medinfoАктуальные проблемы теоретической и клинической медициныActual Problems of Theoretical and Clinical Medicine2790-12892790-1297Казахстанско-Российский медицинский университет10.64854/2790-1289-2025-49-3-11medinfo-498Research ArticleОБЗОР ЛИТЕРАТУРЫREVEWSПРОРЫВНАЯ ПРОТИВОВИРУСНАЯ ТЕРАПИЯ ХРОНИЧЕСКОГО ГЕПАТИТА ДBREAKTHROUGH ANTIVIRAL THERAPY FOR CHRONIC HEPATITIS Dhttps://orcid.org/0009-0003-8724-9684ОтунбаеваД. И.OtunbayevaD. I.

Кандидат медицинских наук, ассоциированный профессор кафедры пропедевтики внутренних болезней

Jamal.o@mail.ruhttps://orcid.org/0000-0003-2555-8644НургалиеваБ. К.NurgalievaB. K.

Доктор медицинских наук РК и РФ, MSP, заведующая кафедрой пропедевтики внутренних болезней, Казахский Национальный Медицинский Университет имени С.Д. Асфендиярова

nurgalieva.b@kaznmu.kzhttps://orcid.org/0009-0002-3584-0694КариеваС. С.KariyevaS. S.

Aссистент кафедры пропедевтики внутренних болезней, Казахский Национальный Медицинский Университет имени С.Д. Асфендиярова

saulekariyeva@gmail.comКазахский Национальный Медицинский Университет имени С.Д. АсфендияроваКазахстанS. D. Asfendiyarov Kazakh National Medical UniversityKazakhstan20252509202503160173Copyright © Отунбаева Д.И., Нургалиева Б.К., Кариева С.С., 20252025Отунбаева Д.И., Нургалиева Б.К., Кариева С.С.Otunbayeva D.I., Nurgalieva B.K., Kariyeva S.S.Данная работа распространяется под лицензией Creative Commons Attribution 4.0.This work is licensed under a Creative Commons Attribution 4.0 License.https://kazrosmedjournal.krmu.edu.kz/jour/article/view/498

Известно, что в течение 46 лет с момента открытия антигена вируса гепатита Д М. Rizzetto в 1977 г., хронический гепатит Д рассматривался совместно с хроническим гепатитом В, как хронический гепатит В с дельта агентом. Соответственно, против обоих вирусов назначалось одинаковое низкоэффективное лечение препаратами интерферона, пегилированного интерферона-α с аналогами нуклеозидов (25 %). Впервые хронический гепатит Д выделен отдельно от хронического гепатита В в первых Практических Рекомендациях Европейской ассоциации по изучению печени по ведению хронического гепатита Д, опубликованных 30 августа 2023 г. Российские Рекомендации по хроническому гепатиту Д были опубликованы в 2021г.

Цель

Цель: освещение и анализ первых Рекомендаций по хроническому гепатиту Д, ознакомление врачей с рандомизированными клиническими исследованиями по применению противовирусного препарата Булевиртид у пациентов с хроническим гепатитом Д и циррозом печени в течение 10 лет.

          Материалы и методы. Поиск литературы был проведен в базе Medline/Pubmed, Cyberleninka, eLibrary.

Результаты

Результаты. В отличие от хронического гепатита В и хронического гепатита С поражение печени при хроническом гепатите Д более тяжелое, агрессивное с прогрессирующим течением, быстрым развитием цирроза печени с декомпенсацией и гепатоцеллюлярной карциномы. Распространенность хронического гепатита Д в мире неоднородная в связи с миграцией населения, по данным двух крупных метаанализов составляет от 12 до 72 миллионов человек.

Применение препарата Булевиртид с 2014 г. явилось началом этиотропного лечения пациентов с хроническим гепатитом Д и циррозом печени. Клинические исследования показали эффективность и безопасность препарата Булевиртид при монотерапии, значительно большую эффективность в комбинации с пег-интерфероном-α в течение 48 недель и более.

Выводы

Выводы. Рекомендации Европейской ассоциации по изучению печени обобщили мировой опыт лечения Булевиртидом у пациентов с хроническим гепатитом Д и циррозом печени в исходе данного гепатита. С 2019 по 2022 гг. препарат Булевиртид был зарегистрирован в России и странах Евросоюза.

For a long period of 46 years since the discovery of the hepatitis D virus antigen by M. Rizzetto in 1977, chronic hepatitis D was considered in conjunction with chronic hepatitis B, classified as chronic hepatitis B with the delta agent. As a result, both viruses were treated with the same low-efficacy therapies, primarily interferon-based treatments, including pegylated interferon-α combined with nucleoside analogues, achieving virological response rates of only around 25 %. For the first time, chronic hepatitis D was recognized as a separate disease entity from chronic hepatitis B in the first Practical Guidelines of the European Association for the Study of the Liveron the management of chronic hepatitis D, published on August 30, 2023. National Russian guidelines on chronic hepatitis D were published earlier, in 2021.

Objective

Objective: To present and analyze the first international guidelines on the management of chronic hepatitis D, and to familiarize clinicians with randomized clinical trials evaluating the use of the antiviral drug Bulevirtide in patients with chronic hepatitis D and liver cirrhosis over 10 years.

Materials and Methods

Materials and Methods: A literature review was conducted using the Medline/PubMed, CyberLeninka, and eLibrary databases.

Results

Results. Unlike chronic hepatitis B or C, liver injury in chronic hepatitis D is more severe and aggressive, with a progressive course, rapid progression to liver cirrhosis with decompensation, and a higher risk of hepatocellular carcinoma. The global prevalence of chronic hepatitis D is heterogeneous due to population migration; according to two major meta-analyses, it is estimated to affect between 12 and 72 million people worldwide.

The use of Bulevirtide since 2014 has marked the beginning of etiological treatment for patients with chronic hepatitis D and liver cirrhosis. Clinical trials have demonstrated the efficacy and safety of Bulevirtide as monotherapy, and even greater efficacy when combined with pegylated interferon-α for 48 weeks or longer.

Conclusions

Conclusions. The EASL guidelines summarize the global experience in treating patients with chronic hepatitis D and liver cirrhosis using Bulevirtide. Between 2019 and 2022, Bulevirtide received regulatory approval in Russia and EU countries.

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The authors declare that there are no conflicts of interest present.