Nilay DANIŞ, Ayşe ARSLAN, Abdullah Murat BUYRUK, Fulya, AYŞIN ZEYTİNOĞLU TÜRKEŞ, İmre ALTUĞLU, Ulus Salih AKARCA

Cerrahi prosedürler öncesi anti-HCV taraması: Hastalar yeterince bilgi sahibi mi?

Giriş ve Amaç: Direkt etkili anti viral ilaçların kullanılmasıyla, hepatit C virüsü enfeksiyonunun tedavisinde başarı oranı %100’e yaklaşmıştır. Bununla birlikte, birçok hasta teşhis konulmayı beklemektedir. Biz mevcut çalışmada cerrahi öncesi hepatit C virüsü taraması yapılan hastalarda anti-hepatit C virüsü ve hepatit C virüs-RNA pozitifliğinin prevalansını belirlemeyi ve hastalığından habersiz olan hastaların oranını araştırmayı amaçladık. Gereç ve Yöntem: 2012-2015 yılları arasında cerrahi kliniklerinde anti-hepatit C virüsü pozitif saptanan hastalar, hepatit C virüs-RNA pozitifliği ve tedavi geçmişi açısından araştırıldı. Hepatit C virüs-RNA pozitifliği açısından hastane kayıtları tarandı. Tedavi bilgilerine Medula Sisteminden (Sosyal Güvenlik Sisteminden entegre bir veri tabanı) ulaşıldı. Tedavisiz anti-hepatit C virüsü pozitif hastalara telefonla pozitiflikten haberdar olup olmadıkları soruldu. Bulgular: 4 yıl boyunca 19627 hasta anti-hepatit C virüsü pozitifliği açısından tarandı. 158 hastada (%0.8) anti-hepatit C virüsü pozitif bulundu (76 erkek, 82 kadın; yaş: 58.2 ± 17.6). Hepatit C virüs-RNA 83 hastada bakılmıştı, 75 hastada hepatit C virüs-RNA testi yoktu. Ulaşılabilen 58 hastanın sadece 14’ü anti-hepatit C virüsü pozitif olduğunu biliyordu. Diğer 44 hasta gastroenteroloji veya enfeksiyon hastalıkları polikliniklerine başvurmaları konusunda uyarıldı. Sonuç: Cerrahi girişim uygulanan 19627 hastanın %0.8’inde anti-hepatit C virüsü genel Türkiye nüfusuna benzer oranda pozitif bulunmuştur. Hastaların neredeyse yarısında hepatit C virüs-RNA test edilmemiş ve çoğu hasta hepatit C virüsü-RNA’nın test edilmesi ve izlenmesi gerektiği bilgisine sahip değildir. Anti- hepatit C virüsünün cerrahi öncesi taranması yeni hastaların tespiti açısından yetersiz bulunmuştur.

Anahtar Kelimeler:

Anti-HCV pozitifliği, HCV-RNA, serolojik tarama

Anti-hepatitis C virus screening before surgical procedures: Are patients sufficiently informed?

Background and Aims: The success rate of hepatitis C virus treatment is ~100% after administration of direct-acting antivirals. However, many patients remain undiagnosed. We determined the prevalence of anti-hepatitis C virus and hepatitis C virus-RNA positivity in patients who were screened for hepatitis C virus before surgical procedures and investigated the rate of awareness of their illness. Materials and Methods: Anti-hepatitis C virus screening data were requested and reviewed from all surgical clinics between 2012 and 2015, and positive patients were evaluated for hepatitis C virus-RNA positivity. Treatment data were collected from the Medula System, an integrated database of the Social Security System. Untreated anti-hepatitis C virus positive patients were contacted by phone and asked whether they were aware of their positivity. Results: A total of 19,627 patients were screened for anti-hepatitis C virus during the study period, of which 158 patients (0.8%) were positive (male: 76; female: 82; age: 58.2 ± 17.6 years). Eighty-three patients were tested for hepatitis C virus-RNA, whereas 75 patients were not. Of the 58 patients who could be contacted, 14 were aware of their anti-hepatitis C virus positivity. The remaining 44 patients were alerted to present to the gastroenterology or infectious diseases outpatient clinic. Conclusion: Among the 19,627 patients screened, 0.8% showed anti-hepatitis C virus positivity, which is similar to the prevalence of anti-hepatitis C virus positivity among the general Turkish population. Almost half of the patients were not tested for hepatitis C virus-RNA, and most of the patients had no information about their anti--hepatitis C virus positivity. These results indicate that pre-surgical anti-hepatitis C virus screening is insufficient for diagnosing new patients.

Keywords:

Anti-HCV positivity, HCV-RNA, serology screening,

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1. Tozun N, Ozdogan O, Cakaloglu Y, et al. Seroprevalence of hepatitis B and C virus infections and risk factors in Turkey: A fieldwork TURHEP study. Clin Microbiol Infect 2015;21:1020-6.
2. Idilman R, Aydogan M, Oruncu MB, et al. Natural history of cirrhosis: changing trends in etiology over the years. Dig Dis. 2020 Nov 3.
3. Hezode C, Treatment of hepatitis C: Results in life. Liver Int 2018;38(Suppl 1):21-7.
4. Akkuzu MZ, Sezgin O, Yaraş S, et al. Patients lost after anti-HCV-positive finding in a tertiary care university hospital: Increased awareness and action is necessary to eradicate HCV. Med Bull Sisli Etfal Hosp 2019;53:366-70.
5. Prince DS, Pipicella JL, Fraser M, et al. Screening emergency admissions at risk of chronic hepatitis C (SEARCH) to diagnose or ‘re-diagnose’ infections is effective in Australia. J Viral Hepat 2021;28:121-8.
6. Gentile I, Pinchera B, Viceconte G, et al. Hepatitis C screening in the Emergency Department of a large hospital in Southern Italy: results of a pilot study. Infez Med 20191;27:32-9.
7. Ndako JA, Owolabi AO, Olisa JA, et. al. Studies on the prevalence of Hepatitis C virus infection in diabetic patients attending a tertiary health-care facility South-west Nigeria. BMC Infect Dis 2020;20:664.
8. Arhan M, Akdoğan M, İbiş M, et al. Data of hepatocellular carcinoma from a single center: A retrospective study. Akademik Gastroenteroloji Dergisi 2009;8:18-23.
9. Calvaruso V, Craxì A. Hepatic benefits of HCV cure. J Hepatol 2020;73:1548-56.
10. Yeh ML, Kuo HT, Huang CI, et al. Eradication of hepatitis C virus preserve liver function and prolong survival in advanced hepatocellular carcinoma patients with limited life expectancy. Kaohsiung J Med Sci 2020 Oct 6. 10.1002/kjm2.12303 [Epub ahead of print]
11. Butt AA, Yan P, Shuaib A, et al. Direct-acting antiviral therapy for HCV infection is associated with a reduced risk of cardiovascular disease events. Gastroenterology 2019;156:987-96.e8.
12. Graf C, Welzel T, Bogdanou D, et al. Hepatitis C clearance by direct-acting antivirals impacts glucose and lipid homeostasis. J Clin Med 2020;9:2702.
13. Waheed Y, Siddiq M, Jamil Z, Najmi MH. Hepatitis elimination by 2030: Progress and challenges. World J Gastroenterol 2018;24:4959-61.
14. Denniston MM, Klevens RM, McQuillan GM, Jiles RB. Awareness of infection, knowledge of hepatitis C, and medical follow-up among individuals testing positive for hepatitis C: National Health and Nutrition Examination Survey 2001-2008. Hepatology 2012;55:1652-61.
15. Kileng H, Gutteberg T, Goll R, Paulssen EJ. Screening for hepatitis C in a general adult population in a low-prevalence area: the Tromsø study. BMC Infect Dis 2019;19:189
16. Adland E, Jesuthasan G, Downs L, et al. Hepatitis virus (HCV) diagnosis and access to treatment in a UK cohort. BMC Infect Dis 2018;18:461.
17. Erbay K, Hızel K, Özdil T. Importance of anti-HCV screening before invasive procedures. Klimik Dergisi 2019;32:229-32.