003; 36 (2) : 170-4.Rowan P.J., Tabasi S., Abdul-Latif M. et al. Psychosocial factors are the most common contraindications for antiviral therapy at initial evaluation in veterans with chronic hepatitis C. J. Clin. Gastroenterol. 2004; 38 (6): 530-4.Rifai M.A., Gleason O.C., Sabouni D. Psychiatric care of the patient with hepatitis c: a review of the literature. Primary Care. Companion. J. Clin. Psychiatry. 2010; 12 (6): 215-8.Schaefer M., Capuron L., Friebe A. et al. Hepatitis C infection, antiviral treatment and mental health: a European expert consensus statement. J. Hepatol. 2012; 57 (6): 1379-90.Chequer P., Cuchi P., Mazin R. et al. Access to antiretroviral treatment in Latin American countries and the Caribbean. AIDS. 2002; 16 (Suppl. 3): 120-5.Binswanger H.P Public health. HIV/AIDS treatment for millions. Science. 2001; 292 (2515): 221-7.Chin J., Mann J. Global surveillance and forecasting of AIDS. Bull. World Hlth. Org. 1998; 76 (5): 429-32.