İmmünosupresif Tedaviler Altında Farklı Romatolojik Hastalıklarla İzlenen Hastalar Viral Hepatitlere Karşı Yeterince Taranıyor ve Korunuyor mu?

Amaç: Çalışmanın amacı immünosupresif tedavi altındaki romatoloji hastalarının viral hepatit B (HBV) ve C (HCV) için taranma sıklığının değerlendirilmesi, HBV reaktivasyon sıklığının tespit edilmesi, HBV aşılanma oranlarının değerlendirilmesidir. Gereç ve Yöntem: Bu retrospektif çalışmaya romatoloji polikliniğinde izlenmekte olan immünosupresif tedavi alan hastalar dahil edilmiştir. İmmünosupresif tedaviler biyolojik (bDMARD) ve konvansiyonel sentetik (ksDMARD) hastalığı modifiye eden antiromatizmal ilaçlar olarak sınıflandırılmıştır. Hastaların İmmünosupresif tedavi başlanmadan hemen önce veya tedavi esnasında bakılan serum HBsAg, anti-HBs, anti HBc-IgM, anti HBc-IgG, HBV DNA ve anti-HCV belirteçleri dosya taramalarından elde edilmiştir. Bulgular: Çalışmada 451 hasta yer almıştır [%61,9 kadın, ortalama yaş 41,1 yıl, (standart sapma: 13,78)]. Bu hastalar bDMARD (n=348) ve ksDMARD (n=103) kullananlar olarak iki gruba ayrılmıştır. Tüm hasta grubunda 20 (%4,4) hastanın HBV verisi, 23 (%5) hastanın ise HCV verisi olmadığı izlendi, bu hastaların tamamının ksDMARD grubunda olduğu görüldü. Ayrıca bDMARD grubundaki 51 hastanın (%14,7) HBV seroloji tetkiklerinin yeterli ayrıntıda olmadığı izlendi (anti-HBc-IgM ve anti HBc-IgG tetkikleri izlenmedi). Tüm kohortta izlem esnasında akut HBV enfeksiyonu veya HBV reaktivasyonu hiç izlenmedi. bDMARD hasta grubunda HBsAg negatif fazda kronik HBV’si olmasına rağmen profilaksi almayan 39 hastada da HBV reaktivasyonu izlenmediği görüldü. Hastalardan 129’unun (%28,6) immünosupresif tedavi öncesinde non-immün/aşısız olduğu görüldü. Bu hastalardan izlemleri esnasında tekrarlayan HBV serolojisi kontrol edilenlerin (n=75) halen non-immün/aşısız olduğu gözlendi. Sonuç: İmmünosupresif tedavi altındaki romatoloji hastalarının yapılan HBV ve HCV serolojilerinin tarama sonuçları başarılı olarak değerlendirildi. Tüm grupta hiç HBV reaktivasyonu izlenmedi. Bu çalışmanın sonuçları ayrıca HBV non-immün olan romatoloji hastalarının takipte aşılanmalarının yetersiz düzeyde olduğunu göstermiştir.

Are Patients with Different Rheumatologic Diseases Under Immunosuppressive Therapies Adequately Screened and Protected Against Viral Hepatitis?

ABSTRACT Aim: The aim of this study is to determine the screening rates for hepatitis B (HBV) and C virus (HCV) in patients with rheumatologic diseases who receive immunosuppressive therapies, to evaluate the prevalence of HBV reactivation during the regimens and also to reveal the frequency of vaccination. Materials and Methods: This retrospective study included the patients who were followed-up with different rheumatologic diseases in two rheumatology outpatient clinics. The immunosuppressive regimens were categorized into two groups as biologic (bDMARDs) and conventional synthetic disease modifying anti rheumatic drugs (csDMARDs). The markers of HBsAg, anti-HBs, anti-HBc-IgM and anti-HBc-IgG, HBV DNA, anti- HCV levels were all taken from the patients’ charts checked prior and during the immunosuppressive treatments. Results: There were 451 patients [61.9% female, mean age 41.1 years, (standard deviation: 13.78)] who were taking bDMARDs (n=348) and csDMARDs (n=103). The data for HBV for 20 (4.4%) patients and HCV for 23 (5%) patients were missing, all in the csDMARDs group. Also, HBV serology tests were found to be incomplete in 51 patients (14.7%) in the bDMARDs group, as not checking the anti-HBc-IgM and anti-HBc-IgG. During the follow-up, HBV reactivation was not observed in the whole cohort. In the bDMARDs group, there were 39 patients who did not receive prophylaxis despite having HBsAg negative phase of chronic HBV infection; no HBV reactivation was observed also in this group. One hundred twenty nine (28.6%) of the patients were evaluated as never infected and unvaccinated prior to immunosuppressive therapies. Recurrent HBV serology controls were performed in nearly half (n=75) of them during their follow-up and it was observed that all were still non-immune. Conclusion: The screening rates of HBV and HCV serology were detected as successful in rheumatology patients under immunosuppressive therapies. No HBV reactivation was observed in the entire group. Also, the study showed that there was a significant deficiency in immunizing patients against HBV in follow-up.

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