A micro-elimination approach to addressing hepatitis C in Turkey

Background: In 2016, WHO passed the Global Health Sector Strategy on Viral Hepatitis (GHSS), calling for its elimination by 2030. Two years later, Turkey approved a strategy to reach the WHO targets. This study reports new national prevalence data, breaks it down by subpopulation, and models scenarios to reach HCV elimination. Methods: Literature was reviewed for estimates of HCV disease burden in Turkey. They were discussed with stakeholders and used as inputs to develop a disease burden model. The infected population was estimated by sequelae for the years 2015–2030. Three scenarios were developed to evaluate the disease burden in Turkey: a Base 2017 scenario, representing the current standard of care in Turkey; an increased treatment scenario, representing the impact of improved access to DAAs; and a WHO targets scenario, which meet the WHO GHSS viral hepatitis targets of a 65% reduction in mortality and 90% diagnosis rate of the infected population by 2030. Results: At the beginning of 2017, 271,000 viremic infections were estimated. Of these, 58,400 were diagnosed and 10,200 treated. Modelling results showed that, with the current treatment paradigm in Turkey, by 2030 the total number of viremic HCV infections would decline by 35%, while liver-related deaths, hepatocellular carcinoma (HCC), and decompensated cirrhosis would decrease by 10–25%. In the increased treatment scenario, by 2030 viremic HCV infections would decrease by 50%; liver-related deaths, HCC and decompensated cirrhosis would decrease by 45–70%. In the WHO targets scenario, HCV infections would decrease by 80%; sequelae would decrease by 80–85%. Data on disease burden in micro-elimination target subpopulations are largely unavailable. Conclusions: To meet the WHO Global Health Sector Strategy targets for the elimination of HCV, Turkey needs to increase treatment. Better data are needed as well as countrywide access to DAAs

Diagnosis and treatment of iron deficiency anemia in patients with inflammatory bowel disease and gastrointestinal bleeding: iron deficiency anemia working group consensus report

Iron deficiency (ID) and iron deficiency anemia (IDA) are important signs of gastrointestinal (GI) hemorrhage. Therefore, the evaluation of the GI tract should be a part of the diagnostic protocol in patients with IDA. GI hemorrhage is not a disease but a symptom, which might have different underlying causes. ID and IDA have significant negative impacts on the life quality and work ability, and they may lead to frequent hospitalization, delay of discharge, and increased healthcare costs. Therefore, an optimal management of the disease causing GI hemorrhage should include iron replacement therapy, along with the treatment of the underlying condition. IDA in inflammatory bowel disease (IBD) has received particular attention owing to its high prevalence, probably due to a number of other factors such as chronic hemorrhage, reduced dietary iron intake, and impaired absorption of iron. Historically, in IBD and in patients with GI hemorrhage, the diagnosis and management of IDA have been suboptimal. Options for iron replacement include oral and intravenous (IV) iron supplementation. Oral iron supplementation frequently results in GI side effects, and theoretically, it may exacerbate IBD activity; therefore, IV iron supplementation is usually considered in patients not responding to or not complying with oral iron supplementation or patients having low hemoglobin concentration and requiring prompt iron repletion. The aim of this report was to review the diagnostic and therapeutic considerations of IDA in IBD and GI hemorrhage with a multidisciplinary group of experts and to formulate necessary practical recommendations

Scenarios to manage the hepatitis C disease burden and associated economic impact of treatment in Turkey

Hepatitis C virus (HCV) infection is a significant health problem. The aim of this study is to evaluate the cost-effectiveness of HCV treatment and estimate its economic burden in Turkey

Scenarios to manage the hepatitis C disease burden and associated economic impact of treatment in Turkey

Hepatitis C virus (HCV) infection is a significant health problem. The aim of this study is to evaluate the cost-effectiveness of HCV treatment and estimate its economic burden in Turkey

The Relationship Between the Methods of Male Circumcision Procedures Used in the Past and the Prevalence of Viral Hepatitis

Amaç: Bu çalışma, geçmişte sünnet yapılma şekli ve hepatit B yüzey antijeni (HBsAg), anti-HBs ve anti-hepatit C virüsü (HCV) pozitifliği arasındaki ilişkinin incelenmesi amacı ile dizayn edilmiştir. Gereç ve Yöntemler: Viral Hepatitle Savaşım Derneği'nce hayata geçirilen "Toplum Hepatit Farkındalık Aktiviteleri" kapsamında, tüm Türkiye genelinde sağlık ocaklarına başvuran gönüllü katılımcılar HBsAg, anti-HBs ve anti-HCV pozitifliği açısından taranmıştır. Katılımcıların hepatit B virüsü ve HCV pozitifliği analizleri için kan örneklerinin alındığı sırada, geçmişteki sünnet prosedürü ile ilgili standart anket formu yüz yüze görüşme metodu ile her katılımcı için doldurulmuştur.Bulgular: HBsAg, anti-HBs ve anti-HCV pozitiflik oranları sırası ile %3,6, %9,8 ve %0,6 olarak bulunmuştur. HBsAg pozitifliği sünneti geleneksel, sağlık personeli tarafından yapılmayan grupta sağlık personeli tarafından sünnet edilen gruba göre anlamlı olarak yüksek bulunmuştur (%3,3 vs %5,3, p=0,003). Gruplar arasında anti-HBs ve anti-HCV pozitifliği açısından anlamlı bir ilişki saptanmamıştır (%0,6 vs %0,8, p=0,533). Sonuç: Sünnet, Türkiye gibi islam ülkelerinde, kültürel ve dini geleneklere dayanan oldukça yaygın bir uygulamadır. Türkiye'de, toplu sünnet ve geleneksel berberler gibi sağlık personeli olmayan kişilerce yapılan sünnet, viral enfeksiyonların bulaşma riski ile birlikte, hala önemli sağlık sorunlarından biridir. Sonuçlar, viral hepatit bulaşında önleyici önlemler almaya yardımcı olabilir.Objective: The study was designed to evaluate the relationship between the methods of circumcision procedures used in the past and hepatitis B surface antigen (HBsAg), anti-HBs and anti-hepatitis C virus (HCV) positivity.Materials and Methods: Within the scope of "Public Hepatitis Awareness Activities" executed by the Viral Hepatitis Society, volunteer participants who were admitted to primary healthcare centers across the Turkey, were screened for HBsAg, anti-HBs and anti-HCV positivity. A standard questionnaire form regarding their circumcision procedure in the past was applied via face-to-face interview method to each participant while their blood samples were collected for the analysis of hepatitis B virus and HCV positivity. Results: HBsAg, anti-HBs and anti-HCV positivity rates were 3.6%, 9.9% and 0.6% respectively. HBsAg positivity was significantly higher in group of participants who have been circumcised by a traditional non-medical person than in the other group of subjects who have been circumcised by a health professional (3.3% vs 5.3%, p=0.003). Conclusion: Circumcision is a widespread practice based on the existing cultural and religious traditions in islamic countries like Turkey. Mass circumcision and circumcision performed by traditional nonmedical persons like barbers is still one of the important health-care problems with the risk of transmission of viral infections in Turkey. The results will help to take measures for preventing viral hepatitis transmission

The Utility of Serum Receptor-Binding Cancer Antigen Expressed on Siso Cells in Gastrointestinal Tract Cancers

BACKGROUND: Receptor-binding cancer antigen expressed on SiSo cells (RCAS1) is a novel tumour marker that has been described in various kinds of cancer. The majority of observations include immunohistochemical studies; however, there are not enough data about the utility of this antigen as a serum tumour marker and its tumour specificity

Effectiveness of fixed-dose combination of paritaprevir, ritonavir, ombitasvir, and dasabuvir in patients with chronic hepatitis C virus infection and chronic kidney diseases: real-life experiences

Introduction Both hepatitis C virus infection (HCV) and chronic kidney disease (CKD) have been comorbid illnesses with increasing morbidity and mortality. The present study was conducted to present real-life experiences about treatment of HCV and CKD with a fixed-dose combination of paritaprevir 150 mg/day, ritonavir 100 mg/day as a booster, ombitasvir 25 mg/day, and dasabuvir 250 mg twice/day, the PROD regimen. Patients and methods This was a multicenter, retrospective cohort study. Seventy-five patients with both HCV and CKD were treated with a PROD-based regimen with or without ribavirin. Fifty-three of 75 patients were on maintenance hemodialysis program. Seven patients had compensated liver cirrhosis. The patients with genotype 1a or compensated liver cirrhosis were treated with the PROD regimen and ribavirin in a dose of 200 mg every other day for 12 weeks. The patients with genotype 1b were treated with PROD for 12 weeks. The patients with genotype 4 were treated with a combination of paritaprevir, ritonavir, ombitasvir, and ribavirin 200 mg every other day. Results All patients except one were HCV-RNA negative (98.6%) at the end of treatment. One patient had decompensated after the fourth day of therapy. She stopped the treatment, and she was exitus after 2 months. Two patients died of reasons not related to the drugs 2 months after negativity of HCV-RNA. Sustained viral rate 12 weeks after treatment was found in 96% of the patients. Conclusion The PROD regimen was very effective and safe for treatment in patients with HCV and CKD who were in stages 4 and 5. Copyright (C) 2019 Wolters Kluwer Health, Inc. All rights reserved

Evaluation of Risk Factors Associated with HBsAg and Anti-HCV Seropositivity: Results of a Nationwide Population Based Epidemiological Survey Study in Turkey

Objective: 'lb evaluate the factors associated with HBsAg and anti-HCV positivity through the database of the "Raising Public Awareness to Hepatitis and Determination of the Alterations in Epidemiology an activity conducted by Viral hepatitis Society in Turkey