[Efficacy and safety of bulevirtide in patients with chronic hepatitis D and compensated cirrhosis].

AIM: To study the efficacy and safety of bulevirtide, the HBV and HDV entry inhibitor. MATERIALS AND METHODS: Analysis of the results of using bulevirtide in randomized controlled open-label comparative studies MYR202 and MYR203 in 56 patients with chronic hepatitis D and compensated cirrhosis, in monotherapy and combination with pegylated interferon alpha-2a (PEG-IFN). RESULTS: Monotherapy with bulevirtide for 24 weeks in the MYR202 study in 46 patients with compensated liver cirrhosis demonstrated: 1) a high rate of virological (100%) and biochemical response (alanine aminotransferase normalization rate 45.7%), 2) superiority of bulevirtide in efficacy over the control group (tenofovir), 3) comparability of treatment efficacy in patients with and without cirrhosis, 4) no progression of liver fibrosis with elastometry in most patients. Treatment with bulevirtide in monotherapy and combination with PEG-IFN for 48 weeks in 10 patients with compensated liver cirrhosis in the MYR203 study was accompanied by a high rate of virological response (80%) and normalization of alanine aminotransferase (70%). Bulevirtide was well tolerated, there was no deterioration in tolerability compared with patients without cirrhosis, there were no serious adverse events and cases of treatment cancellation due to adverse events. CONCLUSION: Bulevirtide is recommended as the first line of treatment for chronic hepatitis D in patients with compensated cirrhosis in monotherapy and combination with PEG-IFN.

[Chronic hepatitis C in Russia: current challenges and prospects].

This paper evaluates the impact of different medical care strategies for chronic hepatitis C patients in relation to its prevalence, frequency of adverse outcomes and mortality rate.

Hospital-based surveillance of rotavirus and other viral agents of diarrhea in children and adults in Russia, 2005-2007.

During a 2-year period in 2005-2007, we conducted surveillance of group A rotaviruses and other enteric agents among patients hospitalized with acute gastroenteritis in 8 different cities of the Russian Federation. Fecal specimens were gathered from 3208 children (including 2848 children aged <5 years) and 1354 adults who were admitted to hospitals in Moscow, St. Petersburg, Chelyabinsk, Nizhnii Novgorod, Tyumen, Khabarovsk, Makhachkala, and Yakutsk. Polymerase chain reaction was performed to detect rotaviruses of groups A and C, noroviruses of genogroups I and II, astrovirus, sapovirus, and enteric adenoviruses (group F). Group A rotavirus was the most common viral pathogen detected among children aged <5 years (43.6%), followed by norovirus (12.5%), whereas norovirus was the pathogen most commonly detected in adults (11.9%). P and G genotypes were determined for 515 rotavirus specimens, and the most prevalent genotypes were G1P[8] (44.9%), G4P[8] (40.0%), G2P[4] (8.5%), and G3P[8] (6.6%). This study is the first multicenter study of rotaviruses in the Russian Federation and documents the important burden of disease caused by this pathogen, which soon may be preventable by vaccination.

[Norovirus infection in general hospitals for adults].

AIM: To determine the role of noroviruses in the rise of hospital outbreaks of acute intestinal infections (AII), to study clinical and epidemiological aspects of hospital noroviral infection. MATERIAL AND METHODS: Routine diagnostic methods and diagnostic tests on the base of polymerase chain reaction (PCR) were used for identification of group A rotaviruses, noroviruses, astroviruses, adenoviruses, salmonella, thermophilic campilobacteria, shigella, enteroinvasive echerichia (EIEC) in 70 adult patients with AII transferred from general hospital to infection hospital in 2003-2007. A part of the strains was typed with primers specific for genetic cluster G2/4. RESULTS: Routine methods failed to identify causes of hospital infection. PCR detected AII etiology in 77.8% patients. Norovirus of the second genotype (G2) was identified as monoinfection in 87.8% verified cases, in association with other agents--in 12.2%. Typed noroviruses belonged to cluster G2/4. Nosocomial norovirus infection was characterized by winter-spring occurrence and a moderate course. CONCLUSION: An essential role of noroviruses in hospital AII outbreaks in elderly patients in winter-spring is shown.

[Characteristic of the etiologic structure of acute enteric infections in adults based on the data from infectious diseases hospital].

Study of the etiologic spectrum of sporadic cases of causative agents of acute enteric infections (AEI) in 753 patients aged 15-85 years old using polymerase chain reaction (PCR) was performed in the infectious diseases hospital during 12 months. It was shown that detection of the causative agents of AEI by PCR was 2.2 times more effective than routine microbiologic diagnostics supplemented with test of feces on rotavirus by ELISA method and allowed to detect etiologic agent in 54.3% of the patients. Viral etiology of AEI was determined in 22.6% of the patients. The most significant causative agents of AEI comparable on the rate of detection with salmonella and shigella were genotype 2 noroviruses and group A rotaviruses which were isolated in 10.4 and 8.9% of the patients respectively. Seasonal change of dominating viral pathogens causing diarrheal diseases was noted: predominance of group A rotaviruses during winter-spring period, noroviruses--during spring-summer months, and astroviruses--during fall and in the beginning of winter.

[Season and age related structure of acute intestinal infections morbidity in the Russian Federation].

AIM: To study seasonal and age features of etiological structure of acute intestinal infections (AII) in the territory of the RF. MATERIAL AND METHODS: A total of 7388 AII inpatients aged from 1 day to 90 years from 7 cities (Moscow, St-Petersburg, Nizhniy Novgorod, Chelyabinsk, Tyumen, Makhachkala and Khabarovsk) of the RF participated in a trial conducted from December 2001 to September 2006 The patients were examined with diagnostic tests based on polymerase chain reaction (PCR) for detection of rotaviruses of group A (RVA), noroviruses, astroviruses, adenoviruses, salmonella, termophilic campilobacteria, shigella and enteroinvasive Escherichia coli (EIEC). RESULTS: The above agents were detected in 72% children and 52% adults. In children RVA and noroviruses occurred most frequently (29.5% and 11%, respectively). The adults carried most often salmonella (9.3%), noroviruses (8.4%), RVA (7.8%) and Schigella in combination with EIEC (7.0%). CONCLUSION: Viral agents are essential or prevailing causative agents of AII at different ages. Seasonal and age-related trends of AII morbidity are characterized.

[Acute intestinal infections of virus etiology in adults].

AIM: To describe clinical symptoms of sporadic cases of noro- and astroviral infection in adults; to compare a clinical picture and a course of rotaviral infection (R VI), noroviral infection (NVI) and astroviral infection (A VI). MATERIAL AND METHODS: Reverse transcription and polymerase chain reaction (RT-PCR) method was used to examine fecal samples from 1032 patients with acute intestinal infections (All) at the age of 15 to 90 years admitted to the infectious department of the clinic of Chelyabinsk State Medical Academy in 2004-2005. Detectability and severity of some symptoms in R VI, NVI and A VI patients were analysed and clinical manifestations of viral intestinal monoinfections were compared. RESULTS: Monoinfection was diagnosed in 230 (22.3 %)fecal samples: RVI (n = 101), NVI (n = 100), A VI (n = 29). Sporadic morbidity was the highest from March to May, March to September, October to December for R VI, NVI and A VI, respectively. Gastroenteritis syndrome was prevalent in all the infections studied. Diarrhea with marked dehydration was more typical for RVI, dyspepsia and abdominal pain--for NVI. Intoxication occurred with the same frequency in all the infections. Severe RVI ran with normal body temperature in many patients over 60 years of age. CONCLUSION: Viral diarrheal diseases are frequent in adults of all ages and run with similar clinical picture. The most serious course of the infection with most severe syndromes of gastroenteritis and dehydration was typical for RVI. Etiological nature of viral intestinal infections can be established only with laboratory diagnostic methods.