İzmir bölgesinde sağlıklı kan vericilerinde ANTİ-HTLV-I/II seroprevalansının araştırılması

Almost 10-20 million people in the world are thought to be infected by human deltaretroviruses, namely human T-cell lymphotropic virus (HTLV) type I and II, recently. HTLV-I is endemic in southwestern Japan, the Caribbean and sub-Saharan Africa, whereas HTLV-II is more prevalent in intravenous drug addicts, and in American indian populations, endemically. HTLV-I is mainly responsible for adult T-cell leukemia (ATL) and HTLV-Iassociated myelopathy/tropical spastic paraparesis (HAM/TSP), however, HTLV-II is not clearly associated with a known clinical disease. Both viruses may be transmitted by sexual contact, parenteral route, whole blood transfusion and breast-feeding. in most of the countries [USA, Canada, South America, Caribbean, Japan, Taiwan and some Europe countries (France, UK, Ireland, Sweden, Denmark, the Netherlands, Portugal, Romania, Greece)] routine screening of anti-HTLV-I/II in blood donors is mandatory, however, there is no such practice in Turkey since seroepidemiologic data on HTLV-I/II infections is insufficient. in this study, the seroprevalence of HTLV-I/II in healthy blood donors admit- ted to the blood bank of Ege University Medical Faculty Hospital, Izmir (located at Aegean region), was investigated to support data on the decision making process on routine screening of anti-HTLV-I/II in blood centers. Serum samples from 10.000 healthy blood donors (mean age: 32.6 years; 87.8% were male), who succeeded the donor history questionnaire, were included to the study, and HTLV-I/II antibodies were screened by a commercial enzyme immunoassay (ELISA) (Murex HTLVI-II, Murex Diagnostics, UK) method. Serum samples which were yielded reactive and borderline results were retested by ELISA, and repeated reactive/borderline results were then confirmed by HTLV-I/II confirmation test (INNO-LIA HTLV-I/II, Innogenetics, Belgium). Seven samples yielded reactive/borderline reactive results by both ELI-SA lots, however, all of them were found negative by confirmatory test. According to our data HTLV-I/II infections are not endemic in Izmir region, and anti-HTLV-I/II screening of blood donors is not required in our blood center currently. Nevertheless, screening HIV which is very rare in prevalence among the donor population, is mandatory for blood donors in our country. Thus, even its prevalence is very low, much more comprehensive and multi-centered studies are necessary for making the decision of integrating HTLV-I/II in routine blood bank screening tests in Turkey.Günümüzde yaklaşık 10-20 milyon kişinin, insan deltaretroviruslarından olan HTLV (Human T-lymphotropic virus) tip I ve II ile enfekte olduğu düşünülmektedir. HTLV-I, güneybatı Japonya, Karayipler ve Sahra-altı Afrika’da endemik olarak bulunurken, HTLV-II daha ziyade intravenöz ilaç kullanıcılarında ve endemik olarak da Amerikan yerli popülasyonunda görülmektedir. HTLV-I, yetişkin T hücre lösemisi (ATL) ve HTLV-I ile ilişkili myelopati/tropikal spastik paraparezi (HAM-TSP)’den sorumlu tutulurken; HTLV-II’nin bilinen klinik bir hastalıkla ilişkisi tam olarak açıklanmamıştır. HTLV-I/II bulaşı, cinsel temas, parenteral yol, tam kan transfüzyonu ve anne sütü ile gerçekleşebilmektedir. Kan vericilerinde rutin olarak anti-HTLV-I/II taraması, birçok ülkede [ABD, Kanada, Güney Amerika, Karayipler, Japonya, Tayvan ve bazı Avrupa ülkeleri (Fransa, İngiltere, İrlanda, İsveç, Danimarka, Hollanda, Portekiz, Romanya, Yunanistan)] kan bankalarında zorunlu olarak uygulanmaktadır. Ülkemizde ise HTLV-I/II enfeksiyonları ile ilgili yeterli seroepidemiyolojik verilerin olmaması nedeniyle böyle bir tarama yapılmamaktadır. Bu çalışmada, Ege Üniversitesi Tıp Fakültesi (EÜTF) Hastanesi Kan Merkezine başvuran sağlıklı kan vericilerinde HTLV-I/II seroprevalansının araştırılması ve anti-HTLV-I/II testinin kan merkezi rutin tarama programında yer alma gerekliliğinin irdelenmesi amaçlanmıştır. Çalışmada, donör sorgulamasından geçmiş 10.000 sağlıklı kan vericisinin (yaş ortalaması: 32.6 yıl; %87.8’i erkek) serum örneğinde anti-HTLV-I/II antikorları ticari bir enzim immunoassay (ELISA) yöntemiyle (Murex HTLVI-II, Murex Diagnostics, İngiltere) araştırılmış; reaktif ve sınırda reaktif bulunan örneklerde ELISA tekrarlanmış ve yine aynı sonucun alınması durumunda HTLV-I/II doğrulama (INNO-LIA HTLV-I/II, Innogenetics, Belçika) testi uygulanmıştır. ELISA yöntemiyle reaktif/sınırda reaktif olarak saptanan 7 örnek, ikinci tekrarda da aynı sonucu vermiş; ancak doğrulama testi ile hepsinin negatif olduğu izlenmiştir. Elde edilen veriler, İzmir bölgesinde HTLV-I/II enfeksiyonlarının endemik olmadığını düşündürmüş ve bu aşamada kan vericilerinde anti-HTLV-I/II taranmasının gerekliliğini ortaya koyacak bir sonuca varılamamıştır. Buna karşın, HIV’ın da kan vericiler gibi seçilmiş bir grupta çok nadir görülmesine rağmen, zorunlu tarama testleri arasında yer aldığı düşünülürse, anti-HTLV-I/II taramasının ülkemiz kan merkezlerinde zorunlu testler içinde yer alıp almayacağı kararı için daha geniş kapsamlı ve çok merkezli çalışmalara gerek vardır

Predictive value of FibroScan in detecting liver fibrosis in HBeAg negative patients with chronic hepatitis B whose HBV DNA 2000-20000 IU/ml with ALT 1-2 times the upper limit of normal and those with HBV DNA >20000 IU/ml and normal ALT.

AbstractObjective:&nbsp;In hepatitis B infection, it is difficult to make a treatment decision in patients with slightly elevated transaminases and HBV DNA level between 2000 and 20000 IU/ml, and in those with normal ALT, despite high levels of HBV DNA. Objectives: In HBeAg negative patients whose HBV DNA levels were between 2000 and 20000 IU/ml with ALT 1-2 times the upper limit of normal (ULN) and those with HBV DNA &gt;20000 IU/ml and normal ALT, the concordance between liver fibrosis in biopsy and liver stiffness measured by transient elastography with FibroScan®&nbsp;(FS) was investigated, and diagnostic value of FS to predict the liver fibrosis was tested.Methods:&nbsp;The patients were selected from the outpatient hepatology clinics between the dates of November 2014 and October 2016 among those who were taken liver biopsy. Transient elastography was obtained within 3 months after liver biopsy. The diagnostic value of FS in detecting advanced fibrosis or moderate to advanced (MTA) fibrosis was investigated for each group.Results:&nbsp;In 38 patients with HBV DNA 2000-20000 IU/ml and ALT 1-2×ULN, advanced fibrosis was detected in only one patient (2.6%) on liver biopsy, sensitivity of FS to show advanced fibrosis is 100%, specificity 78.3%, and diagnostic accuracy rate 79%. The area under curve was determined to be 0.892. In detecting MTA fibrosis, these values are 100%, 62%, 71%, and 0.810, respectively. Of 79 patients with HBV DNA &gt;20000 IU/ml and normal ALT, five had advanced (5.5%) and 18 had MTA (23%) fibrosis. Sensitivity of FS in detecting advanced fibrosis was 100%, specificity 87.8%, and accuracy 88.6%, and these values for MTA fibrosis were 85.7%, 81%, and 82.3%, respectively.Conclusion:&nbsp;Because of false negativity in a few patients with HBV DNA &gt;20000 IU/ml in detecting MTA, FS may be combined with other non-invasive techniques. Negative predictive values of FS in predicting advanced or MTA fibrosis were very high, while positive predictive values were low. However, FS may save several patients from liver biopsy.Keywords:&nbsp;Fibrosis; HBV; liver biopsy; transient elastography.</p