Esma KEPENEK KURT, Bahar KANDEMİR, İbrahim ERAYMAN

Hepatit B Yüzey Antijeni (HBsAg) Pozitif Hastalarda Hepatit A ve Hepatit E Virüsü Seropozitifliği

Giriş: Bu çalışmada, Hepatit B yüzey antijeni (HBsAg) pozitifliği ile kliniğimize başvuran hastalarda anti-HAV IgG ve anti-HEV IgG seroprevalansını belirlemeyi amaçladık. Gereç ve Yöntem: 2010-2019 yılları arasında, HBsAg pozitifliği nedeniyle takip edilen 1827 hastanın verileri geriye dönük incelendi. Bulgular: HBsAg pozitif 1827 hastanın yaş ortalaması 42,71±14,84 idi; 730 (%39,96)’u kadın, 1097 (%60,04)’si erkekti. Anti-HAV IgG bakılmış olan 923 HBsAg pozitif hastanın 830’u (%89,9) pozitif, 93 ’ü (%10,1) negatif saptandı. Anti-HAV IgG negatif hastalar %38,7 oranıyla en sık 21-30 yaş aralığındaydı. Yaş ortalamaları, gruplar arasında anlamlı farklılık gösterdi (p=0,001). Anti-HAV IgG pozitif hastalar yaş dağılımı bakımından, anti-HAV IgG negatif olan hastalardan daha yaşlı olma eğilimindeydi. Buna karşılık anti-HAV IgG negatif ve pozitif hastalar arasında cinsiyet bakımından anlamlı bir fark yoktu (p=0,674). Anti-HEV IgG için test edilen 143 HBsAg pozitif hastanın 5’i (%3,5) pozitif saptandı. Sonuç: Genç Kronik Hepatit B hastalarında daha düşük anti-HAV IgG pozitifliği bulmamız ilgi çekicidir. Hepatit B virüsü saptandığında, hastalardan anti-HAV IgG testi istenmeli ve test sonucu negatif çıkarsa hasta aşılanmalıdır. Çalışma veri analizimiz, düşük bir anti-HEV IgG pozitifliğini de ortaya çıkardı.

Anahtar Kelimeler:

Hepatit B virüs, hepatit A virüs, hepatit E virüs, koinfeksiyon, seroprevalans

Hepatitis A and Hepatitis E Virus Seropositivity in Patients with Hepatitis B Surface Antigen (HBsAg) Positivity

Introduction: In this study, we aimed to determine the anti-HAV IgG and anti-HEV IgG seroprevalence in patients admitted to our clinic with Hepatitis B surface antigen (HBsAg) positivity. Material and Method: Data of 1827 patients followed up on for HBsAg positivity between 2010 and 2019 were obtained retrospectively. Results: The mean age of 1827 HBsAg positive patients was 42.71±14.84; there were 730 (39.96%) female patients and 1097 (60.04%)male. Of the 923 HBsAg positive patients whose anti-HAV IgG was measured, 830(%89,9) were detected to be positive, and 93 (10.1%) negative. Anti-HAV IgG negative patients were most often in the 21-30 age range (38.7%). Age medians were significantly different between the groups (p=0.001). HBsAg positive patients who were also positive for anti-HAV IgG tended to be older than anti-HAV IgG negative patients. In contrast, there was no significant difference in gender between anti-HAV IgG negative and positive patients (p=0.674). Of 143 HBsAg positive patients who were tested for anti-HEV-IgG, five were positive (3.5%). Conclusion: It is of interest that we found a lower rate of anti-HAV IgG positivity in young Chronic Hepatitis B patients. When hepatitis B virus is detected, a test for anti-HAV IgG should be requested from patients and if the test result is negative, the patient should be vaccinated. Our study data analysis also revealed a low anti-HEV IgG positivity.

Keywords:

Hepatitis B virus, hepatitis A virus, hepatitis E virus, coinfection, seroprevalence,

PDF

___

Franco E, Meleleo C, Serino L, Sorbara D, Zaratti L. Hepatitis A. Epidemiology and prevention in developing countries. World J Hepatol 2012;4:68-73.
Lavanchy D. Viral hepatitis: Global goals for vaccination. J Clin Virol 2012;55:296-302.
Ozden HT. Hepatitis A seroprevalence in patients with chronic viral hepatitis in Konya, Turkey. Eur J Gastroenterol Hepatol 2016;28:333–7.
Kepenek Kurt E, Kıyak M. Hepatit A Virüs Enfeksiyonu. In:Anılır E, Önal Z, İbrişim D, editors. Hepatoloji kitabı. 1.Baskı. Ankara. Akademisyen kitabevi, 2020;387-94.
Balkan İİ. Hepatit A virüs Enfeksiyonu Klinik ve Yönetimi. In: Güner R, Tabak F, eds. Viral Hepatit 2018 Kitabı.1. Baskı. İstanbul. İstanbul Tıp Kitabevleri. 131-45.
Celen MK, Turker K, Oztoprak N, et al. The Evaluation of Exposure to Hepatitis A Virus in HBsAg-positive Persons: A Multicentre Study from Turkey. J Pure Appl Microbio 2014;8:3063-8.
Vento S. Fulminant hepatitis associated with hepatitis A virus superinfection in patients with chronic hepatitis C. J Viral Hepat 2000;7:7-8.
Pramoolsinsap C. Acute hepatitis A and acquired immunity to hepatitis A virus in hepatitis B virus (HBV) carriers and in HBV- or hepatitis C virus-related chronic liver diseases in Thailand. J Viral Hepat 2000;7:11-2.
Keeffe EB. Is hepatitis A more severe in patients with chronic hepatitis B and other chronic liver diseases? Am J Gastroenterol 1995;90:201-5.
Bekçibaşı M. Hepatitis A Seroprevalence in Chronic Hepatitis B Patients in Diyarbakir, Turkey. Klimik J 2020;33:36-8.
T.C. Sağlık Bakanlığı Türkiye Viral Hepatit Önleme ve Kontrol Programı (2018-2023). Ankara. https://dosyahastane.saglik.gov.tr/Eklenti/62428,viralhematitonlemepdf.pdf?0&_tag1=5A894E52BB71C16366CF1098BBA11F1A4D2012BF.(Erişim tarihi:11.04.2020).
Aslam A, Susheela A, Iriana S, Chan SS, Lau D. Acute hepatitis E superinfection leading to chronic hepatitis B reactivation. BMJ Case Rep 2018.
Lee SH, Kim HS, Park KO, et al. Prevalence of IgG anti-HAV in patients with chronic hepatitis B and in the general healthy population in Korea. Korean J Hepatol 2010;16:362-8.
Alpay Y. Evaluation of seroprevalence of hepatitis A virus infection among patients with chronic hepatitis B virus infection. Klimik J 2019;32:19-21.
Türkoğlu E, Demirtürk N. Investigation of Hepatitis A serology in the patients infected with Hepatitis B virus. Med J Bakırköy 2015;11:116-9.
Alkan Çeviker S, Günal Ö, Kılıç SS, Tahmaz A. Erişkin HBsAg pozitif hastalarda Hepatit A seroprevalansı. Genel Tıp Derg 2020;30:157-61.
Oner SZ, Turkoglu E. Hepatitis A Virus Seroprevalence in Patients with Chronic Hepatitis B Virus Infection. KSU Med J 2020;15:37-9.
Afyon M, Şimşek B. Kronik hepatit B virüs enfeksiyonu olan 18-30 yaş arası erkek hastalarda hepatit A seroprevalansı. Gülhane Tıp Derg 2016;58:373-6.
Schillie S, Vellozzi C, Reingold A, et al. Prevention of Hepatitis B Virus Infection in the United States: Recommendations of the Advisory Committee on Immunization Practices. MMWR Recomm Rep 2018;67:1–31.
Tosun S. Viral Hepatitlerin Ülkemizdeki Değişen Epidemiyolojisi. Ankem Derg 2013;27:128-34.
Ortatatlı M, Gümral R, Üçkardeş H, Kenar L. Anti-HAV Seropositivity in Adult Patients with HBsAg positive from Various Locations of Turkey. Turk Hij Den Biyol Derg 2012;69:61-6.
Kumbasar H, Tabak F, Özaras R, Kocazeybek B, Mert A, Sentürk H. The seroprevalence of hepatitis A virus in patients with chronic hepatitis. Viral Hepat J 2004;9:152-5.
Tosun S. Hepatit B Aşılaması ve Ülkemizdeki Hepatit B Aşılama Sonuçları. In: Güner R, Tabak F, eds. Viral Hepatit 2018 Kitabı.1. Baskı. İstanbul. İstanbul Tıp Kitabevleri. 2018;253-65.
Kim DY, Ahn SH, Lee HW, et al. Anti-hepatitis A virüs seroprevalence among patients with chronic viral liver disease in Korea. Eur J Gastroenterol Hepatol 2007;19:923–6.
Sagnelli E, Stroffolini T, Almasio P, et al. Exposure to HAV infection in patients with chronic liver disease in Italy, a multicentre study. J Viral Hepat 2006;13:67–71.
Özlen Y, İlkay Şahin S. Hepatit E Virüs Enfeksiyonu Doğal Seyir ve Korunma. In Güner R, Tabak F, eds. Viral Hepatit 2018 Kitabı, 1. Baskı. İstanbul. İstanbul Tıp Kitabevleri.2018;397-402.
Aydın NN, Ergünay K, Karagül A, Pınar A, Us D. Investigation of the hepatitis E virus seroprevalence in cases admitted to Hacettepe University Medical Faculty Hospital. Mikrobiyol Bul 2015;49:554-64.
Kalfaoğlu H, Zeytinoğlu A, Öcek ZA. Hepatitis A Virus and Hepatitis E Virus Seroprevalence in Izmir. Flora 2017;22:17-28.
Çakmak-Topfedaisi Ö, Şener A. Seroprevalence of hepatitis E in hospital employees and investigation of risk factors. Klimik J 2020;33:44-51.
Zhang L, Jiang Z, Lv J, et al. Comparison of hepatitis E virus seroprevalence between HBsAg-positive population and healthy controls in Shandong province, China. BMC Infectious Diseases. 2018;18:75.
Leblebicioglu H, Ozaras R. Hepatitis E virus infection in Turkey: a systematic review. Ann Clin Microbiol Antimicrob 2018;2:17:17.
Ozel Yesilyurt A, Ayraler A, Turfan S, Dülger AC, Ayvaz MAl. Hepatitis E Virus Seroprevalence in Patients with Hepatitis Delta Virus Infection. OTJHS 2020;5:1-7.
Kayalı S, Yalnız M, Seyrek A. The Frequency of Hepatitis E Virus Infection in Patients Diagnosed with Chronic Hepatitis and Cirrhosis. Firat Med J 2022;27:140-6.
Bayram A, Eksi F, Mehli M, Sözen E. Prevalence of hepatitis E virus antibodies in patients with chronic hepatitis B and chronic hepatitis C. Intervirology 2007;50:281-6.