In the dissertation, on the basis of a comprehensive epidemiological analysis, the results of clinical and laboratory examination, modern manifestations of the epidemic process in chronic hepatitis B and C against the background of HIV infection were established, the peculiarities of the course and findings of the studied association of diseases were evaluated in order to clarify the concept of epidemiological surveillance for HIV, HBV - and HCV infection, as well as optimization of the therapy algorithm for such patients.
According to our data, the effectiveness of treatment of immunocompetent patients with CHC is generally comparable to the results of CHC therapy in HIV-infected individuals. At the same time, the use of a pangenotypic combination of SSRIs - sofosbuvir 400 mg and velpatasvir 100 mg 1 time per day internally demonstrates somewhat better results compared to mainly monogenotypic antiviral therapy - ledipasvir 90 mg + sofosbuvir 400 mg 1 time per day internally.
A comparative analysis of the results of this study with the results of CHC therapy in international protocols showed that the frequency of SVR in our patients is comparable to similar studies of ASTRAL-1, ASTRAL-3, ASTRAL-5 and American and Western European scientists on CHC therapy, as well as HIV/HCV- coinfections
Thus, treatment of CHC in HIV-infected patients should be started as early as possible, after establishing the diagnosis of chronic hepatitis, until there is no deep fibrosis and clinical signs of liver cirrhosis and the patients do not need ART. In this case, the probability of achieving SVR in HIV/HCV co-infection approaches the results of therapy for patients only on CHC.
Scientific novelty of the obtained work results. A retrospective and operational clinical-epidemiological analysis of the incidence and findings of viral hepatitis in HIV-infected persons in Chernivtsi region and Ukraine established a significant decrease in the incidence of acute hepatitis B and C, while the incidence of chronic forms of these hepatitis increased and co-infection increased - CHB+HCV+HIV infection. .
For the first time, the frequency of formation of "hidden" hepatitis B in HIV-infected persons, in whose blood HBV genetic material is detected together with markers of transferred HBV infection in the absence of a screening marker - HBsAg, was established.
For the first time, calculations of the frequency of transformation of HIV-/HBV-/HCV-infection into cirrhosis of the liver, as well as the probability and relative risk of fatal outcome in such patients at different clinical stages of immunodeficiency, were carried out.
The higher efficiency of the pangenotypic combination of direct-acting antiviral drugs (sofosbuvir and velpatasvir) compared to mainly monogenotypic therapy (ledipasvir and sofosbuvir) in the treatment of HIV-infected patients with chronic hepatitis C has been established.
Practical significance of the obtained results. There is a well-founded need to change the concept of epidemiological surveillance, which involves expanding access to testing for HIV, HBV, and HCV infection of all segments of the population and introducing a new priority direction for the prevention of sexual transmission of HIV aimed at the general population.
In order to rule out "hidden" hepatitis B, the expediency of examining HIV-infected persons for HBV DNA using PCR was proven for the first time, even with a negative result of the HBsAg test and markers of past HBV infection.
In HIV-infected patients with hepatitis B and C, the probability of developing CP and fatal outcomes increases significantly with the deepening of immunodeficiency, which requires a review of the management tactics of this category of patients.
For the first time, a substantiated recommendation to prescribe the treatment of HCV infection as early as possible in HIV-infected patients even in the absence of taking antiretroviral drugs and signs of liver cirrhosis. At the same time, taking into account the effectiveness and safety, preference should be given to the pangenotypic combination of direct-acting antiviral drugs - sofosbuvir 400 mg and velpatasvir 100 mg once a day internally, than to the monogenotypic scheme - ledipasvir 90 mg and sofosbuvir 400 mg once a day internally.
