Real-world efficacy and safety of Ledipasvir plus Sofosbuvir and Ombitasvir/Paritaprevir/Ritonavir +/- Dasabuvir combination therapies for chronic hepatitis C: A Turkish experience

Background/Aims: This study aimed to evaluate the real-life efficacy and tolerability of direct-acting antiviral treatments for patients with chronic hepatitis C (CHC) with/without cirrhosis in the Turkish population.Material and Methods: A total of 4,352 patients with CHC from 36 different institutions in Turkey were enrolled. They received ledipasvir (LDV) and sofosbuvir (SOF)+/- ribavirin (RBV) ombitasvir/paritaprevir/ritonavir +/- dasabuvir (PrOD)+/- RBV for 12 or 24 weeks. Sustained virologic response (SVR) rates, factors affecting SVR, safety profile, and hepatocellular cancer (HCC) occurrence were analyzed.Results: SVR12 was achieved in 92.8% of the patients (4,040/4,352) according to intention-to-treat and in 98.3% of the patients (4,040/4,108) according to per-protocol analysis. The SVR12 rates were similar between the treatment regimens (97.2%-100%) and genotypes (95.6%-100%). Patients achieving SVR showed a significant decrease in the mean serum alanine transaminase (ALT) levels (50.90 +/- 54.60 U/L to 17.00 +/- 14.50 U/L) and model for end-stage liver disease (MELD) scores (7.51 +/- 4.54 to 7.32 +/- 3.40) (p<0.05). Of the patients, 2 were diagnosed with HCC during the treatment and 14 were diagnosed with HCC 37.0 +/- 16.0 weeks post-treatment. Higher initial MELD score (odds ratio [OR]: 1.92, 95% confidence interval [CI]: 1.22-2.38; p=0.023]), higher hepatitis C virus (HCV) RNA levels (OR: 1.44, 95% CI: 1.31-2.28; p=0.038), and higher serum ALT levels (OR: 1.38, 95% CI: 1.21-1.83; p=0.042) were associated with poor SVR12. The most common adverse events were fatigue (12.6%), pruritis (7.3%), increased serum ALT (4.7%) and bilirubin (3.8%) levels, and anemia (3.1%).Conclusion: LDV/SOF or PrOD +/- RBV were effective and tolerable treatments for patients with CHC and with or without advanced liver disease before and after liver transplantation. Although HCV eradication improves the liver function, there is a risk of developing HCC.Turkish Association for the Study of The Liver (TASL

Seropositivity for delta hepatitis in patientswith chronic hepatitisb and liver cirrhosis inturkey: ameta-analysis

Background: Recent reports suggest a decline of delta hepatitis (DH) in theWest as well as in the Far East. Aim: To study the DH seroepidemiology in Turkey. Methods: Statistical power analysis was utilized based on data available in a recent article using prevalence figure estimates. Binominal distribution was applied in order to assess the number of samples required to estimate the prevalence with a given precision. Results: Out of 62 studies in the original study, 32 were eliminated because of insufficient power. A total of 6734 patients (5231 with chronic hepatitis and 1503 with cirrhosis) were analysed. Anti-HDV seropositivity among patients with chronic hepatitis B (CHB) and hepatitis B-induced cirrhosis was lowest in the west of the country and highest in the southeast (5 vs. 27%, Po0.0001 and 20 vs. 46%, Po0.0001) respectively. Compared with data obtained before 1995, after 1995, DH prevalence in patients with CHB and cirrhosis decreased from 29 to 12% (Po0.0001) and from 38 to 27% (P = 0.03) in central and southeast Turkey and from 38 to 20% (Po0.0001) and from 66 to 46% (Po0.002) in west and southeast Turkey respectively. Conclusion: Despite the decrease of its prevalence in Turkey, DH remains a significant health problem in parts of the country with low socio-economic level. Hepatitis B, C and D are the three hepatotrop viruses that can lead to chronic liver disease. Among these three hepatotrop viruses, hepatitis B virus (HBV) and hepatitis C virus infections are the most important and common causes of chronic liver disease in Turkey in parallel to the rest of the world. These infections are a major cause of morbidity and mortality. Almost forgotten is the impact of the third virus, the hepatitis D virus (HDV), on the burden of chronic liver disease. The hepatitis delta virus (HDV) leads to liver disease through the helper function of the HBV (1). Chronic delta hepatitis (DH) is significant in the context that it is associated with the most severe form of chronic viral hepatitis (1). In the 1990s, a number of reports have indicated a decline in the prevalence of HDV infection in the West as well as in the Far East (2–4); however, it needs to be seen and assessed whether the trend is similar in other areas of the world. Turkey is a hepatitis B endemic country where studies in blood donors reported an HBsAg carrier rate between 4 and 5% with striking differences in prevalence rates between the west and the east of the country (5). This variance in prevalence between west and east Turkey is also reflected in studies on HDV prevalence. A major limitation is that these studies (6–8) either were presented only in abstract form or were published in Turkish and thus are practically not available for the rest of the world liver community. A retrospective analysis of data on antiHDV seropositivity rate in chronic hepatitis B (CHB) and liver cirrhosis (LC) patients from different regions of Turkey has recently been published (9). The time period of interest was between 1980 and 2005. In the current study, the above mentioned study was re-analysed with the aim of reaching a more objective epidemiological estimate of the DH burden in Turkey. The prevalence of HDV in the setting of both chronic hepatitis and LC was analysed separately. Regional differences as well as potential chronological changes were investigated

The results of the percutaneous endoscopic gastrostomy insertion: Analysis of 113 cases

Objective: In this study, we aimed to evaluate the results and experiences of the patients who received percutaneous endoscopic gastrostomy (PEG). Methods: A total of 113 patients who admitted to the Dicle University Medical Faculty , Department of Gastroenterology between January 2012 and December 2014 and in whom received PEG was performed. The patients were assessed in terms of indications, complications and results. Results: Among these patients, 70 (61.9%) were male and 40 (38.1%) were female. Though 8 (7%) patients had head, neck and esophageal cancer; 105 (93%) patients had primer or seconder neurological disorders. After the PEG, any serious complication was seen in patients. Wound infections were encountered in five patients (4.4%) and the rate of minor complications was found to be 9.7%. The risk of complications was higher in patients over sixty years and men (p values of 0.049 and 0.022). Conclusion: Percutaneous endoscopic gastrostomy, a simple and safe method of enteral nutrition with a low complication rate, should be the first choice when extended period enteral nutrition is required. There is increased risk of complications in elderly males

Development of hepatocellular carcinoma in patients with chronic hepatitis C who had sustained viral response following direct-acting antiviral therapy

Background and Aim: Several studies have suggested that treatment with direct-acting antivirals (DAAs) in patients with chronic hepatitis C virus (HCV) may be associated with an increased risk of developing hepatocellular carcinoma (HCC). We investigated the incidence and risk factors of HCC in HCV patients who achieved a sustained virologic response (SVR) following DAA therapies. Materials and Methods: The medical data of patients who were diagnosed with HCV and received DAA therapy in two tertiary centers in Turkey were retrospectively collected. Results: Among them, 75 patients (52.4%) were noncirrhotic and 68 patients (47.6%) were cirrhotic. The overall SVR rate was 97.2% (139/143). It was 100% in noncirrhotic and 94.1% in cirrhotic patients. HCC was developed in 5 (7.4%) patients, all of whom had baseline cirrhosis. The annual rate of HCC occurrence was 2.94%, and the 5-year cumulative incidence of HCC was 7.3%. The mean Child-Pugh score (CPS) and Model for End-Stage Liver Disease (MELD) score significantly decreased after DAA treatment (CPS 7.0 vs 5.9, p=0.001; MELD 10.8 vs 9.5, =-0.003). Conclusion: There was no significant increase in the rate of HCC in cirrhotic HCV patients treated with DAAs. This treatment led to a remarkably high SVR rate and lowered CPS and MELD scores in cirrhotic HCV patients

Türkiye'nin doğu ve güneydoğu bölgesinde hepatoselüler karsinomalı vakaların klinik ve epidemiyolojik özellikleri: çok merkezli retrospektif çalışma

Objective: In this multicenter retrospective study, we aimed to investigate the epidemiological and clinical characteristics of patients with hepatocellular cancer (HCC) in the Eastern and Southeastern Anatolian regions of Turkey. Material and Methods: This study included 218 patients from 7 centers-Dicle University (n=96), Yüzüncü Yıl University (n=30), İnönü University (n=28), Fırat University (n=24), Gaziantep University (n=20), Atatürk University (n=19), and Harran University (n=1) hospitals. Information about patients was obtained through pre-prepared forms. Diagnosis of HCC was made histologically or with a combination of clinical, radiological, and laboratory findings. Results: The mean age of the patients was 57.67±12.03 with a male-to-female ratio of 5.8:1. Etiologically, 45% of the study group had HBV infection alone, 29% had HDV co-infection, 15% had HCV infection and 10% were idiopathic cases with unknown etiology. Cirrhotic background was present in 94% of the patients and 89% of cases had an advanced stage disease according to the Okuda classification. Alpha-fetoprotein levels were over 300 ng/ml in 81% of the patients. Conclusion: Hepatitis B virus infection followed by hepatitis delta virus infections appeared to be the leading etiological factors for HCC cases in our region. HBsAg carriage continues to be an important risk factor for HCC in Turkey. The fact that most of the HCC cases are in the late stages of disease, makes it necessary to use effective diagnosis and treatment methods with efficient screening and monitoring programs in our country

Macroscopic Portal Vein Thrombosis in Hcc Patients

Macroscopic portal vein invasion (PVT) by hepatocellular carcinoma (HCC) in the liver is one of the most important negative prognostic factors for HCC patients. The characteristics of a large cohort of such patients were examined. We found that the percent of patients with PVT significantly increased with increasing maximum tumor diameter (MTD), from 13.7% with tumors of MTD 10cm. There were similar numbers of HCC patients with very large tumors with and without PVT. Thus, MTD alone was insufficient to explain the presence of PVT, as were high AFP levels, since less than 50% of high AFP patients had PVT. However, the percent of patients with PVT was also found to significantly increase with increasing blood alpha-fetoprotein (AFP) levels and tumor multifocality. A logistic regression model that included these 3 factors together showed an odds ratio of 17.9 for the combination of MTD>5.0cm plus tumor multifocality plus elevated AFP, compared to low levels of these 3 parameters. The presence or absence of macroscopic PVT may therefore represent different HCC aggressiveness phenotypes, as judged by a significant increase in tumor multifocality and AFP levels in the PVT positive patients. Factors in addition to MTD and AFP must also contribute to PVT development.PubMedWoSScopu