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Perceptions of hepatitis E have transformed over the past decade. This infection was common only in some developing countries. It is known now that hepatitis E occurs in most high - income countries and is largely a zoonotic infection. The review analyzes the relevant key publications and recommendations on the diagnosis and treatment of hepatitis E. Theproblems of diagnosis, treatment and prevention of hepatitis E caused by genotypes 3 and 4 are highlighted. It is shown that with symptoms of acute hepatitis for hepatitis E virus infection (HEV) it is advisable to test not only travelers returning from areas endemic for 1 or 2 genotypes (Asia, Africa, Mexico) and pregnant women, but also all patients, after excluding other reasons for changing liver tests. Testing for HEV is also recommended for patients with chronic liver disease with unexplained deterioration, for patients with immunosuppression and changes of liver tests, for patients with systemic manifestations of diseases of the nervous system. A combination of serological testing and nucleic acid amplification methods are recommended for the diagnosis of HEV infection. Treatment of HEV infection includes the use of antiviral therapy in severe cases; if possible, for patients who underwent transplantation of solid organs - a reduction in doses of immunosuppressive drugs for pregnant women - intensive therapy. Prevention of HEV infection is aimed at people with chronic liver diseases and receiving immunosuppressive therapy who should be excluded from the use of mollusks and poorly fried pig, boar and deer meat.

Background. Despite the progress made in the treatment of chronic hepatitis C (CHC), there remain many unsolved problems in the treatment of patients infected with the 3rd virus genotype. This fact is mainly associated with the presence of hepatocyte steatosis due to the formation of local insulin resistance. Another important medical and social problem is polycystic ovary syndrome (PCOS), patogenetically associated with insulin resistance. Application of metformin in females to reduce insulin resistance can improve the results of antiviral therapy.Material and methods. Overall 81 females with CHC and PCOS were included in original study. The 1st group (35 patients) received metformin in dose of 20 mg/kg of body weight per day as preliminary and concomitant treatment in addition to antiviral therapy. In 14 patients of this group steatosis was revealed. In another subgroup (21 patients) steatosis was not revealed. The 2nd group (46 patients) received antiviral therapy only. Patients of this group were divided into two subgroups by presence (17 patients) or absence (29 patients) of hepatic steatosis. Interferon-α2b in a standard dose of 3 million IU3 times per week in combination to ribavirin 13 mg/kg/day for 24 wks was applied as antiviral therapy. The period of the subsequent follow-up was 24 wks.Results. Patients with hepatic steatosis had higher biochemical and histological scores of activities. In the groups of patients receiving metformin a higher incidence of a sustained virological response was observed. Additional application of metformin did not aff ect the safety profile of antiviral therapy.Conclusions. Women with CHC with the 3rd genotype and PCOS, who took metformin, had a significantly higher frequency of sustained virological response with an equal safety profile.

Цель. Оценить отдаленные результаты противовирусной терапии (ПВТ) омбитасвиром/паритапревиром/ ритонавиром и дасабувиром у больных субкомпенсированным циррозом печени (ЦП) в исходе хронического гепатита С (ХГС). Материалы и методы. В ретроспективный анализ включены данные пациентов с субкомпенсированным ЦП (7-9 баллов по шкале Чайлда-Пью) в исходе ХГС (генотип 1b), получавших безынтерфероновую ПВТ омбитасвиром/паритапревиром/ритонавиром и дасабувиром в течение 12 недель с сентября по декабрь 2015 г. Всего терапию получили 66 пациентов (27 мужчин и 39 женщин), медиана возраста больных составила 56,4 года. Результаты. После завершения ПВТ оценены отдаленные результаты через 147 недель (IQR-Интерквартильный размах (ИКР) 56-156); наблюдению на этот момент были доступны 27 пациентов. Оценка степени компенсации функции печени по шкале Чайлда-Пью показала улучшение у 25-ти (93 %) пациентов. При оценке лабораторных данных выявлено снижение медианы общего билирубина на 13,6 мкмоль/л, а также повышение медианы сывороточного альбумина на 9,7 г/л и медианы тромбоцитов на 41,7 тыс/мкл. Известно о двух летальных исходах вследствие гепатоцеллюлярного рака (ГЦР) и кровотечения из варикозных вен пищевода. ГЦР был выявлен у 8-ми пациентов. Двум пациентам выполнена трансплантация печени. Заключение. ПВТ у больных ЦП в исходе ХГС сопряжена с высокой частотой достижения устойчивого вирусологического ответа. Результаты длительного наблюдения указывают на значительное улучшение функции печени у большинства из них, но также на сохраняющийся высокий риск развития осложнений основного заболевания, в первую очередь ГЦР. Ключевые слова: хронический гепатит С, цирроз печени, лечение, отдаленные результаты Конфликт интересов: авторы заявляют об отсутствии конфликта интересов.