Intravenous drug use rates and results of direct-acting antiviral treatment in prisoner patients

Intravenous drug use (IVDU) is more common inprisoner patients, and this is a global problem. Hepatitis C virus(HCV) infection is higher in prisoners than general population. Inour study, we aimed to examine the IVDU rates and direct-actingantiviral (DAA) treatment results of the prisoners who applied toHatay Mustafa Kemal University Clinic of Infectious Diseases.Materials and Methods: In our study, IVDU rates and HCVtreatment results of 85 prisoners who applied to Hatay MustafaKemal University Faculty of Medicine Clinic of Infectious Diseasesbetween January 2017 and December 2019 were retrospectivelyanalyzed. Treatment results were evaluated by performing modifiedintention to tract (mITT) and per protocol (PP) efficacy analysis,respectively.Results: The rate of IVDU was 37.7% in prisoners who werepositive for HCV. Although sustained virological response (SVR) ratewas 100% in PP analysis, SVR rate was determined as 80.5% inmITT analysis. Viral genotype 3 (41.6%) and genotype 4 (39%) werethe most common.Conclusion: However, data on HCV screening and treatment inprisons in Turkey is inadequate or too low. We think that with theuse of DAAs, patients’ compliance to treatment will increase, it is animportant step for HCV eradication and multicenter studies shouldbe conducted.Mahkum hastalarda intravenöz ilaç kullanımı (IVDU) sıklığı ve hepatit C virüs (HCV) enfeksiyonu prevelansı küresel olarak genel popülasyona göre daha yüksektir. Bu çalışmada Hatay Mustafa Kemal Üniversitesi Enfeksiyon Hastalıkları Kliniği’ne başvurup sağlık hizmeti alan mahkum hastalardaki IVDU oranlarının ve direkt etkili antiviral (DEA) tedavi sonuçlarının incelenmesi amaçlandı. Gereç ve Yöntemler: Çalışmamızda Ocak 2017- Aralık 2019 yılları arasında Hatay Mustafa Kemal Üniversitesi Tıp Fakültesi Hastanesi Enfeksiyon Hastalıkları Kliniği’ne başvurup sağlık hizmeti alan toplam 85 mahkum hastanın IVDU oranları ve DEA tedavi sonuçları retrospektif olarak incelendi. Sırasıyla modifiye intention to tract (mITT) ve per protocol (PP) ile etkinlik analizi yapılarak tedavi sonuçları değerlendirildi. Bulgular: HCV pozitif mahkum hastalarda intravenöz ilaç kullanım oranı %37,7 idi. PP analizinde kalıcı virolojik yanıt (KVY) %100 iken mITT analizinde bu oran %80,5 olarak saptandı. En sık viral genotip 3 (%41,6) ve genotip 4 (%39,0) saptandı. Sonuç: Cezaevlerinde HCV taranması ve tedavisi açısından Türkiye’de yeterli veri yok veya çok azdır. DEA’ların kullanılması ile hastaların tedaviye uyumunun artacağını, HCV eradikasyonu için önemli bir adım olduğunu ve çok merkezli çalışmalar yapılması gerektiğini düşünmekteyiz

Hıv pozitif olgularda viral hepatit ve sifiliz koinfeksiyonu seroprevalansının irdelenmesi

HIV pozitif olgularda beklenen yaşam süresinin uzaması ile viral hepatit ve sifiliz gibi cinsel yolla bulaşan infeksiyonların önemigörece artmıştır. Bu çalışma ile kliniğimizde izlenmiş olan HIV pozitif olgularda viral hepatit ve sifiliz koinfeksiyonu seroprevalansınınirdelenmesi amaçlanmıştır.Materyal ve Metod: Bu retrospektif, kesitsel, tek merkez çalışmaya kliniğimizde Ocak 2018-Kasım 2019 tarihleri arasında izlenmişolan HIV ile infekte 98 olgu dahil edildi. Olgulara ait demografik verilere, fizik muayene bulgularına, CD4 T lenfosit sayısı, HCV RNA,HBsAg, anti-HBc IgG, anti-HBs, anti-HCV, anti-HAV IgG, RPR ve TPHA test sonuçlarına hasta dosyalarından retrospektif olarak ulaşıldı.Bulgular: Olguların ortanca yaşı 33.5 (24-44) yıl olup 73’ü (%74.5) erkek, 13’ü (%13.3) yabancı uyruklu, 69’u (%70.4) tedavi naif,20’si (%20.4) erkeklerle seks yapan erkek (ESE) ve 5’i (%5.1) IV ilaç bağımlılığı öyküsü olan olgulardan oluşmaktaydı. En sık (%75.5)olası bulaş yolu heteroseksüel ilişki, medyan CD4 T lenfosit sayısı ise 249.5 hücre/mm3 (145-358) idi. Olguların 15’inde (%15.3) enaz bir koinfeksiyon mevcuttu. En sık görülen koinfeksiyonlar HIV/sifiliz ve HIV/HBV koinfeksiyonlarıydı [sırasıyla %13.3 (n= 13) ve %4.0(n= 4)]. Sadece bir olguda HIV/HBV/sifiliz koinfeksiyonu tespit edilmiş, ancak HIV/HCV koinfeksiyonuna rastlanmamıştır. Etkin HBV aşılanma oranı %26.5, geçirilmiş HBV infeksiyonu %14.3, izole anti-HBc sıklığı %3.9 olarak bulundu. Viral hepatit veya sifiliz ile koiinfekteolgular sadece HIV ile infekte olgulara oranla daha yaşlıydı ancak gruplar arasında cinsiyet, antiretroviral tedavi (ART) deneyimi, CD4T lenfosit sayısı açısından anlamlı fark olmadığı görüldü (sırasıyla p= 0.013, p= 0.106, p= 0.542 ve p= 0.421). TPHA ve anti-HAV IgGseropozitifliği, ESE olgularında ESE olmayan olgulara göre anlamlı oranda daha yüksekti (sırasıyla, p< 0.001 ve p= 0.035).Sonuç: Kliniğimizde takip edilmekte olan HIV pozitif olgularda HBV, HCV ve HAV seroprevalansı genel popülasyondaki oranlara benzerbulunmuştur. Öte yandan HIV ile infekte ESE olgularının ESE olmayan olgulara oranla daha yüksek TPHA ve anti-HAV IgG seropozitifliğine sahip oldukları görülmüştürThe importance of sexually transmitted infections such as viral hepatitis and syphilis has increased relatively with prolonged life expectancy in HIV-positive cases. The aim of this study was to investigate the seroprevalence of viral hepatitis and syphilis coinfection in HIV-positive cases followed in our clinic. Materials and Methods: This retrospective, cross-sectional, single center study included 98 HIV-infected cases who were followed up in our clinic between January 2018 and November 2019. Demographics, physical examination findings, CD4 T lymphocyte count, HCV RNA, HBsAg, anti-HBcIgG, anti-HBs, anti-HCV, anti-HAVIgG, RPR and TPHA test results were obtained retrospectively from the patients’ files. Results: Median age of the patients was 33.5 (24-44) years, 73 (74.5%) were males, 13 (13.3%) were foreign nationals, 69 (70.4%) were treatment naive, 20 (20.4%) were male sex with male (MSM) and 5 (5.1%) had a history of intravenous drug addiction. The most common transmission route was heterosexual intercourse, and median CD4 T lymphocyte count was 249.5 cells/mm3 (145-358). Overall, 15 (15.3%) of the cases had at least one co-infection. The most common co-infections were HIV/syphilis and HIV/HBV coinfections (13.3% (n= 13) and 4.0% (n= 4), respectively). Only one case had HIV/HBV/syphilis coinfection while HIV/HCV coinfection was not found in this population. The rate of effective HBV vaccination was 26.5%, previous HBV infection was 14.3% and the prevalence of isolated anti-HBc was 3.9%. Cases coinfected with viral hepatitis or syphilis were older than those infected with HIV alone, but there were no significant differences between the groups in terms of sex, antiretroviral therapy (ART) experience, and CD4 T lymphocyte count (p= 0.013, p= 0.106, p=0.542 and p=0.421, respectively. TPHA and anti-HAV IgG seropositivity were significantly higher in MSM cases than in non-MSM cases (p< 0.001 and p= 0.035, respectively). Conclusion: Seroprevalence of HBV, HCV and HAV in HIV-positive cases followed in our clinic were similar to those in the general population. On the other hand, HIV-infected MSM patients had higher anti-HAV IgG and TPHA seropositivity than non-MSM cases

İmmünsüpresif tedavi alacak hastalarda hepatit serolojisi

Amaç: İmmünsupresif ilaç kullananlarda, hepatit B reaktivasyon riskine yönelik tarama yapılması önerilmektedir.Bu çalışmada immünsüpresif tedavi öncesi, Enfeksiyon hastalıkları kliniğine yönlendirilen hastalarda hepatit Bvirüsü (HBV), hepatit C virüsü (HCV) ve hepatit A virüsü (HAV) sonuçları retrospektif olarak irdelenmesiamaçlandı.Materyal ve Metod: Çalışmamızda Ocak 2018 - Aralık 2018 tarihleri arasında immünsüpresif tedavi öncesi,Enfeksiyon hastalıkları kliniğine yönlendirilen 148 hastanın hepatit B yüzey antijeni (HBsAg), hepatit B yüzeyantikoru (Anti-HBs), hepatit B core protein antikoru (Anti-HBc IgG), anti hepatit C virüs antikoru (Anti-HCV) ve antihepatit A virüs antikoru (Anti-HAV) hasta dosyalarından ve hastane otomasyon sisteminden retrospektif olarakincelendi.Bulgular: HBsAg pozitiflik oranı %4,1, Anti-HBs pozitiflik oranı %31,8, İzole Anti-HBc IgG pozitiflik oranı %1,4 veiki hastada ise Anti-HBs bakılmamıştı. Anti-HCV pozitifliği %1,4 tespit edildi. Hastaların %79,7 Anti-HAVbakılmamış, Anti-HAV pozitifliği %12,2 ve Anti-HAV negatifliği %8,1 olarak saptandı.Sonuç: İmmünsüpresif tedavi öncesi tarama yapılmasına rağmen bazı taramaların eksik yapıldığı tespit edildi.Bu nedenle bu hastaları takip eden hekimlere eğitim verilmesi ve özellikle HBV enfeksiyonu konusunda farkındalıkoluşturulmasını önermekteyiz.Background: Screening aimed at hepatitis B reactivation risk is recommended in patients using immunosuppressive drugs. The aim of this study was to investigate the results of hepatitis B virus (HBV), hepatitis C virus (HCV) and hepatitis A virus (HAV) retrospectively in patients referred to the infectious diseases clinic before immunosuppressive treatment. Materials and Methods: In our study, 148 patients who were referred to our infectious disease clinic before immunosuppressive therapeutic usage between January 2018-December 2018. Patients files and hospital automation sysytem were analyzed for Hepatitis B surface antigen (HBsAg), hepatitis B surface antibody (AntiHBs), hepatitis B core protein antibody (Anti -HBc IgG), anti-hepatitis C virus antibody (Anti-HCV) and antihepatitis A virus antibody (anti -HAV) retrospectively. Results: HbsAg positivity rate was 4.1%, Anti-HBs positivity rate was 31.8%, Isolated Anti-HBc IgG positivity rate was 1.4% and Anti-HBs was not detected in two patients. Anti-HCV positivity was detected as 1.4%. Anti-HAV was not examined in 79.7% of the patients, 12.2% was determined to have positive Anti-HAV and 8.1% negative Anti-HAV. Conclusions: Since some screenings are incomplete despite screening performed for the patients, we recommend that physicians who follow patients receiving immunosuppressive therapy should be trained and raise awareness of HBV infection

Evaluation of Four Adult Visceral Leishmaniasis Cases

Leishmania infantum is the species responsible for visceral leishmaniasis [(VL), kala-azar], which is observed sporadically mainly in pediatric age groups in the Aegean, Mediterranean and Central Anatolian regions of Türkiye. The aim of this study is to evaluate the diagnosis, clinic, laboratory results and treatments of four adult patients with VL who applied to our hospital. The patients were referred to our hospital to investigate hematological malignancy. In the study, the data of four patients (three men, one woman; age range: 30-40 years) who were diagnosed with VL and treated in the infectious diseases clinic of our hospital between January 2022 and April 2022 were evaluated retrospectively. The diagnosis of VL was made according to appropriate clinical and physical examination findings, biochemical and serological tests (indirect fluorescent antibody test and rK39 rapid antigen test) and polymerase chain reaction (PCR) results, as well as the presence of amastigote forms of the parasite in bone marrow samples. Serology positivity was found in all patients, and bone marrow positivity was found in two patients. According to the results of RT-PCR in all patients, it was determined that the species causing the disease was L. infantum/L. donovani. Initially, the most common symptoms were fever, fatigue, and abdominal distension. None of the patients had an immunosuppressive condition. It was understood that all the patients lived in the rural area of Syria’s Idlib province. Hepatosplenomegaly, increased erythrocyte sedimentation rate, anemia, leukopenia and thrombocytopenia were found in all patients. The patients were treated with liposomal amphotericin-B (L-AMB). One patient did not come for follow-ups, the other three patients were found to have completely recovered in their follow-up. No recurrence was observed in any of the patients. In conclusion, VL should be considered in patients who apply to health institutions with complaints of fever, hepatosplenomegaly, increased erythrocyte sedimentation rate, anemia, leukopenia and thrombocytopenia

Effectiveness of oral direct acting antivirals in elderly chronic hepatitis C patients: real-world data

Introduction: Objectives: Elderly cases have not been adequately representedin clinical trials with respect to chronic hepatitis C treatment. Extremely limited realworld data is available on new direct-acting antivirals in elderly patients. Herein, weaim to evaluate real-world data on new direct-acting antivirals used in the treatmentof chronic hepatitis C virus.Materials and Method: Medical records of 122 patients who started treatmentwith new direct-acting antivirals between January 2018 and December 2019 owingto chronic hepatitis C virus infection were analyzed retrospectively. Patients weredivided into two age groups: those younger than 65 years and those aged 65 andolder. Sustained virological response at 12 week rates were compared between thetwo groups. Sustained virological response at 12 week treatment efficacy analyseswere performed with both modified intention to tract and per protocol.Results: Sustained virological response in the 12th week post treatment wassimilar in both elderly patients and younger patients. Per protocol analysis was97.6% (42/43) vs. 100% (56/56) and modified intention to tract analysis was 91.3%(43/45) vs. 91.8% (56/61), respectively. The most common genotype of patientsaged 65 years and older were 1b 80%, and the most common genotype of patientsyounger than 65 years was 1b 57%.Conclusion: In the present study, Sustained virological response rates weresimilar in elderly patients compared to younger patients; however, very limitedinformation is available on the effectiveness and safety of new, recently approveddirect-acting antivirals in the elderly population

Hatay ilinde Hepatit C Virüs genotip dağılımı, Türkiye

Objectives: The treatment duration and response of chronic hepatitis C (CHC) are closely related to the genotypes of hepatitis C virus (HCV). This study aimed to determine the genotype distributions among CHC patients in the Hatay province of Turkey. Materials and Methods: In this study, demographic data of 589 patients who received a therapy for CHC at the infectious diseases and gastroenterology clinics between June 2016 and May 2019 were retrieved from the hospital information system and medical charts of the patients and were retrospectively reviewed. Results: The most common HCV genotype in our study was genotype 1b (66.9%), followed by genotype 2 (10.5%), genotype 1a (7.3%), genotype 4 (7.1%), genotype 3 (7%), and mixed genotype (1.2%). Six of the mixed genotypes were identified as 1b+4, while one was 1a+3. There was a statistically significant difference between females and males with regards to the HCV genotypes (p<0.001). Patients with genotype 1b tended to be older, while patients with genotypes 3 and 4 tended to be younger. Conclusion: Genotype 1b is the most common HCV genotype in Hatay province, and it is followed by genotypes 2, 1a, 4 and 3. Compared to the studies conducted in previous years in Turkey, our study identified a lower rate for genotype 1b, along with an increase in the distribution rates of the other genotypes. Monitoring the changes in HCV genotype distribution is of vital importance to develop effective strategies in the treatment of HCVAmaç: Kronik Hepatit C (KHC) enfeksiyonunun tedavi süresi ve tedaviye verilen yanıt hepatit C virüs (HCV) genotipleri ile yakından ilişkilidir. Coğrafi bölgelere göre HCV genotiplerinin dağılımında farklılıklar vardır. Bu çalışmada Hatay ilindeki KHC hastalarında genotip dağılımlarının belirlenmesi amaçlanmıştır. Gereç ve Yöntemler: Çalışmada KHC nedeni ile Haziran 2016-Mayıs 2019 tarihleri arasında enfeksiyon hastalıkları ve gastroenteroloji klinikleri tarafından tedavi başlanan 589 hastanın demografik verileri, hastane elektronik bilgi sistemi ve hasta dosyalarından retrospektif olarak incelendi. Bulgular: HCV-RNA pozitif 589 hastada HCV genotiplerinin yüzdesi genotip 1b: %66,9, genotip 1a: %7,3, genotip 2: %10,5, genotip 3: 41 %7, genotip 4: %7,1 ve mix genotip: %1,2 olarak tespit edildi. Mix genotiplerin 6 tanesi 1b+4, bir tanesi 1a+3 olarak belirlenmiştir. Kadın ve erkek cinsleri arasında HCV genotipleri arasında istatistiksel olarak anlamlı farklılık görüldü (p<0,001). Genotip 1b hastaları daha ileri yaşlarda, genotip 3 ve genotip 4 hastalarının daha genç yaşlarda olduğu tespit edildi. Sonuç: Hatay’da HCV genotip 1b en yaygın genotiptir ve bunu genotip 2, 1a, 4 ve 3 izlemektedir. Bizim çalışmamızda ülkemizdeki önceki yıllarda yapılan çalışmalara göre genotip 1b daha düşük tespit edilmiştir ve diğer genotiplerin dağılımında artış olduğu saptanmıştır. HCV genotip dağılımındaki değişikliklerin izlenmesi HCV’nin tedavisinde etkili stratejilerin geliştirilmesinde hayati öneme sahipti

The high rate of Candida parapsilosis candidemia among non-burn patients with polytrauma in the surgical intensive care units of a university hospital

Aim: Candidemia is a life-threatening infection that has been reported to be associated with poorer outcomes in trauma patients. The present study aimed to investigate the epidemiology of candidemia in non-burn patients with polytrauma. Material and Methods: We conducted a retrospective, single-center, observational study of polytrauma patients with candidemia admitted to the surgical intensive care units of a university hospital in Turkey between 2013 and 2017 on. Results: The incidence of candidemia was 127 episodes per 1000 intensive care unit admissions in polytrauma patients. Nonalbicans Candida species accounted for 75.5% of all candidemia episodes. C. parapsilosis (51.05%) was the predominant species, followed by C. albicans (24.52%) and C. tropicalis (12.21%). The highest crude mortality rate (72%) was observed in patients with C. parapsilosis candidemia. In multivariate analyses, who had undergone prior gastrointestinal surgery were 7.1 times more likely to have C. parapsilosis candidemia than those with other strains. Conclusion: Our study, remarkable, demonstrated a high incidence of Candidemia had in polytrauma patients, and non-albicans Candida species were the most frequently isolated candida species. According to our study findings, a prior history of gastrointestinal surgery may help predict C. parapsilosis, as the causative agent of candidemia in polytrauma patients. However, since our study was observational and limited to such a small number of patients, the results obtained should be applied with caution

Hepatit C enfeksiyonunun ve klirensinin diyabetik hastalarda koroner arter hastalığı sıklığına etkisi

Objectives: Chronic hepatitis C (CHC) infection considered to be associated with an increased risk of coronary artery disease (CAD). However, there is not enough data concerning this association in diabetics. Thus, this study investigated the effect of chronic HCV infection and its clearance on the CAD risk in diabetics. Materials and Methods: This was a retrospective case-control study conducted at the Mustafa Kemal University, Department of Infectious Diseases and Clinical Microbiology, Hatay, between January 2010 and January 2015. The presence of CAD and its main risk factors such as age, sex, hypertension (HT), hyperlipidaemia (HL), chronic obstructive pulmonary disease and chronic renal failure were compared between 100 HCV infected diabetic patients and 100 uninfected diabetic controls. The HCV-infected patients were further divided into a viral clearance group and a persistence group, and the CAD prevalence was also compared between these two groups. Results: Patients with CHC were predominantly male (55% vs 39%) and predominantly older than 60 years of age (68% vs 51%) in comparison with controls. The HCV-infected group had a significantly lower prevalence of CAD, HT and HL compared with controls (p<0.001). Furthermore, no significant differences were found between groups with viral clearance and persistent viremia for the prevalence of CAD (p=0.80). Conclusion: Our data suggested that chronic HCV infection might be a protective factor against CAD and successful HCV eradication may not increase the risk of CAD in diabetics. These findings indicate a need for additional studies to clarify the effects of HCV infection and its clearance on the risk of CAD in diabeticsAmaç: Kronik hepatit C (KHC) enfeksiyonunun artmış koroner arter hastalığı (KAH) riski ile ilişkili olduğu kabul edilmektedir. Bununla birlikte diyabetik hastalarda bu ilişki ile ilgili yeterli veri bulunmamaktadır. Bu nedenle bu çalışma ile kronik HCV enfeksiyonunun ve klirensinin, diyabetik hastalardaki KAH riski üzerine etkisi araştırılmıştır. Gereç ve Yöntemler: Bu çalışma; Mustafa Kemal Üniversitesi, Enfeksiyon Hastalıkları ve Klinik Mikrobiyoloji Anabilimdalı, Hatay’da, Ocak 2010-2015 tarihleri arasında yapılan retrospektif bir olgu kontrol çalışmasıdır. HCV ile enfekte diyabetik olgular (n=100) ile HCV ile enfekte olmamış diyabetik kontrol grubu (n=100) arasında KAH varlığı ve yaş, cinsiyet, hipertansiyon (HT), hiperlipidemi (HL), kronik obstrüktif akciğer hastalığı ve kronik böbrek yetmezliği gibi KAH için risk faktörleri açısından karşılaştırıldı. Buna ek olarak, HCV ile enfekte diyabetik olgular viral klirens gelişen ve persistan viremisi olan olgular olarak iki alt gruba ayrıldı ve bu iki grup arasında da KAH prevalansı karşılaştırıldı. Bulgular: CHC olguları kontrol grubuna göre çoğunluğu erkekti (%55’e karşı %39) ve ağırlıklı olarak 60 yaşından büyüktü (%68’e karşı %51). HCV ile enfekte olan grupta, kontrol grubuna kıyasla KAH, HT, HL prevalansı anlamlı olarak daha düşüktü (p<0.001). Ayrıca, viral klirens gelişen ve persistan viremisi olan olgular arasında KAH prevalansı açısından anlamlı fark bulunmadı (p=0.80). Sonuç: Verilerimiz kronik HCV enfeksiyonunun KAH’a karşı koruyucu bir faktör olabileceğini ve başarılı HCV eradikasyonunun diyabetik hastalarda KAH riskini arttırabileceğini düşündürmektedir. Bu bulgular HCV enfeksiyonunun ve klirensinin diyabetik hastalarda KAH riski üzerindeki etkilerini açıklığa kavuşturmak için ek çalışmalara ihtiyaç olduğunu göstermektedi