Biyolojik Tedavi veya Sitotoksik Kemoterapi İle Takip Edilen Hastalarda Hepatit Serolojisi Tarama Sıklığı ve Viral Reaktivasyonun Değerlendirilmesi

Abstract

Amaç: Çalışmamızın amacı iç hastalıkları kliniğinde (romatoloji, medikal onkoloji ve gastroenteroloji) biyolojik tedavi ve kemoterapötik tedaviler öncesinde hepatit serolojisi taraması sonuçlarını bölümler arası karşılaştırma yaparak değerlendirmek ve virüs reaktivasyon durumunu araştırmaktır. Gereç ve Yöntem: 2019 - 2021 tarihleri arasında medikal onkoloji, romatoloji ve gastroenteroloji bölümüne başvuran sitotoksik kemoterapi ve biyolojik tedavi verilen 18 yaş ve üzeri 1147 hasta çalışmaya dahil edilmiştir. Hepatit taraması için HBsAg, Anti-HBs, Anti-HBc ve Anti-HCV verileri kullanıldı. Bölümler tarama ve reaktivasyon sıklığına göre karşılaştırıldı ve değerlendirildi Bulgular: Kemoterapi veya biyolojik tedavi almadan önce onkoloji hastalarının %77'si, romatoloji hastalarının %40'ı ve gastroenteroloji hastalarının %43'ü hepatit açısından tam olarak taranmıştır. Eksik tarama oranları sırasıyla %16, %48 ve %52 iken, %3, %10 ve %4 hiç taranmamıştır. Toplamda, on iki hastada (%1,0) reaktivasyon gözlenirken, 1135 hastada (%99,0) reaktivasyon gözlenmemiştir. Bölümler ile reaktivasyon varlığı arasında istatistiksel olarak anlamlı bir korelasyon bulunmuştur (p<0.001). Onkoloji hastalarının 1'inde ve romatoloji hastalarının 11'inde reaktivasyon tespit edilirken, gastroenteroloji hastalarının tamamında reaktivasyon görülmemiştir. Sonuç: Kılavuzlarda hepatit için tam tarama önerilmesine rağmen, klinik uygulamada bunun hayata geçirilmediği görülmüştür. Özellikle reaktivasyon riskinin yüksek olduğu kemoterapi veya biyolojik tedavi alan popülasyonlarda tarama oranlarının iyileştirilmesi ihtiyacına dikkat çekmek önemlidir. HBV konusunda farkındalık yaratılması ve klinik uygulamalar için kemoterapi ve biyolojik tedaviler öncesi hepatit serolojisi tarama konusunda hatırlatıcı uygulamalar tarama oranlarının yükseltilmesine yardımcı olabilir.

Keywords

• Hepatit B
• biyolojik tedavi
• kemoterapi
• reaktivasyon

Evaluation of Hepatitis Serology Screening Frequency and Viral Reactivation in Patients Followed with Biological Therapy or Cytotoxic Chemotherapy

Abstract

Objective: Our study aimed to evaluate the results of hepatitis B and C serology screening before biological therapy and chemotherapeutic treatments in internal medicine clinics (rheumatology, medical oncology, and gastroenterology) by comparing between departments and investigating the virus reactivation status. Material and Method: The study included 1147 patients aged 18 and over who were admitted to the medical oncology, rheumatology, and gastroenterology departments between 2019 and 2021 and received cytotoxic chemotherapy and biological treatment. HBsAg, Anti-HBs, Anti-HBc, and Anti-HCV data were used to screen for hepatitis. The departments were compared and evaluated based on the frequency of screening and reactivation. Results: Before undergoing chemotherapy or biological therapy, 77% of patients in oncology, 40% in rheumatology, and 43% in gastroenterology were fully screened for hepatitis. The rates of incomplete screening were 16%, 48%, and 52%, respectively, while 3%, 10%, and 4% were never screened. In total, reactivation was observed in twelve patients (1.0%), while no reactivation was observed in 1135 patients (99.0%). A statistically significant correlation was found between the departments and the presence of reactivation (p<0.001). Reactivation was detected in 1 oncology patient and 11 rheumatology patients, while no reactivation was seen in all gastroenterology patients. Conclusion: Although complete screening for viral hepatitis was recommended by the guidelines, it was observed that it was not implemented in clinical practice. It is important to note the need to improve screening rates, especially in populations receiving chemotherapy or biological therapy, where the risk of reactivation is high. Raising awareness about HBV and reminder practices about hepatitis B and C serology screening before chemotherapy and biological therapies for clinical applications may help to increase screening rates.

Keywords

• Hepatitis B
• chemotherapy
• reactivation
• Biological therapy
• hepatitis C

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