Neziha YILMAZ, Aydın ÇİFCİ, Mehmet BALCI, Salih CESUR, Seda SABAH ÖZCAN, S. Süha ŞEN, Reyhan ÖZTÜRK, Çiğdem KADER, Hasan IRMAK, Mehmet İBİŞ, Laser SANAL

Hemodiyaliz hastalarında okült hepatit B ve hepatit C enfeksiyonu sıklığı

Amaç: Hepatit B virüsü (HBV) ve Hepatit C virüsü (HCV) diyaliz ünitelerinde sıklıkla bulaşabilen virüslerdendir. Okült HBV veya HCV enfeksiyonu serumda HBsAg veya anti-HCV saptanamayan kişilerdeki HBV veya HCV enfeksiyonunun varlığının kan veya karaciğer dokusunda moleküler yöntemlerle (HBV-DNA, HCV-RNA ile) gösterilmesidir. Bu çalışmada hemodiyalize giren, HBV ve HCV seronegatif hemodiyaliz hastalarına ait plazma örneklerinde HBV-DNA ve HCV-RNA tayini ile okült HBV ya da HCV enfeksiyonu sıklığının araştırılması amaçlandı.Gereç ve Yöntem: Çalışmaya hemodiyalize giren, HBV ve HCV göstergeleri (HBsAg, HBcIgG ve IgM , Anti-HCV) negatif olan 121 erişkin hasta dahil edildi. Hastalar hemodiyaliz süresi, kan transfüzyonu öyküsü, ailede hepatit B ve C enfeksiyonu varlığı açısından sorgulandı. Hastalardan alınan plazma örneklerinde HBV-DNA ve HCV-RNA varlığı COBAS® TaqMan® 48 Analyzer (for automated real-time PCR amplification and detection) kullanılarak COBAS Taqman kitleri ( Cobas Taqman HBV v.2 ve HCV v.2 Roche, US) kiti ile kantitatif olarak araştırıldı. . Bulgular: Toplam 121 hemodiyaliz hastasının 1’inde (%0.82) HCV-RNA pozitifliği saptanırken (138.000 IU/ml ), 10(%8.2)’unda HBV-DNA saptanabilir düzeyde idi. HBV-DNA saptanan 10 plasma örneğinin 7 (%70)’sinde HBV-DNA düzeyi < 6IU/ml iken 3 (%30)’ünde HBV-DNA düzeyi > 6IU/ml olarak bulundu. HBV-DNA düzeyi > 6 IU/ml olan 3 hastaya ait HBV-DNA miktarları 108 IU/ml, 157.000.000 IU/ml ve 72.5 IU/ml olarak saptandı. Sonuç: Çalışmamızda Hepatit B ve C yönünden serolojik göstergeleri negatif olan hemodiyaliz hastalarında okült hepatit B enfeksiyonu sıklığı okült hepatit C enfeksiyonundan yaklaşık 10 kat daha fazla oranda saptandı. Serumda, veya karaciğerde HBV DNA veya HCV RNA pozitifliği hemodiyaliz ünitelerinde potansiyel bulaş kaynağıdır. Hemodiyaliz hastalarında HBV veya HCV’ye bağlı okült hepatit varlığı diğer hastalara ve sağlık personeline bulaş olasılığı ve böbrek naklinden sonra hastalarda özellikle hepatit reaktivasyonu veya kronik karaciğer hastalığı gelişmesi açısından önemlidir. Bu nedenle özellikle transplantasyon planlanan hemodiyaliz hastalarında okült hepatit varlığı moleküler yöntemlerle araştırılmasının yararlı olacağı görüşündeyiz.

Anahtar Kelimeler:

Okült hepatit, hepatit B, hepatit C, real time PCR, hemodiyaliz hastaları

Frequency of occult hepatitis B and C infections in hemodialysis patients

Aim: Hepatitis B (HBV) virus and Hepatitis C virus (HCV ) are commonly transmitted viruses in dialysis units. Occult HBV or HCV infections are HBV or HCV infections in patients when HBs Ag or anti-HCV is not detected in serum. In this study, it was aimed to detect HBV DNA and HCV RNA in plasma samples belonging to hemodialysis patients who are seronegative for HBV and HCV and to investigate frequency of occult HBV or HCV infections.Material and Method: 121 adult patients who are receiving hemodialysis and whose HBV and HCV indicators (HBsAg, HBcIgG and IgM, Anti-HCV) are negative were included in the study. Presence of HBV-DNA and HCV-RNA in plasma samples of patients was investigated by using COBAS® TaqMan® 48 Analyzer (for automated real-time PCR amplification and detection) in a quantitative fashion with COBAS Taqman kits (Cobas Taqman HBV v.2 and HCV v.2 Roche, USA)Results: In 1 out of 121 hemodialysis patients (0.82%), HCV-RNA level was detected as 138.000 IU/ml, in 10 out of 121 hemodialysis patients (8.2%) HBV-DNA was at detectable level. While in 7 of 10 plasma samples (70%) in which HBV-DNA was detected, HBV-DNA level was < 6IU/ml, in 3 of 10 plasma samples (30%) HBV-DNA level was found as >6IU/ml. HBV-DNA amounts belonging to 3 patients whose HBV-DNA level was >6 IU/ml were found as 108 IU/ml, 157.000.000 IU/ml and 72.5 IU/ml.Conclusion: It was found out that in hemodialysis patients whose serologic indicators for Hepatitis B and C are negative, occult Hepatitis B infection is seen 10 times more frequently than Hepatitis C infection. Positive demonstration of HBV-DNA or HCV-RNA in serum or liver is potentially seen in hemodialysis units. Incidence of occult hepatitis due to HBV or HCV in hemodialysis patients is of significant importance in terms of the probability of its transmission to other patients and healthcare staff and development of especially hepatitis reactivation or chronic liver disease in patients after kidney transplant. For this reason, we believe it would be particularly useful to investigate the presence of occult hepatitis by molecular methods in hemodialysis patients especially scheduled for transplantation.

Keywords:

Occult hepatitis, hepatitis B, hepatitis C, real-time PCR, hemodialysis patients,

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1. Kasapoğlu B, Türkay C. Okült (OCCULT) Hepatit B Enfeksiyonu. Güncel Gastroentereoloji. Haziran 2007:11;51-6.
2. Gutierrez-Garcia ML, Conrado M Rodriguez F, Navarro JL, Garcia IB. Prevalence of occult hepatitis B virus infection. World J Gastroenterol. 2011;28:1538–42.
3. Hu KQ Occult hepatitis B virus infection and its clinical implications. J Viral Hep 2002; 9: 243-57.
4. Barril G, Castillo I, Arenas MD, et al. Occult hepatitis C virus infection among hemodialysis patients. J Am Soc Nephrol. 2008;19:2288-92.
5. Kwak MS, Kim YJ. Occult hepatitis B virus infection. World j Hepatol. 2014; 27;6:860-9.
6. Hu LP, Liu DP, Chen QY, et al. Occult HBV infection may be transmitted through close contact and manifest as an overt infection. PLoS One. 2015;12;10.1371-83.
7. Eslamifar A, Ramezani A, Ehteram H, et al. Occult hepatitis C virus infection in Iranian hemodialysis patients. J Nephropathol. 2015;4:116-20.
8. Grabarczyk P, Kopacz A, Sulkowska E, et al. Blood donors screening for blood born viruses in Poland. Przeql epidemiol. 2015;69:473-7.
9. Sav T, Gursoy S, Torun E, et al. Occult HBV infection in continuous ambulatory peritoneal dialysis and hemodialysis patients. Ren Fail. 2010;32:74-7. 10. Helaly GF, El Ghazzawi EF, Shawky SM, Farag FM. Occult hepatitis B virus infection among chronic hemodialysis patients in Alexandria, Egypt. J Infect Public Health. 2015;8:562-9.
11. Mandour M, Nemr N, Shehata A, Kishk R, Badran D, Hawass N.A. Occult HBV infection status among chronic hepatitis C and hemodialysis patients in Northeastern Egypt: regional and national overview. Rev soc Bras Med Trop.2015 ;48:258-64.
12. Katayama K, Sato T, Do SH, et al. Hepatitis B virus infection in hemodialysis patients in Japan: Prevalence, incidence and occult hepatitis B virus infection. Hepatol Res 2015.
13. Apica BS, Seremba E, Rule J, Yuan HJ, Lee WM. High prevalence of occult hepatitis B infection in an African urban population.cJ Med Virol. 2015.
14. Oluyinka OO, Tong HV, Bui Tien S, et al. Occult hepatitis B virus infection in Nigerian blood donors and hepatitis B virus transmission risks. PloS One. 2015;6;10.
15. Brechot C, Thiers V, Kremsdorf D, et al. Persistent hepatitis B virüs infection in subjects without hepatitis B surface antigen: clinically significant or purely ‘occult’? Hepatology 2001;34:194-203.