Renal transplant planlanan kronik hepatit C' li hemodiyaliz hastalarında pegile-interferon alfa-2a tedavisine hızlı ve erken virolojik yanıt oranları ile okült hepatit b enfeksiyonunun tedaviye etkisi
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Date
2009
Authors
Keskin, Murat
Journal Title
Journal ISSN
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Publisher
Uludağ Üniversitesi
Abstract
Kronik hepatit C'li hemodiyaliz hastalarında, hepatit C virus (HCV) enfeksiyonu prevalansı genel popülasyona göre belirgin derecede daha yüksektir. Bu hastalarda HCV enfeksiyonu önemli bir morbidite ve mortalite sebebidir. Aynı zamanda hemodiyalize giren kronik hepatit C hastalarında okült hepatit B virus (HBV) enfeksiyonu riski de artmıştır. Bu çalışmada hemodiyalize giren kronik hepatit C' li hastalarda pegile interferon alfa-2a monoterapisine hızlı ve erken virolojik yanıt oranlarının saptanması ve okült HBV enfeksiyonunun bu hasta grubunda tedaviye etkisinin olup olmadığının araştırılması amaçlanmıştır.Çalışmaya 11 hemodiyaliz (3 kez/hafta) hastası alındı. Tüm hastalar interferon naiv, anti-HCV pozitif, polimerize zincir reaksiyonu ile HCV RNA'sı pozitif ve karaciğer fibrozis skoru ?2 olan hastalar idi. Tüm hastalara pegile interferon alfa-2a, 135 µg dozunda, subkutan, haftada bir kez uygulandı. İlaveten, tedavi öncesi dönemde, çalışmaya alınan HbsAg'si negatif, anti- Hbs antikoru pozitif olan hastalara okült HBV enfeksiyonun saptanması için serum HBV DNA testi de yapıldı. Tedavinin 4. ve 12. haftasında hızlı virolojik yanıt (HVY) ve erken virolojik yanıt (EVY) oranları incelendi. Ayrıca okült HBV enfeksiyonu olan hastalarda tedavinin 12. haftasında HBV DNA testi tekrarlandı ve kronik hepatit C tedavisine etkisi incelendi.Sırasıyla, HVY ve EVY, 5 hastada (% 45.5) ve 10 hastada (%90.9) elde edildi. Tedavi öncesi prediktif faktörler olan kadın cinsiyet, 40 yaş altı olma, serum alanin aminotransferaz (ALT) düzeyi, viral yük, karaciğer fibrozis skoru ile HVY arasında ilişki bulunamadı. Hasta sayısı yetersiz olduğu için EVY ile prediktif faktörler arasındaki ilişki incelenmedi. Sadece 1 hastada (%9.1) EVY elde edilemedi ve bu hastada genotip 4 idi. Sırasıyla, tedavinin 4. ve 12. haftasında, 9 (%81.8) hastada ve 5 (%45.5) hastada ilaca bağlı yan etki gelişti. Sadece 1 (%9.1) hasta yan etki nedeniyle tedaviyi bıraktı. Okült HBV enfeksiyonu saptanması için 6 hastada HBV DNA çalışılabildi. Sadece 1 (% 16.7) hastada okült HBV enfeksiyonu saptandı. Bu hastada tedavinin 12. haftasında HBV DNA' sı negatif tespit edildi.Normal böbrek fonksiyonlu kronik hepatit C hastalarına göre hemodiyaliz hastalarında pegile interferon alfa-2a monoterapisi ile daha yüksek HVY ve EVY elde etmek mümkündür. Özellikle renal transplantasyon öncesi dönemde, bu hastaların yakın klinik ve laboratuvar takibi ile pegile inteferon alfa-2a monoterapisi güvenle kullanılabilir. Okült HBV enfeksiyonun hemodiyalize giren kronik hepatit C'li hastalar arasında daha sık olabileceği göz önünde bulundurulmalıdır. Ancak bu hasta grubunda okült HBV enfeksiyonunun seyri ve kronik hepatit C tedavisine etkisi konusunda daha geniş hasta sayılı, prospektif çalışmalara ihtiyaç vardır.
Prevalence of hepatitis C virus (HCV) infections are appearance significantly more than the normal population to heamodialysis patients with chronic hepatitis C. HCV infection is an important cause of morbidity and mortality among in this patients. At the same time, the risk factor of in heamodialysis patients with chronic HCV infection has been increased for occult hepatitis B virus (HBV) infection. The aim of this study has been evaluated the rapidly virologic response (RVR) and early virologic response (EVR) of pegylated interferon alpha-2a and whether occult HBV infection are impacted for treatment on this patients or not.Eleven heamodialysis patients (3 sesion/ weekly) were included into the study. All of the patients were interferon naive, anti-HCV antibodies positive, polymerase chain reaction HCV RNA positive and liver fibosis score ≥ 2. Pegylated interferon alpha-2a, 135 µg, subcutaneous, weekly was applied to all of the patients. Additionally, the patients who had negative HbsAg and anti-HCV positive were tested polymerase chain reaction HBV DNA. In the 4th and 12th week of treatment RVR and EVR were investigated. Separately, HBV DNA test were repeated in the 12th week of treatment in patients with occult HBV infection and influences were investigated on the treatment of chronic hepatitis C.RVR and EVR were observed in 5 patients (45,5 %) and 10 patients (90,9 %), respectively. At the stage of pretreatment, predictive factors are such female sex, less than 40 years-old, serum alanine aminotransferase (ALT) level, viral load, liver fibrosis score were not associated with RVR. Since the number of patients were insufficient, it was not investigated between EVR and predictive factors. The only 1 patient (9.1 %) who did not have any EVR had genotype 4. In the 4th and 12th week of treatment, adverse effect was developed on 9 patients (81.9 %) and 5 patients (45.5, %), respectively. The only 1 patient (9.1 %) was taken out of treatment due to adverse effect. It was applied to 6 patients for HBV DNA test and it was detected on only 1 patient (16.7 %). In this patient, it was observed HBV DNA negative in 12th week.It was obtained with high rate for RVR and EVR on the heamodialysis patients with chronic hepatitis C rather than the normal renal function with chronic hepatitis C with pegylated interferon alpha-2a monotherapy. Especially, before the stage of renal transplantation, pegylated interferon alpha-2a monotherapy can be used on this patients by close to follow up clinically and laboratuary. It should be considered that occult HBV infections are among in heamodialysis patients with chronic hepatitis C. But course of occult HBV infection and impact of chronic hepatitis C on treatment are needed to be studied with high number of patients by prospectively.
Prevalence of hepatitis C virus (HCV) infections are appearance significantly more than the normal population to heamodialysis patients with chronic hepatitis C. HCV infection is an important cause of morbidity and mortality among in this patients. At the same time, the risk factor of in heamodialysis patients with chronic HCV infection has been increased for occult hepatitis B virus (HBV) infection. The aim of this study has been evaluated the rapidly virologic response (RVR) and early virologic response (EVR) of pegylated interferon alpha-2a and whether occult HBV infection are impacted for treatment on this patients or not.Eleven heamodialysis patients (3 sesion/ weekly) were included into the study. All of the patients were interferon naive, anti-HCV antibodies positive, polymerase chain reaction HCV RNA positive and liver fibosis score ≥ 2. Pegylated interferon alpha-2a, 135 µg, subcutaneous, weekly was applied to all of the patients. Additionally, the patients who had negative HbsAg and anti-HCV positive were tested polymerase chain reaction HBV DNA. In the 4th and 12th week of treatment RVR and EVR were investigated. Separately, HBV DNA test were repeated in the 12th week of treatment in patients with occult HBV infection and influences were investigated on the treatment of chronic hepatitis C.RVR and EVR were observed in 5 patients (45,5 %) and 10 patients (90,9 %), respectively. At the stage of pretreatment, predictive factors are such female sex, less than 40 years-old, serum alanine aminotransferase (ALT) level, viral load, liver fibrosis score were not associated with RVR. Since the number of patients were insufficient, it was not investigated between EVR and predictive factors. The only 1 patient (9.1 %) who did not have any EVR had genotype 4. In the 4th and 12th week of treatment, adverse effect was developed on 9 patients (81.9 %) and 5 patients (45.5, %), respectively. The only 1 patient (9.1 %) was taken out of treatment due to adverse effect. It was applied to 6 patients for HBV DNA test and it was detected on only 1 patient (16.7 %). In this patient, it was observed HBV DNA negative in 12th week.It was obtained with high rate for RVR and EVR on the heamodialysis patients with chronic hepatitis C rather than the normal renal function with chronic hepatitis C with pegylated interferon alpha-2a monotherapy. Especially, before the stage of renal transplantation, pegylated interferon alpha-2a monotherapy can be used on this patients by close to follow up clinically and laboratuary. It should be considered that occult HBV infections are among in heamodialysis patients with chronic hepatitis C. But course of occult HBV infection and impact of chronic hepatitis C on treatment are needed to be studied with high number of patients by prospectively.
Description
Keywords
Hemodiyaliz, Kronik hepatit C, Pegile interferon alfa- 2a, Hızlı ve erken virolojik yanıt, Okült hepatit B virus enfeksiyonu, Heamodialysis, Chronic hepatitis C, Pegylated interferon alpha- 2a, Rapidly and early virological response, Occult hepatitis B infection
Citation
Keskin, M. (2009). Renal transplant planlanan kronik hepatit C' li hemodiyaliz hastalarında pegile-interferon alfa-2a tedavisine hızlı ve erken virolojik yanıt oranları ile okült hepatit b enfeksiyonunun tedaviye etkisi. Yayınlanmamış uzmanlık tezi. Uludağ Üniversitesi Tıp Fakültesi.