Viral hepatitis (A, B, C, D and E)

Hepatitis is an inflammatory liver disease. They are caused by a number of reasons, the main one is a viral infection. At the beginning of 2019, 8 types of hepatotropic viruses that can cause inflammation of the liver are known, but most often the "culprits" are three types: hepatitis viruses "A," "B" and "C."

Spread of the disease

In the world

2021

According to the World Hepatitis Alliance for July 2021, the hepatitis B and C virus kills 1.4 million people a year - more than HIV/AIDS and malaria. Worldwide, 90% of people living with hepatitis B and 80% of people with hepatitis C are unaware that they are infected. Many liver diseases are asymptomatic.

2020: 12.9 million people diagnosed with hepatitis C in the world

In February 2022, researchers from the International Foundation for the Center for Disease Analysis calculated the number of people infected with hepatitis C around the world. The researchers modeled the burden of hepatitis C for 110 countries and territories, most of the models were subsequently approved by local experts. The project was funded by the John C Martin Foundation, Gilead Sciences, AbbVie, ZeShan Foundation and The Hepatitis Fund. The data for 125 countries and territories were based on regional averages of indicators, and the research results themselves were published in the journal The Lancet Gastroenterology & Hepatology.

The number of people infected with hepatitis C around the world has been calculated

At the beginning of 2020, there were a total of 56.8 million infections with this virus around the world, and the prevalence of infection was 0.7%, while in 2015 the indicators were measured 63.6 million and 0.9%, respectively.

By the end of 2020, 12.9 million people with a diagnosis of hepatitis C lived in the world. During that year, about 641 thousand patients with such an infection received treatment.

Models were built for 110 countries or territories, with 83 approved by local experts and 27 based on published data alone. Using data from these models, as well as population-weighted regional averages for countries and territories with no models (n = 125), the scientists estimated the global prevalence of IGS viremic infection at 0-7% (95% UI 0-7-0-9).

This analysis includes a literature review, Delphi process, and mathematical modeling to estimate the prevalence of hepatitis C (IHC) infected individuals (viremic infection defined as RNA IHC-positive cases) and the cascade of care among individuals of all ages (age ≥0 years from birth) for the period from January 1, 2015 to December 31, 2030.

According to scientists, it will not be possible to achieve the goals for the elimination of hepatitis C by 2030, which were set by WHO. The authors believe that the new data will help to focus again on these goals after the peak of the COVID-19 pandemic.^[1]

Hepatitis mortality

As of 2020, 500-700 thousand people die annually as a result of hepatitis B infection, more than 350 thousand patients - from complications of hepatitis C.

2018-2019

Diffuse liver disease affects hundreds of millions of people worldwide, causing acute or chronic liver disease. According to the Russian Association of Ultrasound Diagnostics Specialists in Medicine (RASUDM), as of July 2018, 360 million people around the world are infected with hepatitis B, 180 million are carriers of the hepatitis C virus.

For March 2019, viral hepatitis is called one of the most common infectious diseases. According to estimates at this time, about 350 million people are infected with the hepatitis "B" virus in the world, and at least 200 million people are infected with the hepatitis "C" virus.

In Russia

2023:26% increase in hepatitis C incidence

In 2023, acute viral hepatitis C was detected in 1393 people in Russia. This is 27.5% below the multi-year average, but compared to 2022, the value increased by 26%. Such data are given in the materials of Rospotrebnadzor, published on June 1, 2024.

The document says that in 2023, acute viral hepatitis was detected as a first-time diagnosis in 5770 Russians. In the total number of about 61% of cases fell on hepatitis A, and compared to 2010, its share increased 1.3 times. Another 490 people were diagnosed with hepatitis B.

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In general, the incidence rate of acute viral hepatitis per 100 thousand population amounted to 3.93 cases in 2023. This is 43.4% more than the previous year. At the same time, the economic burden of viral hepatitis C amounted to about 65.6 billion rubles, taking into account direct and indirect costs. In four regions of Russia, the incidence of acute hepatitis C exceeded the Russian average more than twice - in the Kostroma region, the Kabardino-Balkarian Republic, St. Petersburg and the Murmansk region.

The Rospotrebnadzor report notes that the incidence of chronic hepatitis C in Russia decreased by 24.5% from 2014 to 2023. This figure in 2023 was at around 31.63 cases per 100 thousand population. In the Omsk region and St. Petersburg, the incidence of chronic hepatitis C exceeded the Russian average by two times or more.

Hepatitis causes liver lesions, including cancer. Of the five types of infectious hepatitis, the highest morbidity and mortality are associated with hepatitis B and C. According to WHO, the Russian Federation, China, Bangladesh, India, Indonesia, Nigeria, Ethiopia, Pakistan, the Philippines and Vietnam together account for almost two-thirds of the global burden of hepatitis B and C.^[2]

2022: The incidence of hepatitis in Russia has decreased by 2.9 times

In 2022, the incidence of hepatitis in Russia decreased by 2.9 times. This is stated in the report of Rospotrebnadzor, which was published in June 2023.

As noted in the department, thanks to the complex of preventive and anti-epidemic measures, the incidence rates of acute hepatitis B and C in the country in 2022 were minimal for all years of observation of levels. The incidence rate per 100 thousand population amounted to 2.74 cases, which does not exceed the average minimum indicator (NSR) (7.94 per 100 thousand population).

In 2022, the dominant position among etiological agents of enterovirus disease (EVI) was occupied by the viruses Koksaki A16 (19.86% of strains identified in patients), Koksaki A6 (19.35%), Koksaki A10 (7.75%). Nonpolyomyelitis enteroviruses of 13 types were identified in patients with computers. More often than others, YeSNO6 viruses (47.39%), Koksaki A9 (20.0%), YeSNO11 virus (7.37%) were detected in patients with computers. Thus, in 2022, the majority of representatives of the Enterovirus A species spread and intensified in Russia, which led to an increase in the incidence of exanthemic and small forms of EVI.

In 2022, the largest share in the incidence of acute viral hepatitis (OVG) is acute viral hepatitis A (GA) - 58%, since 2013 the share of which has decreased by 3.6 times (65% in 2013). Since 2013, the proportion of acute viral hepatitis B (OGV) has decreased by 4.6 times and in 2022 amounted to 11% of the total number of registered cases of OVG (15% in 2013). Since 2013, the share of acute viral hepatitis C (OGS) among OVGs has increased 1.9 times and in 2022 amounted to 27% (16% in 2013). Since 2013, the share of acute hepatitis E (HA) in 2022 amounted to 2% (1% - in 2013), the remaining 2% - other OVG (5% - in 2013).

In 2022, 2,310 cases of GA diseases were registered in Russia, the incidence rate was 1.58 per 100 thousand population, not exceeding the NSR for the period from 2010 to 2019 (4.86). The adult population dominated the age structure of the cases, and the proportion of children under the age of 17 was 43% (997 cases, 3.28 per 100 thousand population).

According to Rospotrebnadzor, the largest incidence rate in 2022 was registered in the Ryazan region (in 2022 - 18.05, 2021 - 18.40) with a 4-fold excess of the NSR. Also, a high incidence was noted in the Khanty-Mansiysk Autonomous Okrug and the Kaluga Region. In 2022, no cases of GA were registered in 12 constituent entities of the Russian Federation (in 2021 - in 9): the Republics of Kalmykia, Adygea, Ingushetia, Altai, Tuva, Kabardino-Balkaria, Karachay-Cherkessia, North Ossetia, in the Nenets and Chukotka Autonomous Districts, the city of Sevastopol and the Astrakhan Region. In the Republics of Kalmykia, Tuva, the Kabardino-Balkarian Republic, the Jewish Autonomous Region, as well as the Nenets Autonomous Okrug, a similar trend has remained since 2010.

According to Rospotrebnadzor, immunization of the population is an effective measure to prevent GA. In Russia, it is carried out within the framework of the calendar of preventive vaccinations for epidemic indications in risk groups, as well as in certain regions of the country among the child population within the framework of regional programs with the use of preventive vaccinations. In 2022, 431,283 people were vaccinated in the state as a whole, including 165,932 children under the age of 17. The largest number of vaccinated is noted in the city of Moscow (155,295), the Sverdlovsk region (39,937), the Novosibirsk region (18,537), the Omsk region (17,591), the Republic of Crimea (15,799).

According to the chief state sanitary doctor of Russia Anna Popova, sanitary and hygienic measures aimed at providing the population in the Russian Federation with benign water, epidemiologically safe food are important in the prevention of hepatitis. Along with a decrease in the incidence of acute forms of hepatitis B and C, high levels of new cases of chronic forms of viral hepatitis continue to be recorded in the country. Considering that the activity of the epidemic process of viral hepatitis is mainly due to chronic forms of infection, to predict the epidemiological situation, to develop effective programs for the prevention of viral hepatitis, it is necessary to take into account all persons with chronic hepatitis B and C, including combined forms. In this regard, the urgent task is to enter the necessary data into the unified register of persons with viral hepatitis throughout Russia.^[3]

2020:17 thousand people a year die from the consequences of hepatitis C

In 2020, the incidence of hepatitis C in Russia was 31 cases per 100 thousand people against 41 cases per 100 thousand in 2019. And in 2020, the detected incidence almost halved from 45 thousand new cases in 2019, the chief freelance specialist in infectious diseases of the Ministry of Health RFVladimir Chulanov said in July 2021.

According to him, a significant decrease in new cases of hepatitis C in 2020 occurred largely because all medicine was mobilized to fight the COVID-19 coronavirus pandemic - "we, unfortunately, were not up to hepatitis C, we were dealing with a completely different problem."

Vladimir Chulanov: The incidence of hepatitis C in Russia by the end of 2020 has halved

Chulanov noted that, according to experts, about 5.7 million people in Russia can be infected with the hepatitis C virus. About 20% of this number of cases recover without treatment, but in most hepatitis goes into chronic form.

The representative of the Ministry of Health also said that peak incidence of hepatitis C is observed among the most active part of the population aged 30 to 50 years. At the same time, there is a tendency to reduce the registration of new cases in the age group from 20 to 29 years and an increase in the group from 40 to 49 years.

The older the age of the patient, the higher the risk of an unfavorable outcome, the infectious disease specialist emphasized.

He added that it is "wrong to think" that hepatitis C is a disease of "some kind of asocial groups and phenomena," therefore, in order to achieve elimination (reduction), it is necessary to introduce effective prevention and detection measures, increase access to testing, and timely assistance. In Russia, about 17 thousand people die every year from the consequences of hepatitis C. At the same time, the country has all the necessary modern means to treat this disease and "there is an opportunity to save a large number of people," Vladimir Chulanov emphasized.^[4]

2019: About 4 million people infected with type "B" and "C" viruses

As of March 2019, there are about 4 million patients infected with B and C viruses in Russia. However, given the incomplete registration of non-gelatinous cases of acute hepatitis and the huge number of asymptomatic carriers of viruses, it can be assumed that the real number of infected is much higher. A significant part of patients have a combined (mixed) infection, i.e. due to several hepatitis viruses at once. The disease is often called an "affectionate killer."

In Russia, in 2019, chronic hepatitis C was detected in 45.4 thousand people, and in general, 82 thousand people fell ill with viral hepatitis.

How hepatitis infections are transmitted

While the clinical presentation of the various hepatitis has many similarities, the transmission pathways and outcomes of these infections differ significantly. So, hepatitis "A" is the only one of this "trinity" transmitted fecally-orally, when eating food or water that contains the virus.

Hepatitis "B" and "C" have the so-called parenteral transmission route, that is, they are transmitted from the patient to the healthy when transfusing blood or its components.

Viral hepatitis "C," according to hepatologists from the clinic of OJSC "Medicine," can reasonably be called "hepatitis of drug addicts." One in two patients with HCV infection refers to those who have been given intravenous drugs.

You can also get infected in dentistry, during manicures, pedicures, tattoos, cosmetic tattoos and piercings, injections of rejuvenating agents, if non-sterile tools are used. The virus can be transmitted through the use of psychoactive substances, rarely as a result of unprotected sexual contact. In 7-8% of cases, hepatitis C is transmitted from the mother to the newborn.

How the disease proceeds

Viral hepatitis "A": Dirty hands disease

Infection occurs through dishes, household items, etc., with which the sick person contacted. That is, hepatitis "A" is a typical "dirty hand disease." The second most common route of infection is eating infected food or water. This pathway is more relevant for countries with low living standards and population hygiene. Most often, vegetables, fruits, mollusks, crustaceans, food ice are infected.

The incubation period for hepatitis "A" (that is, the time from the virus entering the human body to the onset of symptoms) is from 7 to 50 days, more often 15-30 days. The main symptoms of the disease are:

• weakness,
• fever,
• loss or decreased appetite,
• abdominal pain,
• joint pain,
• nausea,
• vomiting,
• darkening of urine,
• jaundice of the skin.

In addition, the infection can proceed in a slightly symptomatic or asymptomatic form. The total duration of the disease is up to 2 months, in rare cases - up to 6 months. The course of viral hepatitis "A" is usually favorable, most cases do not require inpatient treatment and end with recovery with the formation of persistent immunity.

If you find out that you have been in contact with a patient with viral hepatitis "A," the best solution is to see a doctor. If you do this within two weeks after contact with the source of infection, you can carry out the so-called emergency prevention of infection using a specific immunoglobulin or hepatitis "A" vaccine. But the best solution is to get vaccinated against hepatitis "A" as planned, especially if you are going on a tourist trip. Vaccination against hepatitis "A" is safe and effective and consists in twice administration of the vaccine with an interval of 6 months. Vaccination is recommended for children over 1 year old, people planning a trip to countries with a high incidence of hepatitis "A," patients with chronic viral hepatitis "B" or "C." Immunity after vaccination develops on average after 2 weeks.

Viral hepatitis "B"

The virus is transmitted in a "blood-contact" way. The amount of blood with a high concentration of the virus, sufficient for infection, is negligible and amounts to 0.0001 ml, therefore viral hepatitis "B" is considered an infection 50-100 times more contagious than HIV infection. Infection can occur when a person is transfused with infected blood (or its components and drugs). Viruses can penetrate the body through damaged skin and mucous membranes when tattooing, using other people's razor and nail accessories, toothbrushes and other personal hygiene items, during medical and diagnostic manipulations (injections, operations, endoscopic procedures), as well as during sexual contacts (especially homosexual). In 18% of patients with acute viral hepatitis "B" transmission of infection occurs to permanent sexual partners. Partners of patients with chronic viral hepatitis "B" are infected much more often.

The so-called vertical transmission route is possible - from an infected mother to the fetus (more often during childbirth). The risk of infection with hepatitis viruses in intravenous drug users is extremely high. In order to "acquire" the virus, often only one injection is enough. Moreover, as a rule, drug addicts are infected not with one, but with several hepatitis viruses at once.

The source of infection is patients with both manifest and asymptomatic forms of acute and chronic viral hepatitis "B." A patient with the manifest form of acute hepatitis "B" can be infected as early as 2-8 weeks before the appearance of signs of the disease. In most of these patients, the reproduction of the virus in the blood stops with the onset of clinical recovery, but in some of the infected, the pathogen may be present for several years. The greatest epidemic danger is posed by patients with asymptomatic viral hepatitis "B."

Viral hepatitis "B" is one of the most dangerous occupational infections for employees of medical institutions, as well as for those employees who, by the nature of their professional activities, have contact with blood or other infected body fluids. The incidence of viral hepatitis "B" of medical workers is 3-5 times higher than the incidence rates of the adult population.

There is no specific treatment for acute viral hepatitis "B." Patients are usually prescribed dietary nutrition, bed rest, infusion (a method of treatment based on the introduction of various solutions of a certain volume and concentration into the bloodstream) and detoxification therapy are carried out.

The main way to prevent the incidence of hepatitis "B" is vaccination. The current vaccines are effective and safe. The hepatitis "B" vaccine is given three times, the interval between the first two injections is a month, the third injection is made 5 months after the second.

Viral hepatitis "C": the main cause of cirrhosis and liver cancer in prosperous countries

Hepatitis C is an inflammation in the liver tissue caused by the hepatitis C virus (HCV), which is accompanied by the death of its cells and the replacement of their connective (scar) tissue.

This disease stands apart in a number of forms of viral hepatitis. The peculiarity and uniqueness is determined by its pathogen - RNA-containing virus. This is a kind of "many-faced Janus." At the beginning of 2019, at least six of its main varieties (genotypes) are distinguished, which in turn are divided into subtypes.

Hepatitis "C" has a predominantly chronic course. Official statistics indicate the possible detection of chronic hepatitis "C" in at least 250-300 million people in the world. It is the leading cause of cirrhosis and liver cancer in economically developed countries.

With hepatitis "C," the rapid release of hepatic cells - hepatocytes from the pathogen does not occur, which is due to the peculiarities of the reaction to it of the immune system of the sick person. The main mechanism of the "escape" of the virus from immune surveillance is the high level of its replication (reproduction) and the very pronounced variability of the pathogen. This variability is achieved by continuously updating its structure, its antigenic structure, to which the immune system of an infected person does not have time to adapt. As a result of this silent but dramatic struggle, particularly variable, so-called hypervariable strains survive. They become predominant and support the active reproduction of viruses. At the same time, the rate of mutations (changes in the structure) of viruses exceeds the rate of their replication, which determines the perennial course inherent in hepatitis "C." For the same reason - the large number of genotypes and the variability of the virus - so far it has not been possible to develop a vaccine against hepatitis "C."

Acute hepatitis "C" has an incubation period of 20 to 150 days, on average - 40-50 days. The mechanism of infection is parenteral (i.e., when infected blood or its drugs - plasma, serum, etc. - enter the blood of a healthy person). At the same time, the infecting dose for the hepatitis "C" virus is several times higher than for the hepatitis "B" virus. Unlike the causative agent of viral hepatitis "B," the natural routes of spread of hepatitis "C" are of less importance: the risk of infection in everyday life, during sexual contacts and at the birth of a child from an infected mother is relatively low.

The problem with the diagnosis of acute hepatitis "C" is that as such, the acute stage of this infection is often very difficult to recognize. After all, gelatinous, low-symptom or completely asymptomatic forms prevail with it. Patients note weakness, lethargy, rapid fatigue, deterioration of appetite, sometimes a feeling of heaviness in the right hypochondrium. For the most part, complaints are not expressed sharply.

Due to the non-specificity and weak severity of most symptoms, many patients are unaware of their diagnosis and learn about it by chance during routine examinations or in the late stages of the disease.

In the jaundice period, signs of general intoxication are insignificant. The manifestations of jaundice, as a rule, are minimal (more often light yellowing of the sclera and mucous membranes of the palate, light staining of the skin), mild liver enlargement may be detected. Acute liver failure in hepatitis "C" rarely develops.

Unfortunately, at the beginning of 2019, there is no vaccine against hepatitis "C." But in terms of treatment, significant progress has been made here in recent years. With the advent of drugs such as ribavirin and interferons on the medical market, the results of treatment of both acute and chronic forms of viral hepatitis "C" have improved significantly. Active work is underway to create drugs of new classes for the treatment of chronic hepatitis "B" and "C," which will make this treatment even more effective.

Federal Register of Persons with Viral Hepatitis

Main article: Federal Register of Persons with Viral Hepatitis

Diagnostics

Hepatitis "A" always proceeds as an acute infection and does not go into chronic form. But about 10-15% of acute viral hepatitis "B" and more than 70% of acute viral hepatitis "C" as a result take a chronic course.

In the initial stages, chronic viral hepatitis can be almost asymptomatic. So, as of July 2018, 300 million people around the world infected with viral hepatitis are not aware of their diagnosis. Doctors emphasize the importance of timely diagnosis to prevent complications and spread of liver disease.

2022: A way to detect latent viral hepatitis B has been developed

In April 2022, scientists from the St. Petersburg Research Institute of Epidemiology and Microbiology named after Pasteur announced the creation of a new method for detecting latent hepatitis B. The method is based on a two-stage polymerase chain reaction (PCR) with detection from three targets in real time and allows detecting virus DNA in a latent form of chronic viral hepatitis B. More details here.

2018: Shear wave ultrasound elastography

Shear wave ultrasound elastography is a relatively new diagnostic method for 2018, which allows for an accurate, non-invasive and painless assessment of diffuse liver diseases in the early stages. The study takes no more than 20 minutes, does not require complex special training and allows you to obtain accurate results in real time. With this method, doctors can diagnose liver pathologies in time and prescribe the necessary therapy in a timely manner.

"Thanks to ultrasound elastography in Europe, specialists practically do not puncture the liver, since doctors have at their disposal an accurate and, most importantly, non-invasive research method," comments Mitkov Vladimir Vyacheslavovich, MD, professor, president of RASUDM. - In Russia, this technology is still not widely used, but I hope that soon such a study will be available to everyone. I am sure that the future of medicine is behind ultrasound elastography, since this method allows you to identify the disease as soon as possible even at an early stage. "

2021: World's first combined HIV, hepatitis and syphilis tests launched in Russia

At the end of April 2021, the production of the world's first combined test for four infections began in Russia: HIV, hepatitis B and C and syphilis. Test systems called "Multiskrin" are produced by the company "Biopalitra," which is a resident of the special economic zone "St. Petersburg." Read more here.

Federal Register of Patients with Viral Hepatitis

Main article: Federal Register of Patients with Viral Hepatitis

Mutation studies

• Abbott International Program to Monitor and Identify New HIV and Hepatitis B Mutations

History

2024: A fedproject to combat hepatitis C is being launched in Russia. Basic provisions

On August 8, 2024, it became known that the implementation of a new federal project to combat hepatitis C, which will become part of the national project "Long and Active Life," is beginning in Russia. The main goal of the initiative is to significantly reduce the number of cases of chronic viral hepatitis C (HGS) by 2030. Read more [[Long and active life (national project)|here]]

2022

Only 4% of Russians with hepatitis C received therapy

In 2022, only about 4% of patients registered and 1% of the estimated number of people living with chronic hepatitis C in Russia received treatment. Such data from the Zdravresurs expert group, based on materials from the public procurement website, were released at the end of July 2023.

According to experts quoted by the Kommersant newspaper, the number of patients with viral hepatitis C (HCV) who could receive the necessary medicines free of charge according to federal and regional budgets amounted to 26.3 thousand people in 2022. By that time, there were no large-scale purchases of drugs to combat hepatitis C at the federal level. The regions independently announced tenders based on their programs and budgetary opportunities.

Researchers find 4% of people with hepatitis C received therapy in 2022

It is noted that in 2022, 8.3 billion rubles were spent on the purchase of drugs, which is 13% less than a year earlier. This decrease is primarily due to a decrease in the volume of regional purchases. About 14% of the total amount of funds spent fell on Moscow, the second place is occupied by St. Petersburg with 6%.

The representative of the expert group Natalya Egorova expressed concern that in 2023 the budget for drugs for the treatment of HCV in people with HIV decreased significantly - to less than 900 million rubles, which led to a decrease in treatment coverage by almost 30%.

Yuri Zhulev, co-chairman of the All-Russian Union of Patients, who survived hepatitis C, stressed that the effectiveness of modern antivirus therapy reaches 98%. However, he noted that at present, measures for the treatment of only severe cases prevail, while prevention is not given due attention. He called for strengthening measures to combat the disease, which will increase the volume of treatment and reduce the number of patients.^[5]

The first vaccine for the prevention of hepatitis B was registered in Russia

In mid-August 2022, the first vaccine for the prevention of hepatitis B was registered in Russia. We are talking about the drug Sai-Bi-Vac, the distributor of which in the Russian Federation is Pharmsintez (its main shareholder is Rusnano). Read more here.

Hospital in Amur region will pay millions of children infected with hepatitis

The Amur Regional Children's Clinical Hospital will pay a total of more than 7 million rubles due to infection of children with hepatitis C in this institution. The corresponding decision was made on February 18, 2022 by a court in Blagoveshchensk. Read more here.

2021

Purchases of drugs for the treatment of hepatitis C in Russia increased 1.5 times

In 2021, state purchases of drugs for the treatment of viral hepatitis C (HCV) made it possible to provide 28,500 patients in Russia with medicines free of charge, which is 1.5 times more than a year earlier (19,000). This is stated in the report of the project "Coalition for Readiness for Treatment," prepared for the World Hepatitis Day (excerpts from it are cited by Vedomosti).

The authors of the study during it processed the data of 1020 auctions for the purchase of drugs for the treatment of HCV, which were held from December 1, 2020 to November 30, 2021.

Purchases of drugs for the treatment of hepatitis C increased 1.5 times

According to the patient organization, 28.5 thousand patients who received therapy are a maximum of 1% of the total estimated number of patients with chronic hepatitis C living in Russia. There are at least 2.7 million of them by mid-July 2022.

In 2021, clinical recommendations from 2018 were in effect, however, purchases of that period showed that treatment programs were more in line with international recommendations: 98% of all schemes used in 2021 are non-integron, of which 64% are pan-genotype schemes and 33% are non-integron schemes for genotypes 1 and 4, only 2% using interferon.

In the structure of pangenotype schemes, the most popular in 2021 were glecaprevir/pibrentasvir (40% of all pangenotype) and sofosbuvir and daclatasvir (39%). Sofosbuvir/velpatasvir accounted for 20% of all courses among pangenotype.

The cost of hepatitis C treatment in 2021 was about 300-400 thousand rubles. per course, depending on the treatment regimen. Treatment with pan-genotype schemes averages about 400 thousand rubles. regardless of the scheme.

At the end of 2021, the clinical guidelines of the Ministry of Health for the treatment of viral hepatitis C were updated, according to which patients need to be prescribed oral regimens, including pangenotype. We are talking about combinations sofosbuvir + daclatasvir, sofosbuvir/velpatasvir and glecaprevir/pibrentasvir. The recommendations meet the latest international standards for the management of patients with chronic hepatitis C.^[6] of^[7]

Less than 0.5% of patients receive free therapy for hepatitis C in Russia

By the end of 2020, less than 0.5% of patients received free therapy for hepatitis C in Russia. Such data in early August 2021 were published by experts from the Coalition for Readiness for Treatment (ITPCru) based on the results of monitoring public procurement of drugs for the treatment of this disease.

According to the report, excerpts from which RBC cites, in 2020, coverage with hepatitis C therapy in Russia amounted to more than 20.3 thousand people, which is 28% more than a year earlier, but the total coverage with treatment remains at a low level.

In total, 7.3 billion rubles were spent on the purchase of drugs for hepatitis C in 2020. Almost the entire amount (96%) purchased direct-acting antivirals, which is 12% more than in 2019. At the same time, 51% more patients were provided with therapy, which includes only direct-acting antiviral drugs, in 2020, this was due to a decrease in drug prices.

In the Russian Federation, less than 0.5% of patients receive free therapy for hepatitis C

Data on how many people in Russia carry hepatitis C vary: from 2.3 million people, according to a certificate on the implementation of a program to completely eliminate (eradicate) hepatitis C in Russia, to 4.5 million, according to the chief freelance specialist in infectious diseases of the Ministry of Health Vladimir Chulanov. About 17 thousand Russians die from this disease every year.

The volume of purchases of pegylated interferon, which is also used to treat hepatitis C, has significantly decreased both at the regional and federal levels. Experts note that in 2020, almost all therapy regimens used were based on modern antiviral drugs. Pegylated interferon therapy, as Egorova explains, has a number of disadvantages: duration of treatment (up to a year), neurological side effects, etc.^[8]

Creation of a technology for the treatment of chronic hepatitis B in the Russian Federation

July 21, 2021 it became known about the creation Russia in a unique. About chronic hepatitis B treatment technologies his achievement told in. National Medical Research Center for Phthisiopulmonology and Infectious Diseases Ministry of Health More details. here

2020: Nobel Prize in Medicine awarded for the discovery of the hepatitis C virus

On October 5, 2020, the Nobel Prize in Medicine and Physiology was awarded for the discovery of the hepatitis C virus. Scientists Michael Houghton, Harvey Alter and Charles Rice received it. Read more here.

Notes