M. Helvacı, H. Dayıoğlu, M.C. Algın, E. Coşar, E. Soyücen

HEPATITIS C VIRUS INFECTION MAY ALWAYS TERMINATE WITH CHRONIC MANIFESTATIONS OF IT IF LIFE SPAN OF THE HUMAN BEING WOULD BE ENOUGH

Hepatit C virüs (HCV) enfeksiyonu yaşlılarda daha sık gibi görünmektedir. Enfeksiyon sonucu muhtemelen immün sistem tarafından belirlenmektedir. Biz HCV enfeksiyonu prevalansının yaşla birlikte artış gösterip göstermediğini ve eğer gösteriyor ise bu sürenin, enfeksiyonun klinik bulgularının ortaya çıkması için gerekli bir sürenin varlığı ile izah edilip edilemeyeceğini anlamaya çalıştık. Çalışmaya gastroenteroloji polikliniğine herhangibir şikayetle başvuran, daha önce interferon (INF) tedavisi almamış, HCV antikor (anti-HCV) pozitif hastalar rastgele ve prospektif olarak alındı. Anti-HCV yanında tüm hastalardan hepatit B virüs yüzey antijeni ve antikoru (sırasıyla HBs Ag ve anti-HBs), alfa-fetoprotein, rutin hematolojik ve biyokimyasal testler ve idrar analizi istendi. Anti-HCV pozitif vakalarda polimeraz zincir reaksiyonu ile HCV RNA ve HBs Ag pozitif vakalarda moleküler hibridizasyon ile HBV DNA çalışıldı. Gereken vakalarda doku biyopsileri alındı ve bilgisayarlı tomografiyi de içeren ilave radiyografik görüntülemeler yapıldı. Toplam 92 anti- HCV pozitif, INF tedavisi almamış hasta çalışmaya alındı. Hastaların toplam 66’sında HCV RNA pozitifliği tespit edildi. HCV RNA pozitifliği oranı 40 yaş altında %14.28, 40-59 yaşları arasında %68.88 ve 60 yaş ve üzerinde %85 olarak tespit edildi. Ek olarak, toplam 19 siroz, beş hepatosellüler karsinom, dört HBs Ag taşıyıcılığı, birisi romatoid artrit ile birlikte sirozlu olmak üzere iki membranoproliferatif glomerulonefrit, iki liken planus, üç astım, bir siroz ile birlikte prolenfositik lösemi, bir idiyopatik trombositopenik purpura, bir bronşektazi, bir fibromyalji, bir önemi bilinmeyen monoklonal gammopati ve iki non-Hodgkin lenfoma vakası, toplam 92 anti-HCV pozitif birey arasında tespit edildi. Büyük bir fark olarak, iki astım, bir fibromyalji ve bir önemi bilinmeyen monoklonal gammopati vakası haricindeki tüm vakalar HCV RNA pozitif bireyler arasında tespit edildi. Sonuç olarak, HCV RNA pozitifliği yaşla birlikte artış göstermektedir ve anti-HCV pozitif bireyler, hayatları boyunca geç ortaya çıkabilen karaciğer ve multisistemik tutulum riski nedeniyle takip edilmelidirler.

Anahtar Kelimeler:

Hepatit C virüs enfeksiyonu

HEPATITIS C VIRUS INFECTION MAY ALWAYS TERMINATE WITH CHRONIC MANIFESTATIONS OF IT IF LIFE SPAN OF THE HUMAN BEING WOULD BE ENOUGH

Background: It seems that hepatitis C virus (HCV) infection is more common in elderlies. Its outcome is probably influenced by status of immune system. We have tried to understand whether or not there is an increase in prevalence of HCV infection by aging and if so could it be explained by a time period, at least in some of infecteds, required for virus until onset of clinical manifestations.Patients and methods: Patients with anti-HCV positivity, never treated with interferon (INF), have been taken, randomly and prospectively. Additionally anti-HBs, HBsAg, routine hematologic and biochemical tests, alpha-fetoprotein, urinalysis, and abdominal ultrasonography have been performed in all cases. In anti-HCV positives, HCVRNA via polymerase chain reaction and in HBsAg positives, HBVDNA via molecular hybridization have been studied. Tissue samples and additional radiographic films, including computed tomography, have been obtained in required cases.Results: We have taken anti- HCV positive and never INF therapy taken 92 cases into study. Sixtysix of 92 patients have been positive for HCVRNA. Rates of HCVRNA positivity have been 14.28 % under the age of 40 years, 68.88 % between the ages of 40 and 59 years, and 85.00 % at and above the age of 60 years. Additionally, 19 cases of cirrhosis, four HBsAg positivity in the absence of HBVDNA positivity, five hepatocellular carcinoma, two membranoproliferative glomerulonephritis, one of which is together with rheumatoid arthritis and cirrhosis, two lichen planus, three asthma, one prolymphocytic leukemia together with cirrhosis, one idiopathic thrombocytopenic purpura, one bronchiectasis, one fibromyalgia, one monoclonalgammopathy of unknown significance (MGUS), and two cases of non-Hodgkin’s lymphoma have been detected in 92 cases with anti-HCV positivity. As a big difference, except two cases of asthma, one case of fibromyalgia, and one case of MGUS, all of the others have been detected in HCVRNA positive cases. Conclusion: As a result, prevalence of HCVRNA positivity increases by age and anti-HCV positive individuals should be followed-up during their life span for high risk of even delayed-onset hepatic and multisystemic manifestations.

Keywords:

Hepatitis C virus infection,

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