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Öğe İmmünosüpresif tedavi veren hekimlerin hepatit b virusu reaktivasyonuyla ilgili farkındalıklarının ve klinik pratiklerinin değerlendirilmesi(AVES, 2019) Korkmaz, Pınar; Demirtürk, Neşe; Aydın, Güle Ç.; Çeken, Sabahat; Aygen, Bilgehan; Toka, Onur; Gündoğdu, Kıymet; Çelikbaş, Aysel Kocagül; İnan, Dilara; Kuruüzüm, Ziya; Kutsoylu, Oya Özlem Eren; Batırel, Ayşe; Sırmatel, Fatma; Ersöz, Gülden Munis; Hakyemez, İsmail Necati; Aşçı, Zerrin; Yeşilbaǧ, Zuhal; Sönmezer, Meliha Çaǧla; Tulek, N.; Örmen, Bahar Kopraman; Karadağ, Fatma Yılmaz; Yörük, Gülşen; Türker, Nesrin Akbaş; Özkaya, Hacer Deniz; Kalkan, İrem Akdemir; Süer, Hüseyin Kaya; Tekin, Süda; Saltoǧlu, Neşe; Şener, Alper; Yenilmez, Ercan; Çetinkaya, Rıza Aytaç; Özel, Selcan Arslan; Ayaz, Celal; Karagöz, Ergenekon; Aydın, Mehtap; Acar, Ali; Arslan, Eyüp; Ceylan, Mehmet Reşat; Demir, Nazlım Aktuǧ; Çaylak, Selmin Dirgen; Günal, Özgür; Solay, Aslı Haykır; Öztürk, Sinan; Ural, Önur; Sümer, Şua; Kadanalı, Ayten; Altıparmak, Vuslat Ecem Güneş; Akhan, Sıla Çetin; Sayan, Murat; Köse, ŞükranObjective: This study aimed to evaluate the awareness and knowledge levels of all physicians administering immunosuppressive treatment concerning hepatitis B virus (HBV) reactivation, and draw attention to the importance of the subject through evaluation. Methods: The study was carried out by infectious diseases and clinical microbiology specialists in 37 health centers, and it was performed in Turkey between January and March 2017. All specialists providing a written consent and working in the departments of Medical Oncology, Hematology, Dermatology and Venereology, Physical Medicine and Rehabilitation, and Rheumatology of each study center were included in the study. Results: A total of 430 physicians participated in the study. Their mean age was 39.87±7.42 years, and 47.9% of them were males. During their career, 39.3% of these physicians had encountered patients developing HBV reactivation while receiving immunosuppressive treatment. The rate of encountering patients who died due to HBV reactivation was 6.5%. 97% of physicians who participated, considered the risk of HBV reactivation to be important. 70.2% of physicians stated that guidelines related to HBV reactivation and antiviral treatment for these patients were discussed in the congresses they participated, regarding their specialties. The rate of performing hepatitis screening among physicians whose patients developed HBV reactivation was statistically significantly higher than those physicians who had no patients with HBV reactivation (p<0.05). Physicians who used the guidelines related to HBV reactivation in their specialties performed screening for the HBV infection much more often than physicians who did not use the guidelines (p=0.002). Conclusions: According to the results obtained in our study, the rates of conducting screening and awareness of HBV reactivation among physicians administering immunosuppressive treatment were higher compared with similar studies; however, their awareness that HBV DNA and anti-HBc should be utilized much more frequently among the serological tests they use for screening of HBV infection, should be increased.Öğe Molecular identification of HIV-1 in the presence of hepatitis B Virus and hepatitis C virus co-infections(Aves, 2020) Sayan, Murat; Özgüler, Müge; Yıldırım, Figen Sarıgül; Yıldırmak, Taner; Gündüz, Alper; Dokuzoğuz, Başak; Çelen, Mustafa Kemal; İnan, Dilara; Heper, Yasemin; Ersöz, Gülden; Karaoğlan, İlkay; Ceran, Nurgül; Deveci, Aydın; Öztürk, Servet; Kutlu, Selda Sayın; Özdemir, Hülya Özkan; Akbulut, Ayhan; Yazıcı, Saadet; Şener, Alper; Çağatay, Atahan; Ünal, SerhatBackground: Because of their similar modes of transmission, the simultaneous infection of viral hepatitis and human immunodeficiency virus are increasingly seen as a big problem related to human health. Aims: To determine the drug mutations in hepatitis B virus and/or hepatitis C virus co-infected human immunodeficiency virus-1 patients in Turkey. Study Design: Retrospective cross-sectional study. Methods: The present study was conducted between 2010 and 2017. HBsAg, anti-hepatitis C virus, and anti-human immunodeficiency vim were tested with ELISA. All anti-human immunodeficiency virus positive results by ELISA were verified for anti-human immunodeficiency virus positivity by a Western blot test, and Antihuman immunodeficiency virus positive patients with HBsAg andior anti-hepatitis C virus positivity were included in the study. Subtyping and genotypic resistance analyses were performed by population sequencing of the viral protease and reverse transcriptase regions of the human immunodeficiency virus-1 pol gene. Results: We detected 3896 human immunodeficiency virus-1 positive patients whose sera were sent from numerous hospitals across the country to our polymerase chain reaction unit for detection of drug resistance mutations and whose molecular laboratory tests were completed. Viral hepatitis co-infections were detected in 4.3% (n=170) of patients. Hepatitis B virus and hepatitis C virus co-infection were observed in 3.2% and 0.5% of all human immunodeficiency virus-I infected patients, respectively. The major human immunodeficiency virus-1 subtype detected was group M, subtype B (62.9%). However, 13.5% of drug resistance mutation motifs were found in human immunodeficiency virus-1 genomes of patients included in the study. Conclusion: Due to similar transmission routes, HIV1 patients are at risk of hepatitis B and C virus co-infection. However, antiretroviral drug resistance mutation model is similar to patients with hepatitis negative.Öğe Occult hepatitis B infection in Turkish HIV-infected patients: A multicentre, retrospective, cross-sectional study, Schindler study(Wiley-Hindawi, 2021) Ünlü, Gülten; Yıldız, Yeşim; Ören, Meryem Merve; Çabalak, Mehmet; Mete, Özlem; Kömür, Süheyla; Yıldırım, Figen; İnan, Dilara; Toplu, Sibel Altunışık; Akhan, Sıla; Karaşahin, Ömer; Kalkan, İrem Akdemir; Demir, Yakup; Ayhan, Merve; Karaoğlan, İlkay; Taşova, Yeşim; Bayındır, Yaşar; Dal, Tuba; Çelen, Mustafa KemalObjective Occult hepatitis B infection (OHBI) appears to have a higher prevalence in populations at high risk for hepatitis B virus (HBV) infection with concomitant liver disease. The aim was to assess the prevalence of OHBI in a sample of human immunodeficiency virus -1 positive and HBV surface antigen-negative (HIV-1+/HBsAg-) Turkish patients. Methods Ten centres in Turkey were included in the study. Patients were selected on the basis of a power calculation with a known population size of HIV-positive patients and a reported prevalence of OHBI. Gender, age, occupation, place of residence, treatment and clinical status, and laboratory results, including immunodeficiency panel, antibody tests, hemogram, biochemistry, and coagulation studies were evaluated retrospectively. Results The number of HIV-infected patients followed in these centres was 3172 and the sample population numbered 278. All 278 were HBsAg negative. The mean age of the sample was 37.2 +/- 13.1 years and 235 (84.5%) were male. All but one patient (99.6%) had been treated with antiretroviral therapy. Of the 278 patients, 169 (60.6%) were positive for Anti-HBs and 125 (44.8%) were positive for Anti-HBc IgG. HIV RNA was detected in 203/278 (73%) of the patients. Four HBV DNA (1.4%) were diagnosed with OHBI. There was no significant difference in hemogram, hemoglobin or bilirubin concentrations in those with OHBI compared with the other patients. Conclusion In a representative sample of HIV+ patients from 10 Turkish centres, the prevalence of OHBI was found to be 1.4%. In HIV positive patients, it is important to identify those with OHBI for optimal clinical management and prognosis.Öğe Real-life data for tenofovir alafenamide fumarate treatment of hepatitis B: The pythagoras cohort(Kowsar Publication, 2021) Karaşahin, Ömer; Kalkan, İrem Akdemir; Dal, Tuba; Toplu, Sibel Altunışık; Harputoğlu, Murat; Mete, Ayşe Özlem; Kömür, Süheyla; Sarigül, Figen; Yıldız, Yeşim; Esmer, Fatih; Kandemir, Özlem; Nazik, Selçuk; İnan, Dilara; Akgül, Fethiye; Kaya, Şafak; Tunç, Nurettin; Balin, Şafak Özer; Bayındır, Yaşar; Taşova, Yeşim; Aktar, Fesih; Ören, Meryem Merve; Ayhan, Merve; Demir, Yakup; Çelen, Mustafa KemalBackground: Chronic hepatitis B (CHB) is a viral infection that can result in life-threatening conditions, such as hepatocellular carcinoma and cirrhosis. Tenofovir, which is used for the treatment of CHB, is a nucleotide analog that inhibits HBV-DNApolymerase and has two formulations: disoproxil and alafenamide. In contrast to tenofovir disoproxil fumarate (TDF), tenofovir alafenamide fumarate (TAF) penetrates the whole hepatocyte without being eliminated due to its longer plasma half-life and greater plasma stability. As a result, side effects such as proximal renal tubulopathy and loss of bone density are less common in the treatment of TAF and have similar efficacy to TDF. Objectives: The purpose of the study was to evaluate the effectiveness and reliability of TAF using real-life data. Methods: This retrospective cohort study was carried out in secondary or tertiary healthcare centers in southern Turkey. A total of 480 patients aged 18 years and older were administered TAF for an appropriate indication by the infectious diseases and gastroenterology clinics of the healthcare centers participating in this study. The data collected at t = 0, t =3, and t = 6 months of treatment were analyzed. The chi-square, Mann-Whitney U, Friedman, Wilcoxon, Cochran's Q, and McNemar's tests were used. Results: The mean age of the patients was 47.40 +/- 14.5, and 327 of them (68.1%) were male. A total of 78.1% of the 480 patients who underwent the TAF treatment had previous antiviral therapy experience (TDF, n =340; 70.8 %), and 21.9% were treatment-naive. The most common reasons for the initiation of TAF treatment were the use of drugs affecting bone mineral density (BMD) (42.9%) and osteoporosis (22.3%). Patients who had taken TDF experienced a significant improvement in glomerular filtration rate (GFR), hip and spine T-scores, and phosphorus levels from t = 0 months tot = 6 months after switching to TAF (P < 0.05). For this group, no statistically significant difference was observed concerning LDL and cholesterol levels from t= 0 months to t = 6 months. Side effects were reported by 5.7% of patients in the third month and 7.1% in the sixth month, with the most common side effect being hair loss (1%). Conclusions: TAF was found to be an effective and safe alternative to TDF with lower incidences of its long-term effects, such as nephrotoxicity and decreased bone density.Öğe Real-world data from Turkey: Is sofosbuvir/ledipasvir with or without ribavirin treatment for chronic Hepatitis C really effective?(Aves, 2021) Demirtürk, Neşe; Aygen, Bilgehan; Çelik, İlhami; Mistik, Reşit; Akhan, Sıla; Barut, Şener; Ural, Onur; Batırel, Ayşe; Şimsek, Funda; Ersöz, Gülden; İnan, Dilara; Kınıklı, Sami; Türker, Nesrin; Bilgin, Hüseyin; Gürbüz, Yunus; Tülek, Necla; Tarakçı, Hüseyin; Yıldız, Orhan; Türkoğlu, Emine; Güzel, Deniz Kamalak; Şimsek, Sümeyra; Tuna, Nazan; Demir, Nazlım Aktuğ; Çağatay, Atahan; Çetinkaya, Rıza Aytaç; Karakeçili, Faruk; Hakyemez, İsmail Necati; Ertem, Günay Tuncer; Örmen, Bahar; Korkmaz, Pınar; Sili, Uluhan; Kuruüzüm, Ziya; Şener, Alper; Özel, Selcan Arslan; Öztürk, Sinan; Süer, Kaya; Çelen, Mustafa Kemal; Konya, Petek; Asan, Ali; Saltoğlu, Neşe; Doğan, NurhanBackground: In this study, we aimed to investigate the efficacy and safety of sofosbuvir-based therapies in the treatment of chronic hepatitis C in real-world clinical practice. Methods: Data from patients with chronic hepatitis C treated with SOF/LDV +/- RBV or SOF/RBV in 31 centers across Turkey between April 1, 2017, and August 31, 2018, were recorded in a nationwide database among infectious disease specialists. Demographics, clinical, and virological outcomes were analyzed. Results: A total of 552 patients were included in the study. The mean age of the patients was 51.28 +/- 14.2, and 293 (55.8%) were female. The majority had HCV genotype 1b infection (65%), 75.04% of the patients underwent treatment, and non-cirrhosis was present at baseline in 381 patients (72.6%). SOF/LDV +/- RBV treatment was given to 477 patients and 48 patients received SOF/RBV according to HCV genotype. The total SVR12 rate was 99% in all patients. Five patients experienced disease relapse during the study and all of them were genotype 2. In patients infected with HCV GT2, SVR12 was 77.3%. SVR was 100% in all patients infected with other HCV genotypes. All treatments were well tolerated by patients without causing severe adverse events. Side effects and side effects-associated treatment discontinuation rates were 28.2% and 0.4%, respectively. Weakness (13.7%) was the common side effect. Conclusion: The present real-world data of 525 patients with HCV genotypes 1, 1a, 1b, 3, 4, and 5 who underwent SOF/LDV +/- RBV treatment in Turkey demonstrated a high efficacy and safety profile. HCV GT2 patients should be treated with more efficacious treatment.Öğe Real-world efficacy, safety, and clinical outcomes of ombitasvir/paritaprevir/ritonavir ± dasabuvir ± ribavirin combination therapy in patients with hepatitis C virus genotype 1 or 4 infection: The Turkey experience experience(AVES, 2020) Aygen, Bilgehan; Demirtürk, Neşe; Yıldız, Orhan; Çelen, Mustafa Kemal; Çelik, İlhami; Barut, Şener; Ural, Önur; Batırel, Ayşe; Mıstık, Reşit; Şi̇mşek, Funda; Asan, Ali; Ersöz, Gülden Munis; Türker, Nesrin Akbaş; Bilgin, Hüseyin; Kınıklı, Sami; Karakeçili, Faruk; Zararsız, Gökmen; Günal, Özgür; Akhan, Sıla Cetin; Tulek, N.; İnan, Dilara; Çaǧatay, Arif Atahan; Gürbüz, Yunus; Şener, Alper; Çelikbaş, Aysel Kocagül; Çetinkaya, Rıza Aytaç; Kadanalı, Ayten; Hakyemez, İsmail Necati; Kuruüzüm, Ziya; Özel, Selcan Arslan; Korkmaz, Pınar Yagiz; Tuna, Nazan; Saltoǧlu, Neşe; Tarakçı, Hüseyin; Uysal, Burcu; Karagöz, Ergenekon; Koçulu, Safiye; Ayaz, Celal; Güzel, Deniz Kamalak; Türkoğlu, Emine; Demir, Nazlım Aktuğ; Şimşek, Sümeyra; Kantürk, Arzu; Akça, Mustafa Özgür; Evik, Güliz; Örmen, Bahar Kopraman; Sili, Uluhan; Hatipoǧlu, Çiǧdem Ataman; Binay, Umut Devrim; Kılıç, Sırrı; Arslan, Kader; Yenilmez, Ercan; Çomoǧlu, Şenol; Koç, Meliha Meriç; Gökgöz, Altan; Dursun, Zehra Beştepe; Sümer, Şua; Heper, Yasemin; Yíldírmak, Taner T.; Öztürk, Sinan; Güğül, Tuğba Demirel; Yüce, Zeynep TüreBackground/Aims: mbitasvir/paritaprevir/ritonavir (OMV/PTV/r) ± dasabuvir (DSV) ± ribavirin (RBV) combination has demonstrated excellent rates of sustained virologic response (SVR) and a very good safety profile in patients with the chronic hepatitis C virus (HCV) genotype 1 or 4 infections. We aimed to investigate the effectiveness and safety of OMV/PTV/r ± DSV ± RBV combination regimen in a real-world clinical practice. Materials and Methods: Data from HCV genotype 1 and 4 patients treated with OMV/PTV/r ± DSV ± RBV (n=862) in 34 centers across Turkey between April 1, 2017 and August 31, 2018 were recorded in a large national database. Demographic, clinical, and virologic data were analyzed. Results: The mean age of the patients was 55.63, and 430 patients (49.9%) were male. The majority had HCV genotype 1b infection (77.3%), and 66.2% were treatment-naïve. Non-cirrhosis was present at baseline in 789 patients (91.5%). SVR12 rate was 99.1% in all patients. Seven patients had virologic failure. No significant differences were observed in SVR12 according to HCV genotypes. HCV RNA was undetectable at treatment week 4 in 90.9%, at treatment week 8 in 98.5%, and at the end of treatment (EOT) in 98.9%. SVR12 ratio was significantly higher in the non-cirrhotic patients compared to that in the compensated cirrhotic patients. Rates of adverse events (AEs) in the patients was 59.7%. Conclusion: The present real-life data of Turkey for the OBV/PTV/r ± DSV ± RBV treatment of patients with HCV genotype 1b, 1a, or 4 infection from 862 patients demonstrated high efficacy and a safety profile. © Copyright 2020 by The Turkish Society of Gastroenterology
