It Is Always Not Easy To Choose Who Should Receive Treatment First And Who Should Wait

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It Is Always Not Easy To Choose Who Should Receive Treatment First And Who Should Wait
It Is Always Not Easy To Choose Who Should Receive Treatment First And Who Should Wait

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It is always not easy to choose who should receive treatment first and who should wait

With the advent of modern antiviral drugs, hepatitis C is officially recognized as a curable disease. Nevertheless, in Russia, in conditions of a lack of funding, it continues to claim many lives. Including children infected in medical facilities. This was discussed at a press conference dedicated to the new possibilities of interferon-free therapy for hepatitis C in adolescents.

"It is always not easy to choose who should receive treatment first and who should wait"
"It is always not easy to choose who should receive treatment first and who should wait"

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With the advent of modern antiviral drugs, hepatitis C is officially recognized as a curable disease. Nevertheless, in Russia, he continues to claim many lives. In conditions of a lack of funding, treatment is received mainly by patients with liver cirrhosis. But there are other groups of difficult patients - for example, children and adolescents, infected, including in medical facilities. This was discussed at a press conference dedicated to the new possibilities of interferon-free therapy for hepatitis C in adolescents.

Most vulnerable

In the world, about 13.2 million children aged 1-15 years are sick with chronic viral hepatitis C. In Russia, hepatitis C is much more common among children and adolescents than in Europe and the United States. According to the Reference Center for Monitoring Viral Hepatitis, in our country, almost 17 thousand children under the age of 17 are infected with hepatitis C.

Most often, Russian children are infected with hepatitis C in medical institutions and from mothers. For adolescents, as well as for adults, such risk factors as piercing and tattooing, manicure and pedicure are added if, during these manipulations, insufficiently sterilized instruments or non-sterile paint (for tattoos) are used.

“Hepatitis C is widespread everywhere,” said Tatyana Strokova, head of the department of pediatric gastroenterology, hepatology and dietetics of the Federal Research Center for Nutrition and Biotechnology, Doctor of Medical Sciences, Professor of the Russian Academy of Sciences. "In recent years, the number of patients infected from mothers with chronic hepatitis C has increased significantly. In general, the disease is characterized by slow progression and the formation of formidable extrahepatic manifestations of the disease, which worsens the prognosis and quality of life of patients."

All this requires timely diagnosis and the appointment of antiviral therapy, the expert emphasized. Only this will reduce the risk of disease progression, including the development of cirrhosis and liver cancer, as well as extrahepatic manifestations (endocrine, cardiovascular, autoimmune and oncological diseases). “Due to the increase in the period of infection, these complications can appear already at a young age. In this regard, it is necessary to introduce, within the framework of clinical examination of children, examination for markers of viral hepatitis C, and, if necessary, carry out PCR diagnostics to determine indications for antiviral therapy,”says Professor Strokova.

End of the era of interferons

The problem of hepatitis C treatment in children and adolescents remained unresolved for the longest time. At a time when the number of modern, effective and safe options for the treatment of chronic hepatitis in adults was constantly expanding, pediatric specialists could only use interferon therapy regimens. In some cases, they saved children's lives when the disease began to actively develop. But they were prescribed with caution and only in cases of deterioration, and they did not always help. In 2019, the situation in Russia has changed. Effective and safe treatment for chronic hepatitis C is now also available to adolescents aged 12 and older.

“The emergence of an opportunity to stop the spread of a socially significant infection that leads to chronic diseases and imposes a serious burden on the health care system is a good chance to make a significant contribution to the protection of the health of children and adolescents,” stressed the chief freelance pediatrician of the Moscow region, MD. Niso Odinaeva ". There are a number of problems, for example, the lack of DRGs for children, difficulties with diagnosis and routing, but all of them can be solved, the expert believes. A program for the prevention and treatment of viral hepatitis in children and the creation of a children's hepatological center are currently being discussed in the Moscow Region. “It takes some time to implement a new approach to treatment.However, the end of the era of interferons with severe side effects and low efficiency, and the beginning of the interferon-free era of hepatitis C treatment in adolescents, allow us to be convinced of the reality of the WHO goal of eliminating viral hepatitis,”said Professor Odinaeva.

Residence discrimination

The Ministry of Health also admits the problem - recently the department announced plans to develop a draft federal law "On the prevention of the spread of viral hepatitis." However, as is often the case, the main problem is related to funding. “In a situation where medicine is able to cure every patient with chronic viral hepatitis C, the lack of a long-term strategy and program for hepatitis treatment in the region looks like a neglect of the needs of the region's residents,” said Nikita Kovalenko, Chairman of the Board of Together Against Hepatitis.

However, this is the case. In Russia, drugs are registered that quickly deal with this infection, but the regions in which modern treatment is available to patients can be counted on one hand. Mednews talked about the experience of the Oryol region, where the proportion of patients covered by treatment at the expense of the region is approaching 100%. In other regions, it is difficult to achieve treatment of 50-200 patients per year, and these are even better examples.

Even in Moscow, where there is a large-scale program to combat viral hepatitis, it is necessary to choose whom to provide first of all assistance. “It is very important that every Moscow resident with chronic viral hepatitis is referred to our center and undergoes a full examination. Our task is to prioritize who should be prescribed therapy in the first place, and to choose the right treatment regimen so that we can treat as many patients as possible. Every year, more and more patients receive hepatitis C therapy within the framework of regional and state programs: in 2016, 1,900 people were treated, in 2017 - already 2,676, and in 2018 - 3,695 patients,”said the head of the Center's day hospital at a press conference. for the treatment of chronic viral hepatitis of the Moscow Infectious Clinical Hospital No. 1, Ph.D. Marina Rusanova.

Hard choice

The task of choosing whom to provide first of all to help, when funds for the treatment of all those in need are not enough, is incredibly difficult. Including from an ethical point of view. But Russian doctors have to solve it somehow

“It is always not easy to choose those who will receive treatment first and who should wait,” said Yuri Zhulev, co-chairman of the All-Russian Union of Patient Organizations, President of the All-Russian Hemophilia Society. - At one time, when there was a question about who, first of all, to provide with blood clotting factors, we chose children. And thanks to this, a generation of people with hemophilia has grown up without those severe complications that we faced. So it is with hepatitis C. First of all, we must raise a healthy generation. It is also important to think about the people who are most harmed by the infection. Among them, patients with an advanced stage of the disease, as well as those in whom the hepatitis C virus strongly worsens the prognosis for an underlying chronic disease. These are patients with hemophilia, chronic kidney disease, HIV and other diseases."

In Russia, about 70 thousand new patients with chronic viral hepatitis are registered annually. Most of them (52-55 thousand) are hepatitis C, the rest is added by chronic hepatitis B. (Hepatitis A, or Botkin's disease, is transmitted through water and food, is acute and never becomes chronic). The true number of patients chronically infected with hepatitis viruses is unknown. According to estimates from the Central Research Institute of Epidemiology of Rospotrebnadzor, it can reach 7.5 million people. Today, there is an international global plan for the elimination of chronic viral hepatitis as a socially significant problem, which Russia, together with other WHO member states, signed in May 2016.However, so far in our country there is no uniform approach to the prevention and treatment of hepatitis at the national level - each region is fighting hepatitis in its own way, but even more often invites patients to do it on their own.

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