Gebelerde Hepatit B, Hepatit C ve HIV Seroprevalansı; Altı yıllık deneyim

Year 2020, , 89 - 95, 30.09.2020

İbrahim Kale , Rahime Bayık , Semra Kavas

https://doi.org/10.46969/ezh.742307

Abstract

Amaç: 01 Ocak 2014 ile 31 Aralık 2019 tarihleri arasında Ümraniye Eğitim ve Araştırma Hastanesi’nin gebe polikliniğine başvuran gebelerdeki Hepatit B (HBV), Hepatit C (HCV) ve İnsan İmmunyetmezlik Virüsü (HIV) seroprevalansını belirlemek ve yıllara göre vakaların dağılımını ortaya çıkarmaktır.
Gereç ve Yöntem: Hastanemizin gebe polikliniğine başvuran gebelerden alınan kan örneklerinden çalışılan Hepatit B yüzey antijen (HBsAg), Hepatit B yüzey antijen antikoru (Anti-HBs), Hepatit C virüs antikoru (Anti-HCV) ve HIV antikoru (Anti-HIV) sonuçları hastane kayıtlarından retrospektif olarak tarandı. Anti-HIV reaktivitesi olan hastalara yapılan Line Immunassay doğrulama testi sonuçlarına hastane kayıtlarından ulaşıldı.
Bulgular: 11,263 gebede Anti-HBs bakılmış, 3898 gebede sonuç pozitif olarak gelmiştir (%34,61), 55,639 gebede HBsAg bakılmış, 822 gebede sonuç pozitif olarak gelmiştir (%1,48), 47,990 gebede Anti-HCV bakılmış, 159 gebede (%0,33) sonuç pozitif olarak gelmiştir. 44,107 gebede Anti-HIV bakılmış, 40 gebede sonuç reaktif olarak gelmiştir (%0,09). Anti-HIV reaktif gelen 40 gebede doğrulama line immunassay yöntemi ile yapılmıştır ve 5 gebede HIV enfeksiyonu kesin olarak doğrulanmıştır (%0,01). 2014 ile 2019 yılları arasında yıllara sırası ile göre seropozitiflik oranları Anti-HBs için %26,16, %28,94, %32,20, %34,82, %39,66, %41,73; HBsAg için %1,54, %1,52, %1,46, %1,53, %1,45, %1,36; Anti-HCV için %0,25, %0,40, %0,32, %0,39, %0,29, %0,32 ve Anti-HIV için %0 %0,07, %0,13, %0,07, %0,15, %0,17 olarak tespit edilmiştir.
Sonuç: Antenatal dönemde gebeler HBV, HCV ve HIV açısından taranmalıdır. HCV ve HIV için gebelikte erken tanı ve tedavi enfeksiyonların uzun dönem komplikasyonlarının önlenmesi ve anneden bebeğe olan geçişin azaltılması için önemlidir.

Keywords

Antenatal tarama, gebelik, Hepatit B Virüsü, Hepatit C Virüsü, İnsan İmmun Yetmezlik Virüsü

Hepatitis B, Hepatitis C and HIV seroprevalence in pregnant women: Six years of experience.

Abstract

Aim: To determine the seroprevalence of hepatitis B (HBV), hepatitis C (HCV), and human immunodeficiency virus (HIV) in pregnant women who presented to the pregnancy outpatient clinic at Umraniye Training and Research Hospital between January 1, 2014, and December 31, 2019, and to reveal the distribution of cases by year.
Material and method: Hepatitis B surface antigen (HBsAg), hepatitis B surface antigen-antibody (Anti-HBs), hepatitis C virus antibody (Anti-HCV), and HIV antibody (Anti-HIV) results from blood samples taken from pregnant women admitted to our hospital’s pregnancy outpatient clinic were retrospectively scanned. The results of the line immunoassay validation test performed on patients with Anti-HIV reactivity were obtained from hospital records.
Results: Anti-HBs values were examined in 11,263 pregnant women, and positive results were found in 3,898 (34.61%). HBsAg values were examined in 55,639 pregnant women, with positive results in 822 (1.48%). Anti-HCV values were examined in 47,990 pregnant women, and the results were positive in 159 (0.33%). Anti-HIV values were examined in 44,107 pregnant women, and the result was found to be reactive in 40 (0.09%). HIV infection was confirmed in 5 pregnant women (0.01%). The seropositivity rates by year between 2014 and 2019 were 26.16%, 28.94%, 32.20%, 34.82%, 39.66%, and 41.73% for Anti-HBs; 1.54%, 1.52%, 1.46%, 1.53%, 1.45%, and 1.36% for HBsAg; 0.25%, 0.40%, 0.32%, 0.39%, 0.29%, and 0.32% for Anti-HCV; and 0%, 0.07%, 0.13%, 0.07%, 0.15%, and 0.17% for Anti-HIV.
Conclusion: During the antenatal period, pregnant women should be screened for HBV, HCV and HIV. Early diagnosis and treatment of HCV and HIV in pregnancy is vital to prevent long-term complications of infections and to reduce the transmission from the mother to the infant.

Keywords

Antenatal screening, pregnancy, Hepatitis B virus, Hepatitis C virus, Human immunodeficiency virus

References

• World Health Organization (WHO). Global hepatitis report, April 2017. Available from: https://www.who.int/hepatitis/publications/global-hepatitis-report2017/en/ (Erişim: 28.09.2020).
• World Heath Organization website. Available from: https://www.who.int/gho/hiv/en/ (Erişim: 28.09.2020).
• Türkiye viral Hepatit önleme ve kontrol programı, 2018. Available from: https://hsgm.saglik.gov.tr/depo/birimler/Bulasici-hastaliklar-db/duyurular/Turkiye_Viral_Hepatit_Onleme_ve_Kontrol_Programi/Turkiye_Viral_Hepatit_Onleme_ve_Kontrol_Programi_TR.pdf (Erişim: 28.09.2020).
• Madendağ Y, Çöl Madendağ İ, Çelen Ş, Ünlü S, Danışman N. Hepatitis B, Hepatitis C and HIV Seroprevalence in All Obstetric and Gynecological Patients Admitted to Our Hospital Turkey Clinics J Gynecol Obst 2007; 17:442-446.
• Spera AM, Eldin TK, Tosone G, Orlando R. Antiviral therapy for hepatitis C: has anything changed for pregnant/lactating women? World J Hepatol 2016; 8:557-565.
• Republic of Turkey, Ministry of Health, General Directorate of Public Health. https://hsgm.saglik.gov.tr/tr/bulasici-hastaliklar/hiv-aids/hiv-aids-liste/h%C4%B1v-aids-istatislik.html (Erişim: 24.05.2020)
• Jonas MM. Hepatitis B and pregnancy: an underestimated issue. Liver Int 2009; 29 Suppl 1:133-139.
• Borgia G, Carleo MA, Gaeta GB, Gentile I. Hepatitis B in pregnancy. World J Gastroenterol 2012; 18:4677-4683.
• Dogan K, Guraslan H, Ozel G, Aydan Z, Yasar L. Seroprevalence rates of toxoplasma gondii, rubella, cytomegalovirus, syphilis, and hepatitis B, seroprevalences rate in the pregnant population in Istanbul. Turkiye Parazitol Derg 2014; 38:228-233.
• Balık G, Üstüner I, Kâğıtçı M et al. HBsAg, AntiHBs and Anti-HCV seroprevalance in pregnant women living in Rize region. Dicle Med J 2013; 40:254–257.
• Terrault NA, Bzowej NH, Chang KM, Hwang JP, Jonas MM, Murad MH. American Association for the Study of Liver Diseases. AASLD guidelines for treatment of chronic hepatitis B. Hepatology 2016; 63:261-283.
• Castillo E, Murphy K, van Schalkwyk J. No. 342-Hepatitis B and Pregnancy. J Obstet Gynaecol Can 2017; 39:181-190.
• Gagnon A, Davies G, Wilson RD; Genetics Committee. Prenatal invasive procedures in women with hepatitis B, hepatitis C, and/or human immunodeficiency virus infections. J Obstet Gynaecol Can 2014; 36:648-653.
• Yang J, Zeng XM, Men YL, Zhao LS. Elective caesarean section versus vaginal delivery for preventing mother to child transmission of hepatitis B virus--a systematic review. Virol J 2008; 5:100.
• Yang M, Qin Q, Fang Q, Jiang L, Nie S. Cesarean section to prevent mother-to-child transmission of hepatitis B virus in China: A meta-analysis. BMC Pregnancy Childbirth 2017; 17:303.
• Chen HL, Cai JY, Song YP, Zha ML, Qin G. Vaginal delivery and HBV mother to child transmission risk after immunoprophylaxis: A systematic review and a meta-analysis. Midwifery 2019; 74:116-125.
• Hill JB, Sheffield JS, Kim MJ, Alexander JM, Sercely B, Wendel GD. Risk of hepatitis B transmission in breast-fed infants of chronic hepatitis B carriers. Obstet Gynecol 2002; 99:1049-1052.
• Özcan Dağ Z, Gül S, Işık Y, Tulmaç ÖB, Şimşek Y. Hepatitis B and hepatitis C seropositivity rates in pregnants who live in Kırıkkale region. Bozok Medical Journal 2015; 5:1–4.
• Keskin D, Keskin S. Seroprevalence of toxoplasma, Rubella, CMV, HBV, AntiHBs, HCV, HIV in first trimester pregnant women. Selcuk Medical Journal 2013; 29:123-126.
• Çakmak B, Karataş A. Sero-positivity ratios of hepatitis B and C in pregnant women living in Kocaeli region. Selcuk Medical Journal 2012; 28:80–82.
• Society for Maternal-Fetal Medicine (SMFM). Hughes BL, Page CM, Kuller JA. Hepatitis C in pregnancy: screening, treatment, and management. Am J Obstet Gynecol 2017; 217:B2-B12.
• Huang Q, Hang L, Zhong M, Gao Y, Luo M, Yu Y. Maternal HCV infection is associated with intrauterine fetal growth disturbance. Medicine (Baltimore) 2016; 95:e4777.
• Kölgelier S, Güler D, Demiraslan H. Frequency of HBsAg and Anti-HCV in pregnant women in Adıyaman. Dicle Med J 2009; 36:191-194.
• Cooper ER, Charurat M, Mofenson L, et al. Women and Infants' Transmission Study Group. Combination antiretroviral strategies for the treatment of pregnant HIV-1 infected women and prevention of perinatal HIV-1 transmission. J Acquir Immune Defic Syndr 2002; 29:484-494.
• Altuğlu İ, Yaşar M, Ergenoğlu A.M, Zeytinoğlu A. Seroprevalence of HBsAg, Anti-HIV1 / 2 and Anti-HCV in Pregnant Women in Ege University Medical Faculty Hospital. Flora 2017; 22:120-125.
• Klarkowski D, O'Brien DP, Shanks L, Singh KP. Causes of false-positive HIV rapid diagnostic test results. Expert Rev Anti Infect Ther 2014; 12:49-62.
• European Mode of Delivery Collaboration. Elective caesarean-section versus vaginal delivery in prevention of vertical HIV-1 transmission: a randomised clinical trial. Lancet 1999; 353:1035-1039.
• Raffe SF, Savage C, Perry LA, et al. The management of HIV in pregnancy: A 10-year experience. Eur J Obstet Gynecol Reprod Biol 2017; 210:310-313.
• World Health Organization, Guideline: Updates on HIV and Infant Feeding: The Duration of Breastfeeding, and Support from Health Services to Improve Feeding Practices Among Mothers Living with HIV [Internet], 2016. Available from: http://www.ncbi.nlm.nih.gov/books/NBK379872/ (Erişim: 28.09.2020).