Melnyk T. Clinical course and treatment dynamics monitoring of chronic hepatitis B among people infected with human immunodeficiency virus

The dissertation is devoted to the study of the clinical course of chronic hepatitis B, treatment response among HIV-infected individuals and forecasting the consequences of the course and treatment results of patients with HIV/CHB coinfection based on a role of the clinical and biochemical liver inflammation determining indicators and quantitative serum concentration of HBsAg among patients with HIV infection. Scientific data of the clinical and laboratory course features of HBV among HIV positive patients were supplemented. It has been established presents in 1.45 times higher rate of astheno-vegetative syndrome, in 2.42 times – dyspeptic syndrome, in 2.47 times complaints of intermittent nausea and loss of appetite, in 1.14 times higher serum ALT level among HIV/CHB coinfected patients. At the same time, patients with coinfection were 2.33 times more likely to have individuals with a high HBV viral load and 2.60 times more likely to have severe liver fibrosis (F3). The quantitative concentration of HBsAg was 2,30 times higher in the serum of patient with HBeAg negative chronic hepatitis B phase among coinfected people as well as 3,38 times higher in general among HIV positive patients with CHB compared with CHB patients only. The quantitative serum HBsAg concentration was 19,13 times increased in case when elevated ALT level has been presented in the blood of HIV / HBV coinfected patients compared with those HIV/CHB coinfected without elevated ALT and 2,69 times increased compared with an analogous group of HIV negative patients with CHB and elevated ALT. It has been established the relationship between the quantitative concentration of HBsAg in the serum of coinfected HIV/CHB patients with ALT levels (r=0.639) and the quantity of HBV viral load (r=0.718). There have been revealed futures of the dynamics of ALT levels in the serum of HBV/HIV coinfected patients during antiviral therapy conducting. It has been established 4.50 times increase of patient’s number with “ALT flare” in ≤ 6 months’ treatment period among HIV/CHB coinfected compared with HBV monoinfected as well as increasing 2,33 times of patients’ number with “ALT flare” presence among HIV-positives in treatment dynamics. Scientific data on the dynamics of the quantitative concentration of HBsAg in the serum of CHB coinfected with HIV patients during antiviral therapy with the tenofovir disoproxil fumarate administration were supplemented. It was stated first time quantitative concentration of HBsAg 1,56, 6,61, and 21,10 times decreasing in the serum of HIV/CHB coinfected patients in accordance with the treatment duration periods and 1,31 – 72,72 times decreasing among those coinfected patient who experienced “ALT flare”. Patients with HBV coinfected with HIV were 2.67 times more often achieved a serum qHBsAg decreasing per 2 log10 at ˃ 6 ≤ 12 and ˃ 12 months after starting treatment in the presence of "ALT flare" and in 13.08 and 6.48 times, respectively, more often than patients without a significant increase in serum ALT. The quantitative HBsAg serum concentration in was lower by 11.24 times after ˃ 12 months of therapy in the group of HIV/CHB coinfected patients with “ΔCD4 + ˃ 100 cells/μl within first three months of observation” compared with the group of coinfected patients with “ΔCD4 + 0 - 100 cells / μl within first three months of observation”. A model of factors influences on the reduction per 2 log10 HBsAg in the serum of patients with CHB coinfected with HIV during antiviral therapy with a parametric approach was built. The significant acceleration per 2 log10 HBsAg in serum among HIV-positive patients with the occurrence of “ALT flare” in the first 6 months after start of the therapy (beta = 0.44 ± 0.02, p <0.0001), and in the presence of the first and the second HIV-infection stages on start of the treatment (beta = -1.38 ± 0.03, p <0.0001) has been proven.