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

Effects of levels of mannose binding lectin and mannose binding lectin polymorphisms to the response of treatment in chronic hepatitis C infection.

TEZ7863Tez (Uzmanlık) -- Çukurova Üniversitesi, Adana, 2010.Kaynakça (s. 66-77) var.vii, 78 s. : res. ; 29 cm.Objectives: Hepatitis C virus is the most frequent cause of chronic liver disease. It is estimated that approximately 170 million people are infected with HCV worldwide. The natural history and outcome of HCV infections are usually associated with the interaction of virus and the host immune response. Mannose binding lectin, a key factor of the immune system, has genetic polymorphism, and individuals who carry certain genotypes of mannose binding lectin are known to be more prone severe and prolonged infectious diseases. A role for mannnose binding lectin in hepatitis C virus infection had been indicated by few previous studies examining mannose binding lectin levels and polymorphisms in relation to disease progression and response to treatment. We undertook this study to investigate the correlation of treatment response with serum concentration of mannose binding lectin and polymorphisms of mannose binding lectin gene. Material and Methods: In this study, serum mannose binding lectin concentration was measured by ELISA and codon 54 mutation of mannose binding lectin gene was searched with PCR-RFLP method both in chronic hepatitis C infected patients and control group. Fifty hepatitis C infected patients treated with combination of pegylated interferon and ribavirin and 75 healthy controls were included into study. Results: Codon 54 mutation was increased in hepatitis C infected patient compared to control subjects but there was no statistically significant difference between two groups. There was statistically significant decrease in serum mannose binding lectin concentration in subject with codon 54 gene mutation. Relatively higher decrease in mannose binding lectin concentration in hepatitis C virus infected patients compared to control group was not statistically significant. Also mutation frequencies and mannose binding lectin serum concentration were similar between responders and non-responders. Conclusion: Low mannose binding lectin levels does not increase susceptibility to hepatitis C infection, and mannose binding concentrations does not have a major influence on the course of the disease and response to antiviral therapy but a larger sample size is necessary to confirm the present results.Amaç: Hepatit C virüsü kronik karaciğer hastalığının en sık nedenidir. Dünyada yaklaşık 170 milyon kişinin hepatit C virüsü ile enfekte olduğu tahmin edilmektedir. Hepatit C enfeksiyonunun doğal seyir ve klinik gidişi virüs ve konağın immün cevabının etkileşimi ile ilişkilidir. Bağışıklık sisteminin önemli bir öğesi olan mannoz bağlayan lektin genetik polimorfizme sahiptir ve belirli genotiplere sahip bireylerin daha ciddi ve uzun süreli enfeksiyonlara yatkınlığı bilinmektedir. Mannoz bağlayan lektinin hepatit C virüsü enfeksiyonundaki rolü mannoz bağlayan lektin seviyeleri ve polimorfizmlerinin hastalık seyiri ve tedavi cevabını inceleyen az sayıda çalışmada gösterilmiştir. Biz bu çalışmada mannoz bağlayıcı lektin düzeyi ve mannoz bağlayan lektin geni polimorfizmleri ile tedavi cevabı arasındaki ilişkiyi ortaya koymayı amaçladık. Gereç ve Yöntem: Bu çalışmada kronik hepatit C hastaları ve kontrol grubunda serum mannoz bağlayan lektin düzeyleri ELİSA yöntemi ölçüldü ve kodon 54 mutasyon varlığı PCR-RFLP tekniği ile araştırıldı. Çalışmaya pegile interferon ve ribavirin kombinasyonu ile tedavi edilmiş 50 kronik hepatit C hastası ve 75 sağlıklı kontrol alındı. Bulgular: Kodon 54 mutasyonu hepatit C hastalarında kontrol grubuna oranla daha sıktı fakat aralarındaki fark istatistiksel olarak anlamlı değildi. Hasta ve kontrol gruplarında kodon 54 mutasyonu olanlarda serum mannoz bağlayan lektin düzeyleri belirgin olarak düşük bulundu. Hepatit C hastalarında mannoz bağlayan lektin düzeyi kontrol grubuna göre daha düşük olmakla birlikte iki grup arasında istatistiksel olarak anlamlı fark saptanmadı. Ayrıca tedavi yanıtı saptanan ve saptanmayan hastalarda serum mannoz bağlayıcı serum düzeyleri ve mutasyon sıklığı oranları benzerdi. Sonuç: Düşük mannoz bağlayan lektin düzeyleri hepatit C enfeksiyonuna duyarlılığı artırmamaktadır ve mannoz bağlayan lektin düzeyinin hastalığın seyiri ve tedavi cevabı üzerine belirgin bir etkisi saptanmamış olmakla birlikte daha net sonuçlar ortaya koyabilmak için daha geniş hasta gruplarını içeren çalışmalara ihtiyaç vardır.Bu çalışma Ç.Ü. Tıp Fakültesi Araştırma Fonu tarafından desteklenmiştir. Proje No: TF2009LTP029

Neuropsychiatric evaluation in HIV positive patients: a preliminary study

Amaç: Bu çalışmada HIV (+) bireylerde nöropsikiyatrik belirtilerin ve ilişkili sosyodemografik ve klinik bulguların değerlendirilmesi amaçlanmıştır. Gereç ve Yöntem: Çalışmaya Çukurova Üniversitesi Tıp Fakültesi Hastanesi Enfeksiyon Hastalıkları ve Klinik Mikrobiyoloji polikliniğinden takipli 10 HIV (+) hasta alınmıştır. Kognitif işlevlerin değerlendirilmesi amacıyla her hastaya 8 testten oluşan nöropsikolojik test bataryası uygulanmıştır. Genel psikolojik belirtilerin taranması amacıyla her hasta SCL-90 doldurmuş, depresif belirtiler Hamilton Depresyon Derecelendirme Ölçeği (HAM-D) ile değerlendirilmiştir. Bulgular: Çalışmaya alınan 10 hastanın sosyo-demografik özellikleri ele alındığında; grubun 6'sının erkek, 4'ünün kadın, tümünün düşük ya da orta sosyoekonomik düzeyde, yarısının evli ve üçü dışında tümünün lise ve üzeri eğitim almış olduğu belirlendi. Hastaların tümünde belirgin dikkat daralması ve dikkat daralmasına ikincil bellek ve yürütücü işlev bozukluğu saptandı. Çalışmaya alınan olguların 4'ünde depresyon saptanmazken (HAM-D<7), geriye kalan 6 olguda hafif ve orta derecede depresyon mevcuttu. Sadece bir hasta antidepresan tedavi almaktaydı. Geriye kalan hastaların psikiyatrik başvurusu ya da tedavi öyküsü yoktu. SCL-90 ile yapılan genel psikiopatolojik belirti taramasında depresyon, obsesif-kompülsif özellikler, somatizasyon ve kişilerarası duyarlılık alt ölçek puanları yüksek olarak saptandı. Sonuç: Bilişsel bozulma ve depresyon HIV (+) olgularda oldukça sıktır ve hayat kalitesini olumsuz etkilemektedir. Hastanın psikososyal işlevselliğini ve tedavi uyumunu önemli derecede etkileyen bu bozukluklar muayene sırasında rutin olarak sorgulanmalı, gerekli durumlarda kişiler enfeksiyon ve tedavisinden bağımsız olarak tedavi edilmelidir.Purpose: The aim of this study was to assess neuropsychiatric symptoms of HIV infected patients and determine related socio-demographic and clinical features. Material and Methods: A total of 10 HIV (+) outpatients who have been followed in Department of Infectious Diseases and Clinical Microbiology, Cukurova University Medical School were included in the study. To evaluate cognitive functions, a neuropsychological test battery consisted of 8 tests were administered. All patients completed Symptom Check List (SCL-90) to determine psychological symptoms and Hamilton Depression Rating Scale (HAM-D) were used to evaluate the severity of depression. Results: The sample included 10 patients (4 females, 6 males). All patients had low or mid socioeconomic status, one half were married and seven patients had high or more level education. Executive functions and memory were impaired secondary to attentional narrowing in all HIV infected patients. Four patients were not diagnosed as depression (HAM-D<7) and other had mild to moderate depression. Only one patient was using an antidepressant medication. Others were neither referred for a psychiatric assessment, nor took a psychiatric treatment. Depression, obsessive-compulsive symptoms, somatization and interpersonal sensitivity subscales found to be high as were measured by SCL-90. Conclusion: Cognitive impairment and depression is highly prevalent in HIV (+) patients and have negative effects on treatment adherence, psychosocial functioning and quality of life, so these disorders should be examined in regular psychiatric interviews and be treated regardless infection and its treatment

Hepatit C tedavisinde karşılaşılan telaprevir ilişkili DRESS sendromu

Kronik hepatit C tedavisinde telaprevir yüksek kalıcı viral yanıt ve kısa süreli tedavi özelliğiyle dikkat çekmektedir, ancak özellikle çeşitli cilt yan etkileri olmak üzere yeni yan etkilerle ilişkilidir. Biz telaprevir bazlı hepatit C tedavisi esnasında sistemik semptomlar ve eozinofilinin eşlik ettiği ilaç reaksiyonu gelişen 66 yaşında bir kadın hasta sunduk. Hastanın tüm antiviralleri kesildi ve destek tedavi verildi. Takibinde sistemik ve cilt bulguları düzeldi. Nadir olmasına rağmen telaprevir bazlı tedavi esnasında ciddi cilt reaksiyonları akılda tutulmalıdırIn chronic hepatitis C patients telaprevir attracts attention with high sustained virologic response and short term treatment however it is associated a new spectrum of adverse events, especially several cutaneous manifestations. We report a 66-year-old female patient developed drug reaction with eosinophilia and systemic symptoms during telaprevir based hepatitis C treatment. All antivirals were discontinued and she was treated with supportive care. Systemic and cutaneous symptoms resolved in follow-up. Although rare, clinicians should be aware of potentially severe cutaneous skin reactions during telaprevir -based therapy. J Microbiol Infect Dis 2015;5(1): 36-3

Sudden respiratory failure and eosinophilic pneumonia in patients treated with daptomycin: a report of five cases

Daptomisin, dirençli gram pozitif enfeksiyonların tedavisinde kullanıma giren siklik lipopeptidlerin ilk üyesidir. Gram pozitif bakteriler ile oluşan ciddi enfeksiyonların tedavisinde iyi bir seçenek olabileceği çeşitli çalışmalarda gösterilmiştir. Eozinofilik pnömoni daptomisin kullanımı sırasında nadiren gelişebilir. Bu yazıda daptomisin ilişkili eozinofilik pnömoni düşünülen 5 olgu sunulmuştur. Hastalarda ani gelişen solunum yetmezliği, takipne, taşikardi görülmüş, bir olguda periferik eozinofili saptanmıştır. Destek tedavisi ve ilacın kesilmesiyle genellikle semptomlar kontrol altına alınmış, ancak bazı hastalarda steroid ve mekanik ventilasyon ihtiyacı olmuştur. Daptomisin kullanımı esnasında ani gelişen solunum yetmezliğinde eozinofilik pnömoni akılda tutulmalıdır.Daptomycin is the first member of cyclic lipopeptides came into use in the treatment of resistant gram-positive infections. It is shown to be a good option in the treatment of serious infections caused by gram-positive bacteria. Eosinophilic pneumonia may occur rarely during the use of daptomycin. In this paper we described 5 cases of daptomycin-associated eosinophilic pneumonia. Sudden onset of respiratory failure with tachypnea, tachycardia was observed, peripheral eosinophilia was detected in one patient. The symptoms usually resolved with supportive treatment and after discontinuation of the drug, but steroid treatment and mechanical ventilation was required in some patients. Eosinophilic pneumonia in the sudden onset of respiratory failure should be kept in mind during daptomycin treatment

Effects of mannose-binding lectin and mannose-binding lectin polymorphisms on treatment response in patients with chronic hepatitis C

Background/Aims: The natural course and clinical outcome of hepatitis C virus (HCV) infection is related to the interaction between HCV and the immune response of the host. Only a limited number of studies have investigated the role of mannose-binding lectin (MBL) levels in HCV infection. The aim of the present study was to explore the relationship between MBL levels and gene polymorphisms on treatment response in patients with chronic hepatitis C (CHC).Materials and Methods: Serum MBL levels from 50 CHC patients who completed treatment at least 24 weeks before the present study and 75 healthy HCV-negative controls were measured. In addition, the presence of codon 54 mutations was investigated. Correlational analyses were performed to determine relationships between MBL levels and treatment response.Results: In patients, mean serum MBL levels were lower and the rate of codon 54 mutations was higher. However, these differences were not statically significant. In both patients and controls, serum MBL levels were significantly lower in individuals with codon 54 mutations. Moreover, serum MBL levels and the rate of the codon 54 mutation were similar in patients regardless of treatment response.Conclusion: Our findings suggest that low MBL levels do not increase the susceptibility for HCV infection. Furthermore, MBL levels were not found to have a significant effect on the course of the disease or treatment response.Background/Aims: The natural course and clinical outcome of hepatitis C virus (HCV) infection is related to the interaction between HCV and the immune response of the host. Only a limited number of studies have investigated the role of mannose-binding lectin (MBL) levels in HCV infection. The aim of the present study was to explore the relationship between MBL levels and gene polymorphisms on treatment response in patients with chronic hepatitis C (CHC).Materials and Methods: Serum MBL levels from 50 CHC patients who completed treatment at least 24 weeks before the present study and 75 healthy HCV-negative controls were measured. In addition, the presence of codon 54 mutations was investigated. Correlational analyses were performed to determine relationships between MBL levels and treatment response.Results: In patients, mean serum MBL levels were lower and the rate of codon 54 mutations was higher. However, these differences were not statically significant. In both patients and controls, serum MBL levels were significantly lower in individuals with codon 54 mutations. Moreover, serum MBL levels and the rate of the codon 54 mutation were similar in patients regardless of treatment response.Conclusion: Our findings suggest that low MBL levels do not increase the susceptibility for HCV infection. Furthermore, MBL levels were not found to have a significant effect on the course of the disease or treatment response