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Öğe Awareness of Hepatitis B Virus Reactivation Among Physicians Administering Immunosuppressive Treatment and Related Clinical Practices(Aves, 2019) Korkmaz, Pinar; Demirturk, Nese; Aydin, Gule; Ceken, Sabahat; Aygen, Bilgehan; Toka, Onur; Gundogdu, KiymetObjective: 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 Evaluation of Dual Therapy in Real Life Setting in Treatment-Naïve Turkish Patients with HCV Infection: A Multicenter, Retrospective Study(2016) Gürbüz, Yunus; Tülek, Necla Eren; Tütüncü, Emin Ediz; Koruk, Süda Tekin; Aygen, Bilgehan; Demirtürk, Neşe; Kınıklı, SamiBackground: Before the introduction of direct-acting antivirals in the treatment of chronic hepatitis C patients, the combination of peginterferon alpha and ribavirin was the standard therapy. Observational studies that in-vestigated sustained virological response (SVR) rates by these drugs yielded different outcomes. Aims: The goal of the study was to demonstrate real life data concerning SVR rate achieved by peginterferon al-pha plus ribavirin in patients who were treatment-naïve. Study Design: A multicenter, retrospective observa-tional study.Methods: The study was conducted retrospectively on 1214 treatment naïve-patients, being treated with pegin-terferon alpha-2a or 2b plus ribavirin in respect of the current guidelines between 2005 and 2013. The patients' data were collected from 22 centers via a standard form, which has been prepared for this study. The data includ-ed demographic and clinical characteristics (gender, age, body weight, initial Hepatitis C virus RNA (HCV RNA) level, disease staging) as well as course of treatment (du-ration of treatment, outcomes, discontinuations and ad-verse events). Renal insufficiency, decompensated liver disease, history of transplantation, immunosuppressive therapy or autoimmune liver disease were exclusion criteria for the study. Treatment efficacy was assessed according to the patient's demographic characteristics, baseline viral load, genotype, and fibrosis scores. Results: The mean age of the patients was 50.74 (±0.64) years. Most of them were infected with genotype 1 (91.8%). SVR was achieved in 761 (62.7%) patients. SVR rate was 59.1% in genotype 1, 89.4% in genotype 2, 93.8% in genotype 3, and 33.3% in genotype 4 pa-tients. Patients with lower viral load yielded higher SVR (65.8% vs. 58.4%, p=0.09). SVR rates according to his-tologic severity were found to be 69.3%, 66.3%, 59.9%, 47.3%, and 45.5% in patients with fibrosis stage 0, 1, 2, 3 and 4, respectively. The predictors of SVR were male gender, genotype 2/3, age less than 45 years, low fibrosis stage, low baseline viral load and presence of early viro-logical response. SVR rates to each peginterferon were found to be similar in genotype 1/4 although SVR rates were found to be higher for peginterferon alpha-2b in patients with genotype 2/3. The number of patients who failed to complete treatment due to adverse effects was 33 (2.7%). The number of patients failed to complete treatment due to adverse effects was 33 (2.7%).Conclusion: Our findings showed that the rate of SVR to dual therapy was higher in treatment-naïve Turkish pa-tients than that reported in randomized controlled trials. Also peginterferon alpha-2a and alpha-2b were found to be similar in terms of SVR in genotype 1 patients.Öğe Evaluation of Dual Therapy in Real Life Setting in Treatment-Naive Turkish Patients with HCV Infection: A Multicenter, Retrospective Study(Galenos Publ House, 2016) Gurbuz, Yunus; Tulek, Necla Eren; Tutuncu, Emin Ediz; Koruk, Suda Tekin; Aygen, Bilgehan; Demirturk, Nese; Kinikli, SamiBackground: Before the introduction of direct-acting antivirals in the treatment of chronic hepatitis C patients, the combination of peginterferon alpha and ribavirin was the standard therapy. Observational studies that investigated sustained virological response (SVR) rates by these drugs yielded different outcomes. Aims: The goal of the study was to demonstrate real life data concerning SVR rate achieved by peginterferon alpha plus ribavirin in patients who were treatment-naive. Study Design: A multicenter, retrospective observational study. Methods: The study was conducted retrospectively on 1214 treatment naive-patients, being treated with peginterferon alpha-2a or 2b plus ribavirin in respect of the current guidelines between 2005 and 2013. The patients' data were collected from 22 centers via a standard form, which has been prepared for this study. The data included demographic and clinical characteristics (gender, age, body weight, initial Hepatitis C virus RNA (HCV RNA) level, disease staging) as well as course of treatment (duration of treatment, outcomes, discontinuations and adverse events). Renal insufficiency, decompensated liver disease, history of transplantation, immunosuppressive therapy or autoimmune liver disease were exclusion criteria for the study. Treatment efficacy was assessed according to the patient's demographic characteristics, baseline viral load, genotype, and fibrosis scores. Results: The mean age of the patients was 50.74 (+/- 0.64) years. Most of them were infected with genotype 1 (91.8%). SVR was achieved in 761 (62.7%) patients. SVR rate was 59.1% in genotype 1, 89.4% in genotype 2, 93.8% in genotype 3, and 33.3% in genotype 4 patients. Patients with lower viral load yielded higher SVR (65.8% vs. 58.4%, p=0.09). SVR rates according to histologic severity were found to be 69.3%, 66.3%, 59.9%, 47.3%, and 45.5% in patients with fibrosis stage 0, 1, 2, 3 and 4, respectively. The predictors of SVR were male gender, genotype 2/3, age less than 45 years, low fibrosis stage, low baseline viral load and presence of early virological response. SVR rates to each peginterferon were found to be similar in genotype 1/4 although SVR rates were found to be higher for peginterferon alpha-2b in patients with genotype 2/3. The number of patients who failed to complete treatment due to adverse effects was 33 (2.7%). The number of patients failed to complete treatment due to adverse effects was 33 (2.7%). Conclusion: Our findings showed that the rate of SVR to dual therapy was higher in treatment-naive Turkish patients than that reported in randomized controlled trials. Also peginterferon alpha-2a and alpha-2b were found to be similar in terms of SVR in genotype 1 patients.Öğe Management of Chronic Hepatitis C Virus Infection: A Consensus Report of the Study Group for Viral Hepatitis of the Turkish Society of Clinical Microbiology and Infectious Diseases(Aves, 2014) Aygen, Bilgehan; Keten, Derya; Akalin, Halis; Asan, Ali; Bozdag, Heval; Cagir, Unal; Demirturk, NeseStudy Group for Viral Hepatitis of the Turkish Society of Clinical Microbiology and Infectious Diseases convened a meeting to develop a consensus report on management of chronic hepatitis C virus (HCV) infection, a global public health problem, affecting nearly 170 million people worldwide. Relevant literature and international guidelines were reviewed, and recommendations agreed are presented at the end of each section such as epidemiology and natural history of HCV infection, economic burden of chronic hepatitis C (CHC), diagnosis of acute hepatitis C (AHC) and CHC, treatment of AHC, goals, endpoints, stopping rules and pre-therapeutic assessment of CHC therapy, indications for treatment, treatment of CHC, monitoring and managing treatment safety and side effects, measures to improve treatment adherence, posttreatment follow-up of patients who achieve a sustained virological response, contraindications to therapy, retreatment of non-sustained virological responders, follow-up of untreated patients and of patients with treatment failure, and prevention of HCV infection. Examples of some selected recommendations are as follows: [1] It should be kept in mind that approximately 75-85% of people who become infected will develop chronic HCV infection, up to 20% of them develop cirrhosis within 20 years, and the average annual risk of hepatocellular carcinoma among them is 1-4%. [2] In addition to the HCV RNA quantification, the HCV genotype should be assessed to provide relevant information with respect to treatment duration and different response rates prior to treatment initiation. [3] If predicted response rate is not appropriate to any of the existing regimens, the patient should be kept waited until alternative therapeutic options become available.Öğe Management of Chronic Hepatitis C Virus Infection: A Consensus Report of the Study Group for Viral Hepatitis of the Turkish Society of Clinical Microbiology and Infectious Diseases-2017 Update(2017) Aygen, Bilgehan; Demirtürk, Neşe; Türker, Nesrin; Asan, Ali; Eraksoy, Haluk; Gürbüz, Yunus; İnan, DilaraTürk Klinik Mikrobiyoloji ve İnfeksiyon Hastalıkları Derneği Viral Hepatit Çalışma Grubu tarafından, ilk olarak 2014 yılında tüm dünyada önemli bir sağlık sorunu olan hepatit C virusu (HCV) infeksiyonunun yönetimine ilişkin bir uzlaşı raporu hazırlanmış ve Klimik Dergisi'nde yayımlanmıştır. Kronik hepatit Recently, we needed to update this report considering the new developments in treatment of chronic hepatitis C (CHC). This new consensus report is based on review of current literature and international guidelines. Agreed recommendations are presented at the end of each section such as epidemiology and natural history of HCV infection, diagnosis of acute hepatitis C (AHC) and CHC, treatment of AHC, goals of CHC therapy and pre-therapeutic assessment of CHC therapy, indications for treatment, contraindications to therapy, direct-acting antivirals (DAA) in the treatment of CHC and drug-drug interactions in the treatment of DAA, resistance problem in DAA treatment and clinical assesment of resistance, monitoring and managing treatment safety and side effects, post-treatment follow-up of patients who achieve a sustained virological response (SVR), follow-up of patients who didn't achieve an SVR and prevention of HCV infection. Klimik Dergisi 2017; 30(Suppl. 1): 2-36Öğe Management of chronic hepatitis C virus infection: A consensus report of the study group for viral hepatitis of the Turkish society of clinical microbiology and infectious diseases-2017 update(AVES Ibrahim Kara, 2017) Aygen, Bilgehan; Demirtürk, Neşe; Türker, Nesrin; Asan, Ali; Eraksoy, Haluk; Gürbüz, Yunus; İnan, DilaraPreviously a consensus report about management of hepatitis C virus (HCV) infection, a major health problem all over the world had been prepared by Study Group for Viral Hepatitis of the Turkish Society of Clinical Microbiology and Infectious Diseases. It was first published in the Klimik Journal in 2014. Recently, we needed to update this report considering the new developments in treatment of chronic hepatitis C (CHC). This new consensus report is based on review of current literature and international guidelines. Agreed recommendations are presented at the end of each section such as epidemiology and natural history of HCV infection, diagnosis of acute hepatitis C (AHC) and CHC, treatment of AHC, goals of CHC therapy and pre-therapeutic assessment of CHC therapy, indications for treatment, contraindications to therapy, direct-acting antivirals (DAA) in the treatment of CHC and drug-drug interactions in the treatment of DAA, resistance problem in DAA treatment and clinical assesment of resistance, monitoring and managing treatment safety and side effects, post-treatment follow-up of patients who achieve a sustained virological response (SVR), follow-up of patients who didn’t achieve an SVR and prevention of HCV infection. © 2017, AVES Ibrahim Kara. All rights reserved.Öğe Ombitasvir/ Paritaprevir/ Ritonavir(Doc Design Informatics Co Ltd, 2019) Aygen, Bilgehan; Demirturk, Nese; Yildiz, Orhan; Celik, Ilhami; Guzel, Deniz Kamalak; Ersoz, Guelden; Batirel, AyseObjective: Objective: Ombitasvir/paritaprevir/ritonavir (OMV/PTV/r) + ribavirin (RBV) combination improved the efficacy, safety, and tolerability of the treatment of chronic hepatitis C virus (HCV) genotype 4 infection. We described the effectiveness and safety of OMV/PTV/r + RBV therapy in patients with genotype 4 infection. Materials and Methods: In this prospective cohort study, HCV genotype 4-infected patients treated with OMV/PTV/r + RBV (n=55) who were registered in a national database were included. Study patients were treatment-naive or interferon plus RBV-experienced with or without compensated cirrhosis. Demographic, clinical and virological data were analyzed. Details of clinical and laboratory adverse events (AEs) were recorded.Results: The mean age of the patients was 55.2, and 52.7% were male. The majority of patients were non-cirrhotic (81.8%), and 69.1% were treatment-naive. The HCV RNA level was below 800.000 IU/mL in 16 of the cases. Seventy-eight percent of the patients had an underlying disease. SVR12 rate was 98% in all patients. One patient had virological failure. HCV RNA was undetectable at treatment week 4 in 77.6%, at treatment week 8 in 100%, and at end of treatment in 98%. The SVR12 rates were 100% and 88.9% for those without or with compensated cirrhosis (p= 0.176). Rates of AEs and AEsassociated treatment discontinuation were 69.1% and 3.6% in the patients, respectively.Conclusion: The OBV/PTV/r + RBV combination was found to have high efficacy and safety profile in the patients with chronic HCV genotype 4 infection.Öğe Real-world data from Turkey: Is sofosbuvir/ledipasvir with or without ribavirin treatment for chronic hepatitis C really effective?(Turkish Society of Gastroenterology, 2021) Demirtürk, Neşe; Aygen, Bilgehan; Çelik, İlhami; Mıstık, Reşit; Akhan, Sıla; Barut, Şener; Şener, AlperBackground: 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 The Efficacy of Glecaprevir/Pibrentasvir in Chronic Hepatitis C Patients and the Impact of the COVID-19 Pandemic: Multicenter Real-Life Data(Doc Design Informatics Co Ltd, 2024) Gurbuz, Yunus; Kocagul-Celikbas, Aysel; Oztoprak, Nefise; Aygen, Bilgehan; Batirel, Ayse; Habiloglu, Arif Dogan; Aktug-Demir, NazlimObjective: This study aimed to demonstrate the real-life efficacy and safety of glecaprevir / pibrentasvir in the treatment of chronic hepatitis C, as well as to identify the problems caused by the COVID-19 pandemic in the follow-up and treatment of patients. Materials and Methods: The study was conducted retrospectively with the participation of researchers from universities or training and research hospitals. It included patients with chronic hepatitis C who were over 18 years of age, treatment-na & iuml;ve or treatment-experienced, had detectable HCV RNA and were receiving glecaprevir/pibrentasvir treatment Results: Only 188 of the 385 patients who participated in the study came to the follow-up visit 12 weeks after treatment, and all of them had a sustained virological response. It was thought that a significant portion of the 177 patients who did not come to the follow-up visit at 12 weeks after treatment refrained from coming to the hospital due to the COVID-19 pandemic. None of the patients who attended the follow-up visits required treatment discontinuation due to adverse events. Conclusion: Glecaprevir/pibrentasvir is a highly effective and relatively safe drug in the treatment of chronic hepatitis C. The COVID-19 pandemic has negatively affected the follow-up and treatment processes of patients. New measures are needed for the follow-up and treatment of patients with chronic hepatitis C during pandemics.
