Hepatitis B virus prevalence, immunization and immune response in people living with HIV/AIDS in Istanbul, Turkey: a 21-year data analysis

Objective: We aimed to determine Hepatitis B virus (HBV) prevalence, immune status, and the prevalence of antibody response in people living with HIV/AIDS (PLWHA) in Istanbul, Turkey. Methods: The study includes PLWHA aged 18 years and older who were followed-up for at least 6 months from 1997 to 2018. Results: Of the 653 patients with PLWHA, 99 (15.2%) were both antiHBc-IgG and antiHBs positive, 120 (18.3%) were antiHBc-IgG positive/antiHBs negative. HBsAg was positive in 40 (6.1%) patients. HBsAg positive coinfection (≤40 years 4.6% vs. >40 years 21.7%, p<0.001) and antiHBc-IgG positivity/antiHBs negativity (≤40 years 14.0% vs. >40 years 26.5, p<0.001) were higher in PLWHA older than 40 years. The prevalence of HIV/HBV coinfection reached a peak level of 22.2% in 2004, and it decreased to 3.3% in 2018. The prevalence of immunization before HIV diagnosis was low (15.6%). The prevalence of antibody response (anti-HBs>10 IU/L) after immunization for HBV was 50%. A higher protective response was associated with CD4+≥350 cell/mm3 (59.3%, p=0.014). Conclusion: HBV coexistence in PLWHA remains an imperatively important problem. The most conclusive methods in solving this problem are to prevent transmission by immunization and control measures. Also, HBV screening should in no manner be neglected in PLWHA. Keywords: HIV; Hepatitis B; prevalence

Farelerde interferon ve steroid uygulamasının karaciğer, dalak ve kemik iliğindeki regülatuvar t-hücrelerine etkisi

Objectives: Regulatory T-cells (T-regs) maintain immune tolerance by affecting other cells of the immune system. They play an important role in autoimmune diseases and the prevention of graft rejection. Steroids suppress the immune system, especially inhibiting cytokine secretion of T-lymphocytes, initiation of the cell- mediated immune response, and stimulation of T-regs. Interferons (IFN) also have immunomodulatory, antiviral, and anti-proliferative effects. They activate macrophages and cytotoxic T-cells and stimulate the differentiation of T-regs. The aim of this study was to evaluate the effects of IFN and steroids on T-regs in the liver, spleen, and bone marrow in a mouse model, and to determine if they exert their immunosuppresive/immunomodulatory effects through T-regs. Materials and Methods: A total of 24 mice were randomly separated into 3 groups and administered an intraperitoneal injection for five days. The control group received 0.1 mL saline every day, the IFN group received IFN-alpha-2b 20,000 IU on the first, third, and fifth days, and only 0.1 mL saline on the other days, and the steroids group received 5 mg/kg dexamethasone in 0.1 mL saline every day. Two days after the end of therapy, each mouse was anesthetized, the portal vein was explored via laparotomy, and 5 mL bovine serum albumin (BSA) was administered through the portal vein. The inferior vena cava was cut to allow BSA perfusion of the liver, and then the mice were sacrificed. The liver, spleen, and bone marrow were removed for analysis. T-regs were identified and counted using flow cytometry. Results: The flow cytometry count results showed no significant difference between the IFN, steroid, and control groups. Conclusion: IFN and steroid use do not seem to affect the quantity of T-regs.Amaç: Regülatuvar T-hücreleri (T-reg) immün sistemde görevli birçok hücre çeşidine etki ederek immünolojik toleransı sağlayan hücrelerdir. Otoimmün hastalıklar, greft rejeksiyonunun önlenmesi ve enfeksiyon hastalıklarında önemli role sahiptirler. Steroidler, immün sistemi baskılarlar; özellikle T-lenfositlerin sitokin salgılamasını ve hücresel immünolojik yanıtın başlamasını önlerler ve T-reg’leri de stimüle ederler. Diğer yandan interferonlar (İFN) immünomodülatör, antiviral ve anti-proliferatif etkiye sahiptirler. Makrofajları ve sitotoksik T-hücrelerini aktive ederler ve T-reg’lerin diferansiyasyonunu uyarırlar. Biz bu çalışmamızda İFN ve steroidin karaciğer, dalak ve kemik iliğindeki T-reg’lere etkisini, bilinen immünosüpresif/immün düzenleyici etkilerini T-reg’ler üzerinden yapıp yapmadıklarını değerlendirmeyi amaçladık. Gereç ve Yöntemler: Bunun için 24 fareye 5 gün boyunca intraperitoneal enjeksiyon yapıldı. Kontrol grubuna 0,1 cc serum fizyolojik her gün uygulandı. İFN grubuna İFN-alfa-2b 20.000 IU 0,1 cc olacak şekilde serum fizyolojik ile sulandırılarak gün aşırı 3 kez diğer günler 0,1 mL serum fizyolojik uygulandı. Steroid grubuna deksametazon 5 mg/kg 0,1 mL olacak şekilde serum fizyolojik ile sulandırılarak her gün uygulandı. Enjeksiyonlar bittikten sonra 2 gün beklendi. Farelere genel anestezi uygulandı, laparotomi yapılıp portal ven açığa çıkarıldı, portal venden 5 mL bovine serum albümin (BSA) verildi, inferior vena kava kesilerek karaciğerin BSA ile perfüzyonu sağlandı, fareler feda edilmiş oldu. Karaciğer, dalak ve kemik ilikleri elde edildikten sonra T-reg’lerin ayrımı yapıldı ve akım sitometrisi ile sayıldı. Bulgular: Akım sitometrisi ile sayımda İFN, steroid ve kontrol grubunda T-reg sayılarında istatiksel olarak anlamlı bir farlılık bulunamadı. Sonuç: Sağlıklı farelerde İFN ve steroid kullanımının karaciğer, dalak ve kemik iliğindeki T-reg’lerin miktarına etki etmediği düşünüldü

An Evaluation of Hepatitis A Seroprevalence and Vaccination Status in Patients with HIV/AIDS: Data from A 20-year Period

Introduction:Hepatitis A infection, caused by the hepatitis A virus (HAV), is a non-chronic disease that can be prevented with vaccination. It is a significant cause of morbidity in adults. Homosexually active males, drug users, the homeless, and prisoners are at a greater risk of HAV infection. This study aimed to determine the hepatitis A seroprevalence and vaccination rates of people living with human immunodeficiency virus (HIV) followed up in our clinic.Methods:A retrospective examination was made of the polyclinic files and laboratory test results in the hospital information system of 1,326 patients aged >18 years, who were diagnosed with HIV/AIDS and followed up in the Infectious Diseases Polyclinic of University of Health Sciences Turkey, Haseki Training and Research Hospital between September 30, 2002 and September 30, 2022.Results:Anti-HAV immunoglobulin G (IgG) positivity was present in 1090 (82.2%) patients. As age increased, anti-HAV IgG positivity also increased, females were significantly more affected, no difference was determined between nationalities, and there was seen to be a significant decrease in the positivity rate over the time period of the study. The positivity rate was determined to be significantly high in heterosexual patients. The hepatitis A vaccination rate was determined to be 16.9%, and serology was examined in 60% of the patients after vaccination. The response to vaccination was determined to be 91.6% in the patients with serology examination.Conclusion:Although improvements in sanitation and vaccination in childhood have provided a decrease in HAV seropositivity, the key populations must be informed about vaccination and vaccination adherence is ensured to prevent small outbreaks

Predictors for tuberculosis co-infection in people living with HIV/AIDS

Background/aim: Tuberculosis (TB) is one of the most common chronic infectious conditions causing mortality and severe outcomes, particularly in people living with HIV/AIDS (PLWHA). In this study, we aimed to determine the prevalence and predictors of TB among PLWHA. Materials and methods: We conducted a retrospective and single-center study of adults ( 6518 years) PLWHA registered at our tertiary teaching and research hospital between 2000 and 2016. Results: A total of 711 PLWHA were included. Of whom, 633 (89.0%) were male. Mean age was 36.53 \ub111.55 years (range, 17-79). Thirty-eight (5.3%) patients were diagnosed with active TB. TB development was associated with low CD4+ lymphocyte count (p<0.001), high viral load (p=0.040) and alcohol consumption (p=0.004) but no association with age (p=0.392), gender (p=0.928) and duration since anti-retroviral therapy initiation (p=0.788) was found. Also, a receiver operating characteristic analysis showed that the area under the curves of CD4+ lymphocyte count as a predictor for TB development in PLWHA was 0.717 (p<0.001). Conclusion: There are still clinical challenges to predict TB diagnosis. However, CD4+ lymphocyte count and viral load may be considered as valuable predictors for TB development. Also, community strategies to reduce harmful effect of alcohol use should be developed

In a real-life setting, direct-acting antivirals to people who inject drugs with chronic hepatitis c in Turkey

Background: People who inject drugs (PWID) should be treated in order to eliminate hepatitis C virus in the world. The aim of this study was to compare direct-acting antivirals treatment of hepatitis C virus for PWID and non-PWID in a real-life setting. Methods: We performed a prospective, non-randomized, observational multicenter cohort study in 37 centers. All patients treated with direct-acting antivirals between April 1, 2017, and February 28, 2019, were included. In total, 2713 patients were included in the study among which 250 were PWID and 2463 were non-PWID. Besides patient characteristics, treatment response, follow-up, and side effects of treatment were also analyzed. Results: Genotype 1a and 3 were more prevalent in PWID-infected patients (20.4% vs 9.9% and 46.8% vs 5.3%). The number of naïve patients was higher in PWID (90.7% vs 60.0%), while the number of patients with cirrhosis was higher in non-PWID (14.1% vs 3.7%). The loss of follow-up was higher in PWID (29.6% vs 13.6%). There was no difference in the sustained virologic response at 12 weeks after treatment (98.3% vs 98.4%), but the end of treatment response was lower in PWID (96.2% vs 99.0%). In addition, the rate of treatment completion was lower in PWID (74% vs 94.4%). Conclusion: Direct-acting antivirals were safe and effective in PWID. Primary measures should be taken to prevent the loss of follow-up and poor adherence in PWID patients in order to achieve World Health Organization’s objective of eliminating viral hepatitis

Female Genital Tuberculosis: Five Case Reports

Female genital tuberculosis (FG-TB) is an important disease leading to substantial morbidity including infertility and abnormal vaginal bleeding. While the incidence of FG-TB is 1% in developing countries. Due to its subtle presentation, many cases are overlooked and diagnosed incidentally. Accordingly, the actual incidence of FG-TB is unknown. The definitive diagnosis of the disease is based on histopathological or microbiological examination but in most cases, the bacteriological test is overlooked. In addition, there is no specific laboratory or imaging evaluation to distinguish FG-TB from others. The first step in the diagnosis of FG-TB is suspicion of the disease. In the case of infertility, FG-TB should be included in the differential diagnosis in developing countries after excluding other common diseases and tissue biopsy should be sent for not only histopathology but also microbiological investigations

The Effect of the Administration of Interferon and Steroids on Regulatory T-cells in the Liver, Spleen, and Bone Marrow of Mice

Objectives: Regulatory T-cells (T-regs) maintain immune tolerance by affecting other cells of the immune system. They play an important role in autoimmune diseases and the prevention of graft rejection. Steroids suppress the immune system, especially inhibiting cytokine secretion of T-lymphocytes, initiation of the cell -mediated immune response, and stimulation of T-regs. Interferons (IFN) also have immunomodulatory, antiviral, and anti-proliferative effects. They activate macrophages and cytotoxic T-cells and stimulate the differentiation of T-regs. The aim of this study was to evaluate the effects of IFN and steroids on T-regs in the liver, spleen, and bone marrow in a mouse model, and to determine if they exert their immunosuppresive/immunomodulatory effects through T-regs.Materials and Methods: A total of 24 mice were randomly separated into 3 groups and administered an intraperitoneal injection for five days. The control group received 0.1 mL saline every day, the IFN group received IFN-alpha-2b 20,000 IU on the first, third, and fifth days, and only 0.1 mL saline on the other days, and the steroids group received 5 mg/kg dexamethasone in 0.1 mL saline every day. Two days after the end of therapy, each mouse was anesthetized, the portal vein was explored via laparotomy, and 5 mL bovine serum albumin (BSA) was administered through the portal vein. The inferior vena cava was cut to allow BSA perfusion of the liver, and then the mice were sacrificed. The liver, spleen, and bone marrow were removed for analysis. T-regs were identified and counted using flow cytometry.Results: The flow cytometry count results showed no significant difference between the IFN, steroid, and control groups. Conclusion: IFN and steroid use do not seem to affect the quantity of T-regs