Kronik delta hepatitli hastalarımızın tedavi sonuçları

Amaç: Kronik delta hepatiti ülkemizde yapılan çalışmalarda %2,3-2,7 oranında bildirilmektedir. Kronik Delta hepatitli olgular hızlı ilerleyerek ve kötü prognoz gösterir ve 5-10 yıl içinde %70 oranında siroz gelişir. Delta hepatiti tedavisinde interferon (IFN) temelli tedavi rejimlerinin başarısı %30 civarındadır. Ancak tedaviyi sonlandırdıktan sonra HBsAg serokonversiyonu gelişmediği sürece sık relaps görülmektedir. Bu çalışmada kronik Delta hepatitli olgular retrospektif olarak incelenmiş ve tedavi başarısı sağlanan hastalar tartışılmıştır.Gereç ve Yöntemler: 2012-2017 tarihleri arasında başvuran 5471 HBsAg pozitif hastanın 243’ünde (%4,44) Anti-HDV pozitifliği saptandı. Hastalara HDV dominant virüs ise Peg-IFN alfa 2a, HBV enfeksiyonu dominant ise Peg-IFN alfa 2a ve tenofovir disoproksil kombinasyonu verildi. Bulgular: Tedavi verilen hastalar değerlendirildiğinde, tedavi sonrası 10’unda (%4,11) HBs Ag serokonversiyonu geliştiği ve Anti-HBs’nin pozitifleştiği görüldü. Sonuç: kronik Delta hepatit olgularında etkili ve zamanında tedavi sağlanması ile karaciğer yetmezliğine bağlı komplikasyonları önleyebilir.

Anahtar Kelimeler:

delta hepatit, hepatit B, tedavi

Treatment results of chronic delta hepatitis patients

Aim: Chronic delta hepatitis has been reported in 2,3-2,7% of studies in our country. Chronic delta hepatitis cases progress rapidly and show poor prognosis and the rate of developing cirrhosis are 70% in 5-10 years. The success of interferon (IFN) based treatment regimens for the treatment of delta hepatitis is about 30%. However, there is frequent relapse at the end of therapy, unless HBsAg seroconversion is developed. Material and Methods: In this study, patients with chronic Delta hepatitis were evaluated retrospectively and the patients who were treated successfully were reviewed by reviewing the literature. Anti-HDV was positive in 243 (4.44%) of 5471 HBsAg positive patients who applied between 2012-2017. Peg-IFN alpha 2a was given if dominated by HDV and Peg-IFN alpha 2a and tenofovir disoproksil were given if dominant by HBV. Results: The patients who were treated were evaluated and at the end of the treatment 10 of the patients had HBs Ag seroconversion and anti-HBs were positive. Conclusion: Effective and timely treatment of chronic hepatic hepatitis cases will prevent the complications related to liver failure and prevent death.

Keywords:

delta hepatitis, hepatitis B, treatment,

PDF

___

1. Rizzetto M. Hepatitis D Virus: Introduction and Epidemiology. Cold Spring Harb Perspect Med. 2015; 5: 021576.
2. Değertekin H, Yalçin K, Yakut M. The prevalence of hepatitis delta virus infection in acute and chronic liver diseases in Turkey: an analysis of clinical studies. Turk J Gastroenterol off. J Turk Soc Gastroenterol 2006; 17: 25–34.
3. Tözün N, Özdoğan O, Çakaloğlu Y, et al. A Nationwide prevalence study and risk factors for hepatitis A, B, C and D infections in Turkey. 61st Annu Meet Am Assoc Study Liver Dis Liver Meet 2010. Hepatology 2010; 52: 697.
4. Yurdaydin C, Idilman R. Therapy of delta hepatitis. Cold Spring Harb Perspect Med. 2015; 5: 10.
5. Chen GY, Su TH, Kao JH. Successful treatment of chronic hepatitis B and D with pegylated-interferon plus entecavir. J Formos Med Assoc Taiwan Yi Zhi 2015; 114: 1140–41.
6. Celen MK, Ayaz C, Hosoglu S, Geyik MF, Ulug M. Anti-hepatitis delta virus seroprevalence and risk factors in patients with hepatitis B in Southeast Turkey. Saudi Med J 2006; 27: 617–20.
7. Mistik R. Hepatit D Virüs ve Enfeksiyonları. Turk Klin J Infect Dis Spec Top. 2013; 6: 69–74.
8. Noureddin M, Gish R. Hepatitis delta: epidemiology, Diagnosis and management 36 years after discovery. Curr Gastroenterol Rep [Internet]. 2014 [cited 2017 Jan 25]; 16. Available from: http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3918112/
9. Karaca C, Soyer OM, Baran B, et al. Efficacy of pegylated interferon-α treatment for 24 months in chronic delta hepatitis and predictors of response. Antivir Ther 2013; 18: 561–66.
10. Brichler S, Le Gal F, Neri-Pinto F et al. Serological and molecular diagnosis of hepatitis delta virus infection: results of a French national quality control study. J Clin Microbiol 2014; 52: 1694–97.
11. Romeo R, Foglieni B, Casazza G, Spreafico M, Colombo M, Prati D. High serum levels of HDV RNA are predictors of cirrhosis and liver cancer in patients with chronic hepatitis delta. PloS One 2014; 9: 92062.
12. Wedemeyer H, Yurdaydin C, Ernst S, et al. O4 prolonged therapy of hepatitis delta for 96 weeks with pegylated-interferon-α-2a plus tenofovir or placebo does not prevent HDV RNA relapse after treatment: the HIDIT-2 study. J Hepatol 2014; 60: 2–3.
13. Kao CN, Su TH, Kao JH. Letter: HBsAg kinetics-guided interferon therapy for chronic hepatitis D. Aliment Pharmacol Ther 2017; 45: 480–81.
14. Mansour W, Ducancelle A, Le Gal F, et al. Resolution of chronic hepatitis Delta after 1 year of combined therapy with pegylated interferon, tenofovir and emtricitabine. J Clin Virol Off Publ Pan Am Soc Clin Virol 2010; 47: 97–99.
15. Ouzan D, Pénaranda G, Joly H, Halfon P. Optimized HBsAg titer monitoring improves interferon therapy in patients with chronic hepatitis delta. J Hepatol 2013; 58: 1258–59.
16. Heller T, Rotman Y, Koh C, et al. Long-term therapy of chronic delta hepatitis with peginterferon alfa. Aliment Pharmacol Ther 2014; 40: 93–104.
17. Zachou K, Yurdaydin C, Drebber U, et al. Quantitative HBsAg and HDV-RNA levels in chronic delta hepatitis. Liver Int Off J Int Assoc Study Liver. 2010 ; 30: 430–37.
18. Pascarella S, Negro F. Hepatitis D virus: an update. Liver Int Off J Int Assoc Study Liver 2011; 31: 7–21.
19. Wedemever H, Yurdaydin C, Dalekos G, et al. 72 week data of the HIDIT-1 trial: a multicenter randomised study comparing peginterferon α-2a plus adefovir vs. peginterferon α-2a plus placebo vs. adefovir ın chronic delta hepatitis. J Hepatol 2007; 46: 4.
20. Farci P, Chessa L, Balestrieri C, Serra G, Lai ME. Treatment of chronic hepatitis D. J Viral Hepat 2007; 14: 58–63.
21. Guo JT, Guo H. Metabolism and function of hepatitis B virus cccDNA: Implications for the development of cccDNA-targeting antiviral therapeutics. Antiviral Res 2015; 122: 91–100.
22. Hughes SA, Wedemeyer H, Harrison PM. Hepatitis delta virus. Lancet Lond Engl 2011; 378: 73–85.
23. Bahcecioglu IH, Sahin A. Treatment of delta hepatitis: today and in the future - a review. Infect Dis Lond Engl 2017;16: 1–10.