Düzce Üniversitesi Hastanesinde immünmodülatör tedavi alan hastaların hepatit B serolojilerinin retrospektif olarak değerlendirilmesi
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Tarih
2020
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Düzce Üniversitesi
Erişim Hakkı
info:eu-repo/semantics/openAccess
Özet
Giriş ve Amaç: İmmünsüprese tedavi alan kronik hepatit B ve daha önce geçirilmiş HBV enfeksiyonu olan hastalarda hepatit B reaktivasyonu görülebilmektedir. Hepatit B reaktivasyonu açısından enfeksiyon hastaları polikliniğinde takip edilen hastaların serolojik durumları ve HBV reaktivasyonunun retrospektif olarak değerlendirilmesi amaçlanmıştır. Gereç ve Yöntem: Hastanemiz Fizik tedavi ve rehabilitasyon ile Dermatoloji polikliniklerinde biyolojik ajan tedavisi alan ve Şubat 2017-Şubat 2020 yılları arasında Enfeksiyon hastalıkları polikliniğinde HBVr açısından takip edilen 166 hasta çalışmaya dahil edilmiştir. Hastaların HBV serolojileri, hepatit B reaktivasyon durumları ve antiviral profilaksileri retrospektif olarak değerlendirilmiştir. Bulgular: Çalışmaya dahil edilen 73 (%43,9) hasta romatoid artrit, 62 (%37,3) hasta ankilozan spondilit, 17 (%10,2) hasta psöriatik artrit, 14 (%8,4) hasta psöriazis nedeni ile biyolojik ajan tedavisi almaktaydı. Hastaların almakta olduğu biyolojik ajanlar hepatit B reaktivasyonu açısından orta risk kategorisindeydi. Serolojik olarak 16 hasta HBsAg pozitif/anti-HBcIgG pozitif, 150 hasta HBsAg negatif ve anti-HBcIgG pozitif olduğu görülmüştür. HBsAg pozitif hastaların tamamına antiviral profilaksi aldığı görülmüş olup lamivudin profilaksisi alan bir hastada HBVr saptanmıştır. HBsAg negatif/anti-HBcIgG pozitif hastalar profilaksi başlanan ve profilaksisiz izlem yapılan hastalar olarak iki grupta değerlendirilmiştir. Profilaksisiz izlem yapılan 104 hastanın 18' inde (%17,3) HBVr saptanmış olup, HBVr saptanan hastalarda HBsAg ters serokonversiyonu olmamış ve AST, ALT değerlerinde artış görülmemiştir. Anti-HBs titresi 100 IU/L altında olan hastalarda 2,5 kat fazla HBVr saptanmıştır. Antiviral profilaksi başlanan 46 hastanın dördünde (%8,7) HBVr görülmüş olup HBsAg ters serokonversiyonu ve AST, ALT değerlerinde artış saptanmamıştır. Sonuç: HBsAg negatif/anti-HBcIgG pozitif HBV reaktivasyonu görülen hastalarda yalnızca HBV DNA pozitifliği saptanmış olup biyokimyasal hepatit ve HBsAg ters serokonversiyonu görülmemiştir. HBV reaktivasyonu açısından orta risk kategorisinde immünsüpresif ajan kullanımı olan hastalarda preemptif tedavi yaklaşımının daha uygun olabileceği düşünülmüştür. Anti-HBs titresi 100 IU/L altında olan hastalarda 2,5 fazla görülmesi nedeni ile Anti-HBs yüksek titrede olmasının HBVr' yi önlemede koruyucu olabileceğini düşündürmüştür. HBsAg pozitif lamivudin profilaksisi alan bir hastada HBVr saptanmıştır. Antiviral profilaksi kararı verilirken yüksek direnç bariyeri olan entekavir ve tenofovir gibi antiviral ajanların tercih edilmesinin daha uygun bir seçenek olabileceği düşünülmüştür.
İntroduction and Aim: Hepatitis B reactivation can be seen in patients with chronic hepatitis B who receive immunosuppressed treatment and those who have previously had HBV infection. In terms of hepatitis B reactivation, we aimed to retrospectively evaluate the serological status and HBV reactivation of the patients being followed up in the infection diseases clinic. Material and Method: 166 patients who were followed up in the infectious diseases clinic for HBVr between February 2017 and February 2020, who received biological agent treatment in our hospital's physical treatment and rehabilitation and dermatology clinics, were included in the study. HBV serology and hepatitis B reactivation status and antiviral prophylaxis of the patients were evaluated retrospectively. Results: Of the patients included in the study, 73 (%43.9) patients with rheumatoid arthritis, 62 patients (%37.3) patients ankylosing spondylitis, 17 (10.2%) patients with psoriatic arthritis, 14 (%8.4) with psoriasis, was receiving biological agent treatment. The biological agents taken by the patients are in the medium risk category in terms of hepatitis B reactivation. Serologically, it is found that 16 patients were HBsAg positive /anti-HBcIgG positive, 150 patients were HBsAg negative ve anti-HBcIgG positive. All of the HBsAg positive patients received antiviral prophylaxis and HBVr was detected in one patient who received lamivudine prophylaxis. HBsAg negative / anti-HBcIgG positive patients were evaluated in two groups as patients who were started prophylaxis and those who were followed up without prophylaxis. HBVr was detected in 18 of 104 patients who were followed up without prophylaxis (%17.3), HBsAg reverse seroconversion did not occur in patients with HBVr and no increase in AST and ALT values were observed. In patients with anti-HBs titres below 100 IU / L, 2.5 times more HBVr was detected. HBVr was observed in 4 (%8.7) of 46 patients in whom antiviral prophylaxis was initiated, and no HBsAg reverse seroconversion and increase in AST, ALT values were observed. Conclusion: In HBsAg negative / anti-HBcIgG positive patients, only HBV DNA positivity was detected in patients with HBV reactivation, and biochemical hepatitis and HBsAg reverse seroconversion were not observed. In terms of HBV reactivation, it was thought that the preemptive treatment approach would be more appropriate in patients with the use of immunosuppressive agents in the medium risk category. Since it is seen 2.5 more in patients with anti-HBs titer below 100 IU / l, it has been suggested that high titre of Anti-HBs may be protective in preventing HBVr. HBVr was detected in a patient receiving HBsAg positive LAM prophylaxis. While deciding on antiviral prophylaxis, it was thought that preference of antiviral agents such as ETV and TDF, which have high resistance barriers, may be a more appropriate option.
İntroduction and Aim: Hepatitis B reactivation can be seen in patients with chronic hepatitis B who receive immunosuppressed treatment and those who have previously had HBV infection. In terms of hepatitis B reactivation, we aimed to retrospectively evaluate the serological status and HBV reactivation of the patients being followed up in the infection diseases clinic. Material and Method: 166 patients who were followed up in the infectious diseases clinic for HBVr between February 2017 and February 2020, who received biological agent treatment in our hospital's physical treatment and rehabilitation and dermatology clinics, were included in the study. HBV serology and hepatitis B reactivation status and antiviral prophylaxis of the patients were evaluated retrospectively. Results: Of the patients included in the study, 73 (%43.9) patients with rheumatoid arthritis, 62 patients (%37.3) patients ankylosing spondylitis, 17 (10.2%) patients with psoriatic arthritis, 14 (%8.4) with psoriasis, was receiving biological agent treatment. The biological agents taken by the patients are in the medium risk category in terms of hepatitis B reactivation. Serologically, it is found that 16 patients were HBsAg positive /anti-HBcIgG positive, 150 patients were HBsAg negative ve anti-HBcIgG positive. All of the HBsAg positive patients received antiviral prophylaxis and HBVr was detected in one patient who received lamivudine prophylaxis. HBsAg negative / anti-HBcIgG positive patients were evaluated in two groups as patients who were started prophylaxis and those who were followed up without prophylaxis. HBVr was detected in 18 of 104 patients who were followed up without prophylaxis (%17.3), HBsAg reverse seroconversion did not occur in patients with HBVr and no increase in AST and ALT values were observed. In patients with anti-HBs titres below 100 IU / L, 2.5 times more HBVr was detected. HBVr was observed in 4 (%8.7) of 46 patients in whom antiviral prophylaxis was initiated, and no HBsAg reverse seroconversion and increase in AST, ALT values were observed. Conclusion: In HBsAg negative / anti-HBcIgG positive patients, only HBV DNA positivity was detected in patients with HBV reactivation, and biochemical hepatitis and HBsAg reverse seroconversion were not observed. In terms of HBV reactivation, it was thought that the preemptive treatment approach would be more appropriate in patients with the use of immunosuppressive agents in the medium risk category. Since it is seen 2.5 more in patients with anti-HBs titer below 100 IU / l, it has been suggested that high titre of Anti-HBs may be protective in preventing HBVr. HBVr was detected in a patient receiving HBsAg positive LAM prophylaxis. While deciding on antiviral prophylaxis, it was thought that preference of antiviral agents such as ETV and TDF, which have high resistance barriers, may be a more appropriate option.
Açıklama
YÖK Tez No: 642222
Anahtar Kelimeler
Klinik Bakteriyoloji ve Enfeksiyon Hastalıkları, Clinical Microbiology and Infectious Diseases
