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Öksüz L, Hindilerden İY, Erciyestepe M, Önel M, Hindilerden F, Çağatay A, Nalçaci M, Ağaçfidan A. The association of CMV infection with bacterial and fungal infections in hematopoietic stem cell transplant recipients: a retrospective single-center study. New Microbiol 2022; 45:40-50. [PMID: 35403846] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Subscribe] [Scholar Register] [Received: 04/11/2022] [Accepted: 04/11/2022] [Indexed: 06/14/2023]
Abstract
This study aims to evaluate the probable association between CMV infection and bacterial or fungalinfections in 91 consecutive adult patients who underwent autologous or allogeneic HSCT within aperiod of two years.The medical records of the patients were retrospectively reviewed. Blood cultures were evaluatedby an automated blood culture system. A quantitative real-time polymerase chain reaction was performedto detect CMV DNA.CMV infection and CMV disease were detected in 42 (46%) and six (6.6%) patients, respectively. Ofthe 158 microorganisms isolated, 115 (73%) were Gram-positive bacteria. Bacteremia and fungemiadeveloped in 55 (60%) and eight (8%) patients, respectively. Concurrent CMV infection and bacteremiawere detected in 17 (18.7%) patients and concurrent CMV infection and fungal infection weredetected in five (5.5%) patients. Graft versus host disease (GVHD) developed in 15 (50%) allogeneicHSCT recipients and two (2.2%) autologous HSCT recipients. Twenty-one (23%) patients including13 (43%) allogeneic and eight (13%) autologous HSCT recipients died.The most common infection is bacteremia, and it develops concurrently with CMV infection in approximatelyone-fifth of HSCT recipients. Gram-positive bacteria are more common in bacteremia.Further studies on the follow-up and treatment of infections after HSCT will improve post-HSCTsurvival rates.
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Affiliation(s)
- Lütfiye Öksüz
- Istanbul Faculty of Medicine, Department of Medical Microbiology, CAPA-ISTANBUL-TURKEY
| | - İpek Yönal Hindilerden
- Istanbul Faculty of Medicine, Department of Internal Diseases, Bone Marrow Transplantation Unit CAPA-ISTANBUL-TURKEY
| | - Mert Erciyestepe
- Istanbul Faculty of Medicine, Department of Internal Diseases, Bone Marrow Transplantation Unit CAPA-ISTANBUL-TURKEY
| | - Mustafa Önel
- Istanbul Faculty of Medicine, Department of Medical Microbiology, CAPA-ISTANBUL-TURKEY
| | - Fehmi Hindilerden
- University of Health Sciences Hamidiye School of Medicine Dr. Sadi Konuk Training and Research Hospital, BAKIRKOY-ISTANBUL-TURKEY
| | - Atahan Çağatay
- Istanbul Faculty of Medicine, Department of Internal Diseases, Infectious Diseases and Clinical Microbiology, CAPA-ISTANBUL-TURKEY
| | - Meliha Nalçaci
- Istanbul Faculty of Medicine, Department of Internal Diseases, Bone Marrow Transplantation Unit CAPA-ISTANBUL-TURKEY
| | - Ali Ağaçfidan
- Istanbul Faculty of Medicine, Department of Medical Microbiology, CAPA-ISTANBUL-TURKEY
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Bölükbaşı Y, Erköse Genç G, Orhun G, Kuşkucu MA, Çağatay A, Önel M, Öngen B, Ağaçfidan A, Esen F, Erturan Z. [First Case of COVID-19 Positive Candida auris Fungemia in Turkey]. MIKROBIYOL BUL 2021; 55:648-655. [PMID: 34666664 DOI: 10.5578/mb.20219716] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Candida auris is a species of fungus that has gained importance in recent years owing to its ability to cause hospital infections and epidemics, resistant to antifungal agents and disinfection processes and frequently misidentified by commercial systems. Hospital outbreaks caused by C.auris have been reported from some countries. It has been determined that C.auris has lower virulence than Candida albicans; however, it is associated with high mortality rates in immunocompromised individuals. An increase in the incidence of invasive fungal infections which can lead to serious complications and death, has been identified in severe coronavirus-2019 (COVID-19) patients or immunocompromised individuals with underlying disease. Studies demonstrated an increase in the frequency of C.auris isolation in COVID-19 patients with candidemia. In this report, the first case of COVID-19 positive C.auris fungemia detected in Turkey was presented. A 71-year-old male patient with a history of myocardial infarction, diabetes mellitus, donation of a single kidney and lobectomy surgery due to lung cancer was hospitalized in the pandemic thoracic surgery service due to the findings consistent with viral pneumonia on thoracic computed tomography. Favipiravir 2 x 600 mg and intravenous dexamethasone 1 x 6 mg therapy was administered. The patient tested positive for SARS-CoV-2 polymerase chain reaction, and severe involvement of the left lung was detected in the following days. Antibiotics were administered, followed by insertion of a right jugular vein catheter and initation of tocilizumab. The patient was transferred to the intensive care unit due to increased respiratory distress. Yeast growth was detected in the patient's hemoculture. The yeast strain could not be identified using API ID 32C (bioMerieux, France) (Sacchromyces kluyveri, Candida sake, unacceptable profile), but was identified as C.auris using the VITEK MALDI TOF MS (bioMerieux, France) (99.9%) system and confirmed by sequencing. The minimum inhibitor concentration values were detected as 3 µg/ml for amphotericin B; > 256 µg/ml for fluconazole; 0.19 µg/ml for voriconazole; 0.19 µg/ml for itraconazole; 0.016 µg/ml for posaconazole; 1 µg/ml for caspofungin and 0.094 µg/ml for anidulafungin by using the antibiotic gradient method. The patient's initial treatment comprised meropenem 3 x 1 g, vancomycin 2 x 1 g, caspofungin 1 x 70 mg, and continued as caspofungine 1 x 50 mg after the loading dose, and vancomycin 1 x 1 g/48 hours from the third day of treatment. The patient died on the ninth day after developing candidemia. The present case is the first case of fungemia caused by C.auris in a COVID-19 positive patient in Turkey, and it emphasizes the need of caution for fungemia due to C.auris in intensive care units in our country which has a high COVID-19 incidence.
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Affiliation(s)
- Yasemin Bölükbaşı
- Istanbul University Istanbul Faculty of Medicine, Department of Medical Microbiology, Istanbul, Turkey
| | - Gonca Erköse Genç
- Istanbul University Istanbul Faculty of Medicine, Department of Medical Microbiology, Istanbul, Turkey
| | - Günseli Orhun
- İstanbul University Istanbul Faculty of Medicine, Department of Anesthesiology and Reanimation, Istanbul, Turkey
| | - Mert Ahmet Kuşkucu
- Istanbul University-Cerrahpasa Cerrahpasa Faculty of Medicine, Department of Medical Microbiology, İstanbul, Turkey
| | - Atahan Çağatay
- İstanbul University Istanbul Faculty of Medicine, Department of Infectious Diseases and Clinical Microbiology, İstanbul, Turkey
| | - Mustafa Önel
- Istanbul University Istanbul Faculty of Medicine, Department of Medical Microbiology, Istanbul, Turkey
| | - Betigül Öngen
- Istanbul University Istanbul Faculty of Medicine, Department of Medical Microbiology, Istanbul, Turkey
| | - Ali Ağaçfidan
- Istanbul University Istanbul Faculty of Medicine, Department of Medical Microbiology, Istanbul, Turkey
| | - Figen Esen
- İstanbul University Istanbul Faculty of Medicine, Department of Anesthesiology and Reanimation, Istanbul, Turkey
| | - Zayre Erturan
- Istanbul University Istanbul Faculty of Medicine, Department of Medical Microbiology, Istanbul, Turkey
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3
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Demirtürk N, Aygen B, Çelik İ, Mıstık R, Akhan S, Barut Ş, Ural O, Batırel A, Şimşek F, Ersöz G, İnan D, Kınıklı S, Türker N, Bilgin H, Gürbüz Y, Tülek N, Tarakçı H, Yıldız O, Türkoğlu E, Kamalak Güzel D, Şimşek S, Tuna N, Aktuğ Demir N, Çağatay A, Çetinkaya RA, Karakeçili F, Hakyemez İN, Tuncer Ertem G, Örmen B, Korkmaz P, Yıldız U, Kuruüzüm Z, Şener A, Arslan Özel S, Öztürk S, Suer K, Çelen MK, Konya P, Asan A, Saltoğlu N, Doğan N. Real-World Data from Turkey: Is Sofosbuvir/Ledipasvir With or Without Ribavirin Treatment for Chronic Hepatitis C Really Effective? Turk J Gastroenterol 2021; 32:155-163. [PMID: 33960939 DOI: 10.5152/tjg.2020.19569] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
Abstract
BACKGROUND In this study, we aimed to investigate the efficacy and safety of sofosbuvir-based therapies in the treatment of chronic hepatitis C in real-world clinical practice. METHODS Data from patients with chronic hepatitis C treated with SOF/LDV ± RBV or SOF/RBV in 31 centers across Turkey between April 1, 2017, and August 31, 2018, were recorded in a nationwide database among infectious disease specialists. Demographics, clinical, and virological outcomes were analyzed. RESULTS A total of 552 patients were included in the study. The mean age of the patients was 51.28 ± 14.2, and 293 (55.8%) were female. The majority had HCV genotype 1b infection (65%), 75.04% of the patients underwent treatment, and non-cirrhosis was present at baseline in 381 patients (72.6%). SOF/LDV ± RBV treatment was given to 477 patients and 48 patients received SOF/RBV according to HCV genotype. The total SVR12 rate was 99% in all patients. Five patients experienced disease relapse during the study and all of them were genotype 2. In patients infected with HCV GT2, SVR12 was 77.3%. SVR was 100% in all patients infected with other HCV genotypes. All treatments were well tolerated by patients without causing severe adverse events. Side effects and side effects-associated treatment discontinuation rates were 28.2% and 0.4%, respectively. Weakness (13.7%) was the common side effect. CONCLUSION The present real-world data of 525 patients with HCV genotypes 1, 1a, 1b, 3, 4, and 5 who underwent SOF/LDV ± RBV treatment in Turkey demonstrated a high efficacy and safety profile. HCV GT2 patients should be treated with more efficacious treatment.
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Affiliation(s)
- Neşe Demirtürk
- Department of Infectious Disease and Clinical Microbiology, Afyon Saglik Bilimleri University Medical Faculty, Afyonkarahisar, Turkey
| | - Bilgehan Aygen
- Department of Infectious Disease and Clinical Microbiology, Erciyes University Medical Faculty, Kayseri, Turkey
| | - İlhami Çelik
- Department of Infectious Diseases and Clinical Microbiology, Kayseri Education and Research Hospital, Saglik Bilimleri University, Kayseri, Turkey
| | - Reşit Mıstık
- Infectious Disease Clinic, Medicana Hospital, Bursa, Turkey
| | - Sıla Akhan
- Department of Infectious Disease and Clinical Microbiology, Kocaeli University Medical Faculty, Kocaeli, Turkey
| | - Şener Barut
- Department of Infectious Disease and Clinical Microbiology, Gaziosmanpasa University Medical Faculty, Tokat, Turkey
| | - Onur Ural
- Department of Infectious Disease and Clinical Microbiology, Selcuk University Medical Faculty, Konya, Turkey
| | - Ayşe Batırel
- Department of Infectious Diseases and Clinical Microbiology, Kartal Lütfi Kırdar Education and Research Hospital, Saglik Bilimleri University, İstanbul, Turkey
| | - Funda Şimşek
- Department of Infectious Diseases and Clinical Microbiology, Ok Meydanı Education and Research Hospital, Saglik Bilimleri University, İstanbul, Turkey
| | - Gülden Ersöz
- Department of Infectious Disease and Clinical Microbiology, Mersin University Medical Faculty, Mersin, Turkey
| | - Dilara İnan
- Department of Infectious Disease and Clinical Microbiology, Akdeniz University Medical Faculty, Antalya, Turkey
| | - Sami Kınıklı
- Department of Infectious Diseases and Clinical Microbiology, Ankara Education and Research Hospital, Saglik Bilimleri University, Ankara, Turkey
| | - Nesrin Türker
- Department of Infectious Disease and Clinical Microbiology, Atatürk Education and Research Hospital, Katip Çelebi University, İzmir, Turkey
| | - Hüseyin Bilgin
- Department of Infectious Disease and Clinical Microbiology, Marmara University Medical Faculty, İstanbul, Turkey
| | - Yunus Gürbüz
- Department of Infectious Disease and Clinical Microbiology, Dışkapı Education and Research Hospital University Medical Faculty, Saglik Bilimleri University, Antalya, Turkey
| | - Necla Tülek
- Department of Infectious Disease and Clinical Microbiology, Atılım University Medical Faculty, Ankara, Turkey
| | - Hüseyin Tarakçı
- Department of Infectious Diseases and Clinical Microbiology, Eşrefpaşa Education and Research Hospital, Saglik Bilimleri University, İzmir, Turkey
| | - Orhan Yıldız
- Department of Infectious Disease and Clinical Microbiology, Erciyes University Medical Faculty, Kayseri, Turkey
| | - Emine Türkoğlu
- Department of Infectious Disease and Clinical Microbiology, Afyon Saglik Bilimleri University Medical Faculty, Afyonkarahisar, Turkey
| | - Deniz Kamalak Güzel
- Department of Infectious Diseases and Clinical Microbiology, Kayseri Education and Research Hospital, Saglik Bilimleri University, Kayseri, Turkey
| | - Sümeyra Şimşek
- Department of Infectious Disease and Clinical Microbiology, Uludağ University Medical Faculty, Bursa, Turkey
| | - Nazan Tuna
- Department of Infectious Diseases and Clinical Microbiology, Sakarya Education and Research Hospital, Saglik Bilimleri University, Sakarya, Turkey
| | - Nazlım Aktuğ Demir
- Department of Infectious Disease and Clinical Microbiology, Selcuk University Medical Faculty, Konya, Turkey
| | - Atahan Çağatay
- Department of Infectious Disease and Clinical Microbiology, İstanbul University İstanbul Medical Faculty, İstanbul, Turkey
| | - Rıza Aytaç Çetinkaya
- Department of Infectious Diseases and Clinical Microbiology, Sultan Abdülhamid Han Education and Research Hospital, Saglik Bilimleri University, İstanbul, Turkey
| | - Faruk Karakeçili
- Department of Infectious Diseases and Clinical Microbiology, Erzincan University of Faculty of Medicine, Erzincan, Turkey
| | - İsmail Necati Hakyemez
- Department of Infectious Diseases and Clinical Microbiology, Bezmiâlem University of Faculty of Medicine, İstanbul, Turkey
| | - Günay Tuncer Ertem
- Department of Infectious Diseases and Clinical Microbiology, Ankara Education and Research Hospital, Saglik Bilimleri University, Ankara, Turkey
| | - Bahar Örmen
- Department of Infectious Disease and Clinical Microbiology, Atatürk Education and Research Hospital, Katip Çelebi University, İzmir, Turkey
| | - Pınar Korkmaz
- Department of Infectious Diseases and Clinical Microbiology, Kütahya Health Sciences University Faculty of Medicine, Kütahya, Turkey
| | - Uluhan Yıldız
- Department of Infectious Disease and Clinical Microbiology, Marmara University Medical Faculty, İstanbul, Turkey
| | - Ziya Kuruüzüm
- Department of Infectious Disease and Clinical Microbiology, Dokuz Eylül University Faculty, İzmir, Turkey
| | - Alper Şener
- Department of Infectious Diseases and Clinical Microbiology, Çanakkale Onsekiz Mart University Faculty of Medicine, Çanakkale, Turkey
| | - Selcan Arslan Özel
- Department of Infectious Diseases and Clinical Microbiology, Kocaeli Training and Research Hospital, Saglik Bilimleri University, Kocaeli, Turkey
| | - Sinan Öztürk
- Department of Infectious Diseases and Clinical Microbiology, Ümraniye Education and Research Hospital, Saglik Bilimleri University, Kocaeli, Turkey
| | - Kaya Suer
- Department of Infectious Diseases and Clinical Microbiology, Yakın Doğu University of Faculty of Medicine, Nicosia, Turkey
| | - Mustafa Kemal Çelen
- Department of Infectious Diseases and Clinical Microbiology, Dicle University Faculty of Medicine, Diyarbakır, Turkey
| | - Petek Konya
- Department of Infectious Disease and Clinical Microbiology, Afyon Saglik Bilimleri University Medical Faculty, Afyonkarahisar, Turkey
| | - Ali Asan
- Department of Infectious Diseases and Clinical Microbiology, Bursa Yüksek İhtisas Training and Research Hospital, Saglik Bilimleri University, Bursa, Turkey
| | - Neşe Saltoğlu
- Department of Infectious Diseases and Clinical Microbiology, İstanbul University of Cerrahpaşa Faculty of Medicine, İstanbul, Turkey
| | - Nurhan Doğan
- Department of Biostatistics and Medical Informatics, Afyon Saglik Bilimleri University Medical Faculty, Afyonkarahisar, Turkey
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Başaran S, Şimşek-Yavuz S, Meşe S, Çağatay A, Medetalibeyoğlu A, Öncül O, Özsüt H, Ağaçfidan A, Gül A, Eraksoy H. The effect of tocilizumab, anakinra and prednisolone on antibody response to SARS-CoV-2 in patients with COVID-19: A prospective cohort study with multivariate analysis of factors affecting the antibody response. Int J Infect Dis 2021; 105:756-762. [PMID: 33737128 PMCID: PMC7959682 DOI: 10.1016/j.ijid.2021.03.031] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/22/2021] [Revised: 03/01/2021] [Accepted: 03/10/2021] [Indexed: 02/07/2023] Open
Abstract
Objectives Disease severity, previous medications and immunosuppressive agents could affect the antibody response against SARS-CoV-2. This study aimed to analyze variables affecting the humoral response to SARS-CoV-2. Methods This prospective cohort study included adult patients who recovered from COVID-19 and were admitted to a COVID-19 follow-up unit. Eight patient groups were defined in accordance with the results of thoracic computed tomography (CT), SARS-CoV-2 PCR test, and tocilizumab or anakinra use during active disease. Anti-S IgG antibodies were determined by ELISA in serum samples. Anti-S positive and negative cases were compared. Results A total of 518 patients were included in the study. SARS-CoV-2 IgG antibodies were positive in 82.8% of patients. SARS-CoV-2 PCR positivity, extent of lung involvement on CT, and time to antibody testing were independently associated with antibody positivity. Tocilizumab, anakinra or prednisolone use was not a factor affecting the antibody response. The rate of antibody response and sample/CO values among antibody-positive patients showed a linear relationship with the extent of lung involvement on CT. Conclusions The use of tocilizumab, anakinra and prednisolone for COVID-19 did not affect the antibody response against SARS-CoV-2. The main driver of antibody response among patients with COVID-19 was the extent of pulmonary involvement on CT.
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Affiliation(s)
- Seniha Başaran
- Department of Infectious Diseases and Clinical Microbiology, Istanbul Faculty of Medicine, Istanbul University, Istanbul, Turkey.
| | - Serap Şimşek-Yavuz
- Department of Infectious Diseases and Clinical Microbiology, Istanbul Faculty of Medicine, Istanbul University, Istanbul, Turkey
| | - Sevim Meşe
- Department of Medical Microbiology, Division of Virology and Fundamental Immunology, Istanbul Faculty of Medicine, Istanbul University, Istanbul, Turkey
| | - Atahan Çağatay
- Department of Infectious Diseases and Clinical Microbiology, Istanbul Faculty of Medicine, Istanbul University, Istanbul, Turkey
| | - Alpay Medetalibeyoğlu
- Department of Internal Medicine, Istanbul Faculty of Medicine, Istanbul University, Istanbul, Turkey
| | - Oral Öncül
- Department of Infectious Diseases and Clinical Microbiology, Istanbul Faculty of Medicine, Istanbul University, Istanbul, Turkey
| | - Halit Özsüt
- Department of Infectious Diseases and Clinical Microbiology, Istanbul Faculty of Medicine, Istanbul University, Istanbul, Turkey
| | - Ali Ağaçfidan
- Department of Medical Microbiology, Division of Virology and Fundamental Immunology, Istanbul Faculty of Medicine, Istanbul University, Istanbul, Turkey
| | - Ahmet Gül
- Department of Rheumatology, Istanbul Faculty of Medicine, Istanbul University, Istanbul, Turkey
| | - Haluk Eraksoy
- Department of Infectious Diseases and Clinical Microbiology, Istanbul Faculty of Medicine, Istanbul University, Istanbul, Turkey
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5
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Sayan M, Özgüler M, Sarıgül Yıldırım F, Yıldırmak T, Gündüz A, Dokuzoğuz B, Çelen MK, İnan D, Heper Y, Ersöz G, Karaoğlan İ, Ceran N, Deveci A, Öztürk S, Sayın Kutlu S, Özkan Özdemir H, Akbulut A, Yazıcı S, Şener A, Çağatay A, Ünal S. Molecular Identification of HIV-1 in the Presence of Hepatitis B Virus and Hepatitis C Virus Co-infections. Balkan Med J 2020; 37:125-130. [PMID: 32106666 PMCID: PMC7161615 DOI: 10.4274/balkanmedj.galenos.2020.2019.5.89] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/21/2019] [Accepted: 02/24/2020] [Indexed: 01/20/2023] Open
Abstract
Background Because of their similar modes of transmission, the simultaneous infection of viral hepatitis and human immunodeficiency virus are increasingly seen as a big problem related to human health. Aims To determine the drug mutations in hepatitis B virus and/or hepatitis C virus co-infected human immunodeficiency virus-1 patients in Turkey. Study Design Retrospective cross-sectional study. Methods The present study was conducted between 2010 and 2017. HBsAg, anti-hepatitis C virus, and anti-human immunodeficiency virus were tested with ELISA. All anti-human immunodeficiency virus positive results by ELISA were verified for anti-human immunodeficiency virus positivity by a Western blot test, and Anti-human immunodeficiency virus positive patients with HBsAg and/or anti-hepatitis C virus positivity were included in the study. Subtyping and genotypic resistance analyses were performed by population sequencing of the viral protease and reverse transcriptase regions of the human immunodeficiency virus-1 pol gene. Results We detected 3896 human immunodeficiency virus-1 positive patients whose sera were sent from numerous hospitals across the country to our polymerase chain reaction unit for detection of drug resistance mutations and whose molecular laboratory tests were completed. Viral hepatitis co-infections were detected in 4.3% (n=170) of patients. Hepatitis B virus and hepatitis C virus co-infection were observed in 3.2% and 0.5% of all human immunodeficiency virus-1 infected patients, respectively. The major human immunodeficiency virus-1 subtype detected was group M, subtype B (62.9%). However, 13.5% of drug resistance mutation motifs were found in human immunodeficiency virus-1 genomes of patients included in the study. Conclusion Due to similar transmission routes, HIV1 patients are at risk of hepatitis B and C virus co-infection. However, antiretroviral drug resistance mutation model is similar to patients with hepatitis negative.
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Affiliation(s)
- Murat Sayan
- Clinical Laboratory, PCR Unit, Kocaeli University School of Medicine, Kocaeli, Turkey
- Research Center of Experimental, Health Sciences Near East University, Northern Cyprus
| | - Müge Özgüler
- Clinic of Infectious Diseases and Clinical Microbiology, University of Health Sciences, Elazığ Fethi Sekin City Hospital, Elazığ, Turkey
| | - Figen Sarıgül Yıldırım
- Clinic of Infectious Diseases and Clinical Microbiology, University of Health Sciences, Antalya Training and Research Hospital, Antalya, Turkey
| | - Taner Yıldırmak
- Clinic of Infectious Diseases and Clinical Microbiology, University of Health Sciences, Okmeydanı Training and Research Hospital, İstanbul, Turkey
| | - Alper Gündüz
- Clinic of Infectious Diseases and Clinical Microbiology, University of Health Sciences, Şişli Etfal Training and Research Hospital, İstanbul, Turkey
| | - Başak Dokuzoğuz
- Clinic of Infectious Diseases and Clinical Microbiology, University of Health Sciences, Ankara Training and Research Hospital, Ankara, Turkey
| | - Mustafa Kemal Çelen
- Department of Infectious Diseases and Clinical Microbiology, Dicle University School of Medicine, Diyarbakır, Turkey
| | - Dilara İnan
- Department of Infectious Diseases and Clinical Microbiology, Akdeniz University School of Medicine, Antalya, Turkey
| | - Yasemin Heper
- Department of Infectious Diseases and Clinical Microbiology, Uludağ University School of Medicine, Bursa, Turkey
| | - Gülden Ersöz
- Department of Infectious Diseases and Clinical Microbiology, Mersin University School of Medicine, Mersin Turkey
| | - İlkay Karaoğlan
- Department of Infectious Diseases and Clinical Microbiology, Gaziantep University School of Medicine, Gaziantep, Turkey
| | - Nurgül Ceran
- Clinic of Infectious Diseases and Clinical Microbiology, University of Health Sciences, Haydarpaşa Numune Training and Research Hospital, İstanbul, Turkey
| | - Aydın Deveci
- Department of Infectious Diseases and Clinical Microbiology, Ondokuz Mayıs University School of Medicine, Samsun, Turkey
| | - Servet Öztürk
- Clinic of Infectious Diseases and Clinical Microbiology, University of Health Sciences, Fatih Sultan Mehmet Training and Research Hospital, İstanbul, Turkey
| | - Selda Sayın Kutlu
- Department of Infectious Diseases and Clinical Microbiology, Pamukkale University School of Medicine, Denizli, Turkey
| | - Hülya Özkan Özdemir
- Department of Infectious Diseases and Clinical Microbiology, University of Health Sciences, Bozyaka Training and Research Hospital, İzmir, Turkey
| | - Ayhan Akbulut
- Department of Infectious Diseases and Clinical Microbiology, Fırat University School of Medicine, Elazığ, Turkey
| | - Saadet Yazıcı
- Clinic of Infectious Diseases and Clinical Microbiology, Medeniyet University, Göztepe Training and Research Hospital, İstanbul, Turkey
| | - Alper Şener
- Department of Infectious Diseases and Clinical Microbiology, Onsekiz Mart University School of Medicine, Çanakkale, Turkey
| | - Atahan Çağatay
- Department of Infectious Diseases and Clinical Microbiology, İstanbul University School of Medicine, İstanbul, Turkey
| | - Serhat Ünal
- Department of Infectious Diseases and Clinical Microbiology, Hacettepe University School of Medicine, Ankara, Turkey
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Sarıbeyliler G, Alimoğlu SS, Mirioğlu Ş, Demir E, Çağatay A, Yazıcı H. Tuberculosis Mastitis: Fever of Unknown Origin in a Kidney Transplant Recipient. Eur J Breast Health 2019; 15:272-274. [PMID: 31620688 DOI: 10.5152/ejbh.2019.4488] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/17/2018] [Accepted: 01/10/2019] [Indexed: 02/04/2023]
Abstract
Tuberculous mastitis is a rare presentation of tuberculosis, which is a major health problem in kidney transplant recipients due to its high incidence and prevalence, and difficulty in diagnosis as well as high risk of morbidity and mortality. In daily practice, physicians may frequently be led to a misdiagnosis such as breast carcinoma or abscess. We believe it is crucial for clinicians to recognize this important presentation of the disease. Therefore, we present a case of tuberculous mastitis in a kidney transplant recipient who was admitted with fever of unknown origin and successfully treated using standard anti-tuberculosis therapy without any complications.
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Affiliation(s)
- Göktuğ Sarıbeyliler
- Division of Nephrology, Department of Internal Medicine, İstanbul University İstanbul School of Medicine, İstanbul, Turkey
| | - Sevgi Saçlı Alimoğlu
- Division of Nephrology, Department of Internal Medicine, İstanbul University İstanbul School of Medicine, İstanbul, Turkey
| | - Şafak Mirioğlu
- Division of Nephrology, Department of Internal Medicine, İstanbul University İstanbul School of Medicine, İstanbul, Turkey
| | - Erol Demir
- Division of Nephrology, Department of Internal Medicine, İstanbul University İstanbul School of Medicine, İstanbul, Turkey
| | - Atahan Çağatay
- Department of Infectious Diseases and Clinical Microbiology, İstanbul University İstanbul School of Medicine, İstanbul, Turkey
| | - Halil Yazıcı
- Division of Nephrology, Department of Internal Medicine, İstanbul University İstanbul School of Medicine, İstanbul, Turkey
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7
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Sarigül F, Sayan M, İnan D, Deveci A, Ceran N, Çelen MK, Çağatay A, Özdemir HÖ, Kuşcu F, Karagöz G, Heper Y, Karabay O, Dokuzoğuz B, Kaya S, Erben N, Karaoğlan İ, Ersöz GM, Günal Ö, Hatipoğlu Ç, Kutlu SS, Akbulut A, Saba R, Şener A, Büyüktuna SA. Current status of HIV/AIDS-syphilis co-infections: a retrospective multicentre study. Cent Eur J Public Health 2019; 27:223-228. [PMID: 31580558 DOI: 10.21101/cejph.a5467] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/25/2018] [Accepted: 08/22/2019] [Indexed: 11/15/2022]
Abstract
OBJECTIVE Treponema pallidum and HIV are transmitted frequently through sexual contact, these agents with epidemiological similarities co-infect the same host. The current number of HIV-infected cases in Turkey is increasing. For this reason, we aimed to reveal the characteristics of syphilis in HIV/AIDS cases. METHODS A retrospective longitudinal cohort study was performed, patients were followed up at 24 clinics in 16 cities from all seven regions of Turkey between January 2010 to April 2018. We examined the socio-demographic characteristics, laboratory parameters and neurosyphilis association in HIV/AIDS-syphilis co-infected cases. RESULTS Among 3,641 patients with HIV-1 infection, 291 (8%) patients were diagnosed with syphilis co-infection. Most patients were older than 25 years (92%), 96% were males, 74% were working, 23% unemployed, and 3% were students. The three highest prevalence of syphilis were in Black Sea (10.3%), Mediterranean (8.4%) and Marmara Regions (7.4%). As for sexual orientation, 46% were heterosexuals, 42% men who have sex with men (MSM), and no data available for 12%. Patients with the number of CD4+ ≤ 350 mm3 reached 46%, 17% of the patients received antiretroviral therapy and neurosyphilis association reached 9%. CONCLUSION Although HIV/AIDS-syphilis co-infection status appeared high in heterosexuals, MSM had a moderate level increase in cases. Our results suggested syphilis co-infection in HIV/AIDS cases should be integral part of monitoring in a national sexual transmitted diseases surveillance system. However, our data may provide base for HIV/syphilis prevention and treatment efforts in the future.
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Affiliation(s)
- Figen Sarigül
- Infectious Disease and Clinical Microbiology Department, Antalya and Research Hospital, Health Sciences University, Antalya, Turkey
| | - Murat Sayan
- PCR Unit, Clinical Laboratory, Faculty of Medicine, Kocaeli University, Kocaeli, Turkey.,Research Centre of Experiment Health Sciences, Near East University, Nicosia, Northern Cyprus
| | - Dilara İnan
- Infectious Disease and Clinical Microbiology Department, Faculty of Medicine, Akdeniz University, Antalya, Turkey
| | - Aydin Deveci
- Infectious Disease and Clinical Microbiology Department, Faculty of Medicine, Samsun 19 Mayis University, Samsun, Turkey
| | - Nurgül Ceran
- Infectious Disease and Clinical Microbiology Department, Istanbul Haydarpasa Numune Education and Research Hospital, Health Sciences University, Istanbul, Turkey
| | - Mustafa Kemal Çelen
- Infectious Disease and Clinical Microbiology Department, Faculty of Medicine, Diyarbakir University, Diyarbakir, Turkey
| | - Atahan Çağatay
- Infectious Disease and Clinical Microbiology Department, Faculty of Medicine, Istanbul University, Istanbul, Turkey
| | - Hülya Özkan Özdemir
- Infectious Disease and Clinical Microbiology Department, Bozyaka Education and Research Hospital, Health Sciences University, Izmir, Turkey
| | - Ferit Kuşcu
- Infectious Disease and Clinical Microbiology Department, Faculty of Medicine, Cukurova University, Adana, Turkey
| | - Gül Karagöz
- Infectious Disease and Clinical Microbiology Department, Istanbul Umraniye Education and Research Hospital, Health Sciences University, Istanbul, Turkey
| | - Yasemin Heper
- Infectious Disease and Clinical Microbiology Department, Faculty of Medicine, Bursa University, Bursa, Turkey
| | - Oğuz Karabay
- Infectious Disease and Clinical Microbiology Department, Faculty of Medicine, Sakarya University, Sakarya, Turkey
| | - Başak Dokuzoğuz
- Infectious Disease and Clinical Microbiology Department, Ankara Numune Education and Research Hospital, Health Sciences University, Ankara, Turkey
| | - Selçuk Kaya
- Infectious Disease and Clinical Microbiology Department, Faculty of Medicine, Karadeniz Technical University, Trabzon, Turkey
| | - Nurettin Erben
- Infectious Disease and Clinical Microbiology Department, Faculty of Medicine, Eskisehir University, Eskisehir, Turkey
| | - İlkay Karaoğlan
- Infectious Disease and Clinical Microbiology Department, Faculty of Medicine, Gaziantep University, Gaziantep, Turkey
| | - Gülden Munis Ersöz
- Infectious Disease and Clinical Microbiology Department, Faculty of Medicine, Mersin University, Mersin, Turkey
| | - Özgür Günal
- Infectious Disease and Clinical Microbiology Department, Samsun Education and Research Hospital, Health Sciences University, Samsun, Turkey
| | - Çiğdem Hatipoğlu
- Infectious Disease and Clinical Microbiology Department, Ankara Education and Research Hospital, Health Sciences University, Ankara, Turkey
| | - Selda Sayin Kutlu
- Infectious Disease and Clinical Microbiology Department, Faculty of Medicine, Pamukkale University, Denizli, Turkey
| | - Ayhan Akbulut
- Infectious Disease and Clinical Microbiology Department, Faculty of Medicine, Firat University, Elazig, Turkey
| | - Rabin Saba
- Infectious Disease and Clinical Microbiology Department, Private Medstar Antalya Hospital, Antalya, Turkey
| | - Alper Şener
- Infectious Disease and Clinical Microbiology Department, Faculty of Medicine, Onsekiz Mart University, Canakkale, Turkey
| | - Seyit Ali Büyüktuna
- Infectious Disease and Clinical Microbiology Department, Faculty of Medicine, Cumhuriyet University, Sivas, Turkey
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8
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Kaymakoğlu S, Köksal İ, Tabak F, Akarca US, Akbulut A, Akyüz F, Bodur H, Çağatay A, Dinçer D, Esen Ş, Güner R, Gürel S, Köse Ş, Şentürk Ö, Şimşek H, Yamazhan T, Yılmaz Y, Idilman R, Guidelines Study Group VH. Recommendation for treatment of hepatitis C virus infection. Turk J Gastroenterol 2018; 28:94-100. [PMID: 29303106 DOI: 10.5152/tjg.2017.22] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
Affiliation(s)
- Sabahattin Kaymakoğlu
- Turkish Association for the Study of the Liver, İstanbul, Turkey; Viral Hepatitis Society, Ankara, Turkey
| | - İftihar Köksal
- Turkish Association for the Study of the Liver, İstanbul, Turkey; Viral Hepatitis Society, Ankara, Turkey
| | - Fehmi Tabak
- Turkish Association for the Study of the Liver, İstanbul, Turkey; Viral Hepatitis Society, Ankara, Turkey
| | - Ulus S Akarca
- Turkish Association for the Study of the Liver, İstanbul, Turkey; Viral Hepatitis Society, Ankara, Turkey
| | - Ayhan Akbulut
- Turkish Association for the Study of the Liver, İstanbul, Turkey; Viral Hepatitis Society, Ankara, Turkey
| | - Filiz Akyüz
- Turkish Association for the Study of the Liver, İstanbul, Turkey; Viral Hepatitis Society, Ankara, Turkey
| | - Hürrem Bodur
- Turkish Association for the Study of the Liver, İstanbul, Turkey; Viral Hepatitis Society, Ankara, Turkey
| | - Atahan Çağatay
- Turkish Association for the Study of the Liver, İstanbul, Turkey; Viral Hepatitis Society, Ankara, Turkey
| | - Dinç Dinçer
- Turkish Association for the Study of the Liver, İstanbul, Turkey; Viral Hepatitis Society, Ankara, Turkey
| | - Şaban Esen
- Turkish Association for the Study of the Liver, İstanbul, Turkey; Viral Hepatitis Society, Ankara, Turkey
| | - Rahmet Güner
- Turkish Association for the Study of the Liver, İstanbul, Turkey; Viral Hepatitis Society, Ankara, Turkey
| | - Selim Gürel
- Turkish Association for the Study of the Liver, İstanbul, Turkey; Viral Hepatitis Society, Ankara, Turkey
| | - Şükran Köse
- Turkish Association for the Study of the Liver, İstanbul, Turkey; Viral Hepatitis Society, Ankara, Turkey
| | - Ömer Şentürk
- Turkish Association for the Study of the Liver, İstanbul, Turkey; Viral Hepatitis Society, Ankara, Turkey
| | - Halis Şimşek
- Turkish Association for the Study of the Liver, İstanbul, Turkey; Viral Hepatitis Society, Ankara, Turkey
| | - Tansu Yamazhan
- Turkish Association for the Study of the Liver, İstanbul, Turkey; Viral Hepatitis Society, Ankara, Turkey
| | - Yusuf Yılmaz
- Turkish Association for the Study of the Liver, İstanbul, Turkey; Viral Hepatitis Society, Ankara, Turkey
| | - Ramazan Idilman
- Turkish Association for the Study of the Liver, İstanbul, Turkey; Viral Hepatitis Society, Ankara, Turkey
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9
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Benli A, Şimşek-Yavuz S, Başaran S, Çağatay A, Özsüt H, Eraksoy H. Hematologic Adverse Effects of Prolonged Piperacillin-Tazobactam Use in Adults. Turk J Haematol 2018; 35:290-295. [PMID: 29856362 PMCID: PMC6256823 DOI: 10.4274/tjh.2018.0127] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/02/2022] Open
Abstract
Objective: We aimed to find the incidence and risk factors of hematologic adverse effects of piperacillin-tazobactam (TZP). Materials and Methods: Adult patients who used TZP for more than 10 days were included in the study. Results: The incidence of leukopenia, neutropenia, and eosinophilia in 110 TZP therapy episodes was found to be 16.3%, 10%, and 10%, respectively. Lower Charlson Comorbidity Index score, lower initial leukocyte count, combination of TZP with another antibiotic, and total duration of TZP therapy were found to be independent risk factors for leukopenia, while initial higher eosinophil count (IHEC) and usage of TZP for >20 days were independent risk factors for neutropenia and IHEC and total duration of TZP therapy were independent risk factors for eosinophilia. Conclusion: Longer duration of therapy, combination with other antibiotics, younger age with fewer comorbidities, and IHEC could result in hematologic adverse effects in patients treated with TZP. Patients with IHEC may be more prone to allergic reactions, so immunological mechanisms may facilitate the development of hematological adverse effects of TZP.
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Affiliation(s)
- Aysun Benli
- Muş State Hospital, Clinic of Infectious Diseases and Clinical Microbiology, Muş, Turkey
| | - Serap Şimşek-Yavuz
- İstanbul University İstanbul Faculty of Medicine, Department of Infectious Diseases and Clinical Microbiology, İstanbul, Turkey
| | - Seniha Başaran
- İstanbul University İstanbul Faculty of Medicine, Department of Infectious Diseases and Clinical Microbiology, İstanbul, Turkey
| | - Atahan Çağatay
- İstanbul University İstanbul Faculty of Medicine, Department of Infectious Diseases and Clinical Microbiology, İstanbul, Turkey
| | - Halit Özsüt
- İstanbul University İstanbul Faculty of Medicine, Department of Infectious Diseases and Clinical Microbiology, İstanbul, Turkey
| | - Haluk Eraksoy
- İstanbul University İstanbul Faculty of Medicine, Department of Infectious Diseases and Clinical Microbiology, İstanbul, Turkey
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10
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Başaran S, Karabıçak N, Şimşek Yavuz S, Wiederhold NP, Şafak S, Sarıbuğa A, Sutton DA, Bingöl Z, Çağatay A, Özsüt H, Kılıçaslan Z, Eraksoy H. [A case of coccidioidomycosis in Turkey imported from the United States of America]. MIKROBIYOL BUL 2017; 51:183-190. [PMID: 28566083 DOI: 10.5578/mb.54033] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Coccidioidomycosis caused by Coccidioides immitis or Coccidioides posadasii is a rare infectious disease except in endemic regions. In this report the third documented imported case of coccidioidomycosis in Turkey was presented. A thirty-year-old male patient was admitted to our hospital with fever and purulent drainage from his chest tube. He had worked in Arizona, USA, until 4 months before this presentation. While in Arizona, he experienced cough and hemoptysis and was diagnosed as pulmonary coccidioidomycosis. He was treated with itraconazole for two months and he had no symptoms for 3 years. He then returned to Turkey and 2 months after his return to Turkey, he was admitted to another hospital in Istanbul with dyspnea and diagnosed as hydro-pneumothorax, and pleural fluid obtained from the inserted chest tube was found to be purulent. One gram of BID amoxicillin-clavulanate was given. Physical examination on admission revealed a purulent drainage on the right side chest tube, a temperature of 38.5°C and decreased breath sounds on the right lung. Piperacillin-tazobactam 3 x 4.5 g intravenous and fluconazole 400 mg intravenous once daily were started. Human immunodeficiency virus test was negative. Gram-negative diplococci and rods, gram-positive cocci and septate hyphae were seen in the Gram stain of his pleural fluid. Pleural fluid culture revealed Moraxella catarrhalis after 24 hours incubation and a mold after 72 hours of incubation. Anti-coccidioidal antibodies were found positive in a titer of 1/2. Hydro-pneumothorax, atelectasis and a 3 mm nodules in the right lung were seen in his thorax CT. The patient's pleural fluid and the culture plates were sent to the Public Health Institute of Turkey, Mycology Reference Laboratory (PHIT-MRL), with a clinical suspicion of coccidioidomycosis. The specimen and plates were submitted to the PHIT-MRL Bio Safety Level-3 laboratory for mycological evaluation. The microscopic examination of 15% KOH preparations of pleural fluid specimens revealed septate hyphae which appear to be in the early stages of forming arthroconidia. The pleural fluid culture grew buff-white coloured colonies with aerial hyphae, which were suspected of being a Coccidioides spp. The strain was identified as C.immitis/posadasii by direct microscopy and culture, and subsequently confirmed by the FDA-approved DNA probe. DNA sequence analysis of the ITS and D1/D2 rDNA regions confirmed the isolate to be C.posadasii species [ITS 100% match to GenBank Accession No. AB232901 (630/630 base pair match), and D1/D2 100% match to GenBank Accession No. AB232884 (617/617 base pair match)]. ITS1 and ITS2 barcode analysis also confirmed the species to be C.posadasii, which is the species endemic in Arizona. Susceptibility testing was performed according to Clinical and Laboratory Standards Institute M38-A2 guidelines in the Fungus Testing Laboratory of the University of Texas Health Science Center at San Antonio and minimal inhibitory concentration values were; 0.125 µg/ml for amphotericin B, posaconazole and voriconazole, 0.5 µg/ml for itraconazole and 8 µg/ml for fluconazole. He had decortication of the pleura and was discharged from hospital after six weeks treatment with intravenous fluconazole which was continued orally for one year. Anti-coccidioidal antibodies were negative after two months of treatment. The patient is currently asymptomatic. The presented case is the third case reported from Turkey and provides additional contribution to the existing literature with regard to the appearance of arthroconidium, which is the unusual hyphal form, instead of the expected spherules in the infected tissue.
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Affiliation(s)
- Seniha Başaran
- Istanbul University Istanbul Faculty of Medicine, Department of Infectious Diseases and Clinical Microbiology, Istanbul, Turkey.
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11
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Sayan M, Gündüz A, Ersöz G, İnan A, Deveci A, Özgür G, Sargın F, Karagöz G, İnci A, İnan D, Ülçay A, Karaoğlan I, Kaya S, Kutlu SS, Süer K, Çağatay A, Akalın H. Integrase Strand Transfer Inhibitors (INSTIs) Resistance Mutations in HIV-1 Infected Turkish Patients. HIV Clin Trials 2016; 17:109-13. [PMID: 27125365 DOI: 10.1080/15284336.2016.1153303] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
Abstract
OBJECTIVES Integrase strand transfer inhibitor (INSTI) is a new class of antiretroviral (ARV) drugs designed to block the action of the integrase viral enzyme, which is responsible for insertation of the HIV-1 genome into the host DNA. The aim of this study was to evaluate for the first time INSTI resistance mutations in Turkish patients. METHODS This study was conducted in Turkey, between April 2013 and April 2015 using 169 HIV-1-infected patients (78 ARV naive patients and 91 ARV-experienced patients). Laboratory and clinical characteristics of ARV naive and ARV-experienced patients were as follows: gender (M/F): 71/7 and 80/11, median age: 38 and 38.4; median CD4(+) T-cell: 236 and 216 cells/mm(3), median HIV-1 RNA: 4.95+E5 and 1.08E+6 copies/ml. Population-based seqeunces of the reverse transcriptase, protease, and integrase domains of the HIV-1 pol gene were used to detect HIV-1 drug resistance mutations. RESULT INSTI resistance mutations were not found in recently diagnosed HIV-1-infected patients. However, ARV-experienced patients had major resistance mutations associated with raltegravir and elvitegravir; the following results were generated:F121Y, Y143R, Q148R and E157Q (6/91 - 6.6%). CONCLUSIONS The prevalence of INSTI resistant mutations in ART-experienced patients suggested that resistance testing must be incorporated as an integral part of HIV management with INSTI therapies.
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Affiliation(s)
- M Sayan
- a Faculty of Medicine, Clinical Laboratory, PCR Unit , University of Kocaeli , Kocaeli , Turkey.,b Research Center of Experimental Health Sciences, University of Near East , Nicosia , Northern Cyprus
| | - A Gündüz
- c Clinic of Infectious Diseases , Sisli Etfal, Educational and Research Hospital , Istanbul , Turkey
| | - G Ersöz
- d Faculty of Medicine, Department of Infectious Diseases , University of Mersin , Mersin , Turkey
| | - A İnan
- e Clinic of Infectious Diseases , Haydarpasa Numune, Educational and Research Hospital , Istanbul , Turkey
| | - A Deveci
- f Faculty of Medicine, Department of Infectious Diseases , University of 19 Mayis , Samsun , Turkey
| | - G Özgür
- g Clinic of Infectious Diseases , Samsun Educational and Research Hospital , Samsun , Turkey
| | - F Sargın
- h Clinic of Infectious Diseases , Medeniyet University, Goztepe Educational and Research Hospital , Istanbul , Turkey
| | - G Karagöz
- i Clinic of Infectious Diseases , Umraniye Educational and Research Hospital , İstanbul , Turkey
| | - A İnci
- j Clinic of Infectious Diseases , Istanbul Kanuni Sultan Süleyman, Educational and Research Hospital , Istanbul , Turkey
| | - D İnan
- k Faculty of Medicine, Department of Infectious Diseases , University of Akdeniz , Antalya , Turkey
| | - A Ülçay
- l Clinic of Infectious Diseases , Gulhane Military Medical Academy , Istanbul , Turkey
| | - I Karaoğlan
- m Faculty of Medicine, Department of Infectious Diseases , University of Gaziantep , Gaziantep , Turkey
| | - S Kaya
- n Faculty of Medicine, Department of Infectious Disease , University of Karadeniz Technical , Trabzon , Turkey
| | - S S Kutlu
- o Faculty of Medicine, Department of Infectious Diseases , University of Pamukkale , Denizli , Turkey
| | - K Süer
- p Faculty of Medicine, Department of Infectious Diseases , University of Near East , Nicosia , Northern Cyprus
| | - A Çağatay
- q Faculty of Medicine, Department of Infectious Diseases , University of Istanbul , İstanbul , Turkey
| | - H Akalın
- r Faculty of Medicine, Department of Infectious Diseases , University of Uludag , Bursa , Turkey
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