Mpox across countries from Central and Eastern Europe - 2022 outbreak.

BACKGROUND: The aim of the study was to assess socio-demographical characteristics, clinical presentation, and outcomes in patients diagnosed with mpox. METHODS: A survey on patients diagnosed with mpox was performed in 14 countries from Central and Eastern Europe. Data was compared according to HIV status and country of origin (EU vs. non-EU). Mpox diagnosis was confirmed by RT-PCR from oropharyngeal swabs, skin lesions, and other body fluids. RESULTS: Out of 154 patients confirmed with mpox in 2022, 99.3% were males, with a median age (years) of 35 (IQR 30-39), 90.2% MSM and 48.7% PLWH. Compared to HIV-negative subjects, PLWH had more frequent high-risk behaviours:chemsex (p = 0.015), group sex (p = 0.027), and a history of sexually transmitted infections (STIs) (p = 0.004). Persons from EU were more often PLWH (p = 0.042), MSM (p < 0.0001), had multiple sexual partners (p = 0.025), practiced chemsex (p = 0.008) or group-sex (p = 0.005) and had more often history of STIs (p < 0.0001). The median CD4 cell count/mL at mpox diagnosis was 713 (IQR 486-996) and 73.5% had undetectable HIV VL. The commonest clinical features were fever (108 cases), lymphadenopathy (78), and vesiculo-pustular rash: penile (76), perianal (48), limbs (67). Fifty-one (31%) persons were hospitalized due to complications or epidemiological reasons. Three patients received tecovirimat or cidofovir. The outcome was favorable for all patients, including 4 with severe forms. CONCLUSIONS: Mpox was diagnosed predominantly in young MSM, with high-risk behaviors and history of STIs. Effective contact tracing and vaccination are important strategic pillars to control mpox outbreaks.

Turkish Translation and Cross-Cultural Validity of Whoqol-HIV Bref Tool.

BACKGROUND: The assessment of health-related quality of life among people living with HIV (PLWH) has gained increasing importance as it assesses their overall well-being, guides treatment decisions, and addresses psychosocial challenges, improving their quality of life. This study focuses on adapting and validating the Turkish version of the WHOQOL-HIV Bref, a tool developed by the World Health Organization (WHO) to measure health-related quality of life in PLWH. This adaptation is based on the generic WHOQOL-Bref Turkish and WHOQOL-HIV Bref inventory. METHODS: In line with WHO guidelines, the tool was translated and tested on 189 PLWH from Istanbul Sisli Hamidiye Etfal Training and Research Hospital's HIV outpatient clinic. A variety of statistical methods were employed to assess content, construct, concurrent, and known-group validity, as well as internal consistency and reliability. RESULTS: Participants' median age was 35 years (IQR: 14), with 178(94%) being male. The Turkish WHOQOL-HIV Bref showed overall satisfactory psychometric properties. Despite limitations in the spirituality domain, it demonstrated good internal consistency (alpha coefficient: 0.93) and strong validity across several metrics, including test-retest reliability (ICC: 0.79). CONCLUSION: The WHOQOL-HIV BREF in Turkish is a reliable and valid instrument for assessing the quality of life in Turkish PLWH.

Factors Influencing HIV Infection in Children Born to HIV-Infected Mothers in Turkey

Background: Human immunodeficiency virus (HIV) is still a challenge for children. About 15 to 45% of the HIV positive pregnant women can transmit the virus to their children during pregnancy, delivery and/or breastfeeding. The risk of transmission can be decreased my several measures. Aims: To identify factors associated with HIV infection in children born to HIV-infected mothers. Study Design: A multi-center retrospective cohort study. Methods: A ten-year retrospective cohort study in five dedicated HIV centers was conducted. The 325 women in our cohort were between the ages of 18 and 45. During the study period, 44 (13.5%) of these women gave birth and 51 babies were born. Of the 51 infants, 7 (13.7%) were HIV/AIDS positive. Results: Among the factors studied, breastfeeding, having a HIV-positive sibling and being on antiretroviral treatment during pregnancy and detectable HIV-RNA during delivery were found statistically significant. A multivariable logistic regression analysis showed that being on antiretroviral treatment during pregnancy is the most important predictor of mother-to-child transmission. Conclusion: Mother-to-child transmission appears to be an important route of HIV transmission in Turkey. Lack of antiretroviral treatment during pregnancy appears to be a key factor in transmission.

Evaluation of the late presentation and associated factors of people living with HIV in Turkey.

To identify the frequency of late presentation and late presentation with advanced disease, and associated factors in people living with HIV (PLHIV). Data from PLHIV diagnosed between 2008 and 2021 were retrospectively analyzed. Time of diagnosis (categorized based on key events affecting HIV care continuum e.g., national strategies, HIV guidelines, COVID-19 pandemic) and characteristics of late presenters (LP: CD4 ≤350 cells/mm³ or an AIDS defining event) and late presenters with advanced disease (LPAD: CD4 <200 cells/mm³) were describe. Associations between dependent (LP, LPAD) and independent variables were assessed using univariate/multivariate regression tests and presented as odds ratios (95% confidential interval). Of 1585 individuals (93.7% men), 42.5% were LPs and 19.3% were LPADs. Most common route of transmission was sex between men (54.3%). Non-LPs were younger (30 vs. 34 and 36 years; p < 0.001) and included more men who have sex with men (60.3% vs. 46.3% and 39.5%; p < 0.001). Factors associated with being LP and LPAD were age >30 years, heterosexual/unknown route of transmission (vs. sex between men), diagnosis in 2008-2013 or 2020-2021, (vs. 2014-2019). With reference to Turkish subjects, migrants from Africa had higher odds of being LPAD. LP is still an important health issue in HIV care. Heterosexuality, older age (>30 years), migration from Africa, and the COVID-19 pandemic are associated with delays in HIV presentation in Turkey. These factors need to be considered when developing and implementing policies to enable earlier diagnosis and treatment of PLHIV to achieve UNAIDS 95-95-95 targets.

[A Patient Presented with Genital Eruptions: The Second Case of Monkeypox from Türkiye]. / Genital Erüpsiyonla Basvuran Bir Hasta: Türkiye'deki Ikinci Maymun Çiçegi Olgusu.

Human monkeypox (MPX) disease is a re-emerging zoonotic infection caused by the monkeypox virus belonging to the same family as vaccinia and variola. The European Center for Disease Prevention and Control (ECDC) has documented an outbreak of MPX with atypical transmission paths throughout Europe. In this report, male-to-male sexual intercourse was first defined as a means of close humanto-human contact. The Ministry of Health of the Republic of Turkey announced via social media on June 30, 2022 that the first case confirmed by polymerase chain reaction (PCR) for the MPX virus in Turkey was admitted and isolated in a hospital. Four days after this statement, a 24-year-old Turkish man was hospitalized in our clinic with a bacterial infection of the penis and scrotum following local radiofrequency ablation therapy. A week ago, lesions resembling warts were noted in his medical history, for which a local radiofrequency ablation procedure was conducted at an external center. One day after his hospitalization, skin lesions of different stages (from macules, papules to umbilical papules) and several eruptions were detected on his face, nose tip, body, arms, and fingers, which gradually became more evident. After evaluating the risk factors, the patient was isolated with a preliminary diagnosis of MPX disease and samples were collected and sent for MPX virus detection to the reference laboratory according to the Ministry of Health guidelines. MPX virus nucleic acid was detected by PCR in samples taken from the lesion. The patient was discharged after 21 days of isolation and treatment for a secondary bacterial infection. In this case report the significance of differential diagnosis and screening tests for sexually transmitted infections (STI), a previously unreported case of MPX disease in Turkey, and a soft tissue infection that developed after local ablation treatment which was administered to a patient with MPX disease were presented. To be prepared for new and re-emerging infectious diseases, it was emphasized that well-structured continuing education based on current epidemiological data is required. Sexual contact has recently been identified as a new mode of transmission for MPX disease, and symptoms and signs may resemble those of other ulcerative sexually transmitted infections (STIs), such as "molluscum contagiousum" or syphilis. ORF disease is also in the differential diagnosis of MPX disease in Turkey. In addition, patients admitted with unreported STIs are permitted to receive health services without additional screenings. For this reason, easily accessible sexually transmitted disease centers with a high diagnostic efficiency can provide greater control over these diseases.

Does DPP-4 inhibitor treatment affect the clinical outcomes of COVID-19 in type 2 diabetes mellitus patients?

OBJECTIVE: We aim to investigate whether the use of dipeptidyl peptidase inhibitors (DPP-4i) affects the severity of disease, hospital mortality, and 3-month post-discharge mortality in type 2 diabetes mellitus (T2DM) individuals with coronavirus disease 2019 (COVID-19) infection. METHODS: The study included 217 patients with type 2 diabetes hospitalized due to COVID-19 between March and October 2020. The patients included in the study were divided into two groups those using DPP-4i and those not using DPP-4i. Demographic characteristics, laboratory parameters, accompanying risk factors, concomitant comorbidities, hospital mortality, clinical course, and 3-month post-discharge mortality were compared between the patients who used DPP-4i and those who did not use. RESULTS: The duration of hospitalization was 10.96±9.16 days in the group using DPP-4i, 12.22±9.1 days in the group not using DPP-4i, and when both groups were evaluated together, it was determined as 11.91±9.11 days. The hospitalization periods were similar between DPP-4i users and non-DPP-4i users (p=0.384). The need for mechanical ventilation (p=0.478 OR 0.710 95% confidence interval [CI], 0.274-1.836) and high-flow nasal cannula (p=0.457, OR: 0.331, 95% CI: 0.41-2.67) were similar between DPP-4i users and non-users. It was determined that the mortality (p=0.208, OR: 0.409, 95% CI: 0.117-1.429) and 3-month post-discharge mortality (p=0.383) were similar in the group using DPP-4i and those not using DPP-4i. CONCLUSION: This study demonstrated that the use of DPP-4i by patients with T2DM in catching COVID-19 does not affect the mortality due to COVID-19, the severity of COVID-19 disease, and 3-month post-discharge mortality.

Changing Characteristics of Patients Living with HIV/AIDS After the COVID-19 Pandemic in Turkey.

AIMS: The COVID-19 pandemic has substantially changed lives and presented several barriers to health services. HIV care continuum needs a high rate of diagnosis, effective treatment, and sustained suppression of viral replication. The COVID-19 pandemic has affected these three steps of HIV care. This study investigated the characteristics of newly diagnosed patients living with HIV/AIDS (PLWH) during the COVID pandemic and compared them with those before the pandemic. METHODS: All newly diagnosed patients in three HIV healthcare centers, in Istanbul, Turkey, were included in the study. The pandemic period included April 1, 2020, to April 1, 2021, and the prepandemic period included March 1, 2019, to March 1, 2020. RESULTS: 756 patients were diagnosed with HIV/AIDS. In the pandemic period, this figure was 58% less: 315. Patients in the pre-pandemic and pandemic period had comparable age and gender distributions. PLWH diagnosed in the pandemic period had higher rates of low CD4 cells: low CD4 (<350 cells /mm3) was measured in 243 (36.4%) patients in the pre-pandemic period, while it was done in 126 (47.9%) in the pandemic period (p<0.01). Also, the distribution of CD4 cells was significantly different between periods: In the pandemic period, CD4 cell distribution significantly skewed to lower CD4 categories. Symptomatic patient rates and AIDS-defining disorder rates among symptomatic patients were comparable. Viral loads were not significantly different in the two periods. CONCLUSION: A low number of newly diagnosed PLWH can be explained by less HIV testing, less admission to health care, or an actual decrease of HIV prevalence during the pandemic. Sexual behaviors may have changed during the COVID-19 pandemic, leading to HIV transmission restriction. Lower CD4 counts among the newly diagnosed PLWH suggest that admittance to health care is late and a significant portion of PLWH remain undiagnosed.

Mucocutaneous Manifestations of People Living with HIV in Current Antiretroviral Therapy Era.

OBJECTIVE: It has been reported that approximately 90 % of patients infected with the human immunodeficiency virus (HIV) have various cutaneous symptoms related to the virus. This study aims to describe the cutaneous disorders that have developed in HIV-infected patients and to investigate the factors that may be related, such as relationships to drug use and CD4 counts. METHODS: This cross-sectional study included people living with HIV and being followed by our hospital's infectious diseases clinic after being referred to the dermatology clinic because of skin lesions. These patients had been diagnosed with HIV by enzyme-linked immunosorbent assay tests and were included in the study if they were older than 18 years and had agreed to participate. Findings from detailed dermatological examinations were recorded, along with the patients' CD4 counts, the durations of their illnesses, and the treatments they received. RESULTS: 144 patients were included in the study. The most common mucocutaneous manifestation was seborrheic dermatitis, at 28.5 % (n = 41). The mean CD4 count was 607.1 (min-max = 10.6- 1982). The CD4 counts were divided into three groups in the study as follows: 22 (15.3 %) patients with <200, 35 (24.3 seborrheic dermatitis) patients between 200 and 500, and 87 (60.4 %) patients with >500. There were no statistical differences between these groups in terms of dermatological findings. Nevertheless, the highest rate of patients with three or more dermatological conditions was found among those with CD4 counts <200 (n = 11.50 %). CONCLUSION: Skin manifestations are common in patients who are HIV-positive; however, many skin disorders can be seen in HIV/acquired immunodeficiency syndrome (AIDS) patients whatever CD4 cell counts of these patients are.

Fibrosis scores that can be used in follow-up of after direct-acting antiviral treatment: APRI, FIB-4, King score and GUCI.

INTRODUCTION: Sustained virologic response in the treatment of chronic hepatitis C can be achieved with direct-acting antivirals (DAA) in recent years. Monitoring virologic and histologic response to treatment is essential and noninvasive methods are preferred. In our study, we aimed to determine the regression of fibrosis following DAA treatment with serum fibrosis indices constituting a noninvasive method. METHOD: Patients with chronic hepatitis C to whom DAA treatment is started between January 2016 and January 2018 in our clinic are evaluated retrospectively. The fibrosis scores [fibrosis 4 index (FIB-4), aminotransferase platelet ratio (APRI), Fibro QKing score, age platelet index, Goteburg University Cirrhosis Index (GUCI), aspartate transaminase/alanine transaminase ratio (AAR)] are calculated with routine biochemical and hematologic tests of DAA-treated patients before treatment, at the end of treatment, and in the 12th and 24th weeks of treatment. In total, the course of seven scores calculated at four separate times including baseline was recorded and compared. RESULTS: In total 91 patients are included in the study. The average age was 51.16 ± 13.78 and 59.3% (n = 54) of patients were women. According to the baseline FIB-4 values, the patients were grouped as cirrhotic or noncirrhotic, and 11 of them were cirrhotic (12.1%). Statistically significant regression in APRI, FIB-4, GUCI and King scores is seen in all groups regardless of their cirrhotic status, treatment experience or genotype (P < 0.001). Specified scores had a positive, significant correlation with pretreatment biopsy results [area under curve (AUC): 0.800, 0.782, 0.749 and 0.746]. CONCLUSION: APRI, FIB-4, GUCI and King scores that have a positive correlation with biopsy can also be used for fibrosis recovery follow-up after treatment with DAAs.

The Prevalence and Associated Factors of Reduced Bone Mineral Density (BMD) Among Men with Suppressed Viral Load Taking Antiretroviral Therapy.

BACKGROUND: Reduced bone mineral density (BMD) is a frequent comorbidity observed in people living with HIV (PLHIV). OBJECTIVE: The aim of the study is to determine the prevalence and associated factors of reduced bone mineral density (BMD) among men with suppressed viral load taking antiretroviral therapy. METHODS: The study was conducted as a cross-sectional design between January to April 2019. 211 patients were included in the study. Z-score at either body site between -1.0 and -2.0 or -2 or less was defined as osteopenia or osteoporosis, respectively. Multivariate logistic regression analysis was used to evaluate the factors affecting the development of reduced BMD. RESULTS: The mean age of the patients involved in the study was 34.8 ± 7.6. Osteoporosis was detected in 21.4% and osteopenia in 44.5% of the patients. There was a significant relationship found between HIV diagnosis time, ART usage duration, tenofovir disoproxil fumarate (TDF) use, TDF use in the past, total TDF usage time and decreased BMD. Multivariate logistic regression analysis showed that the likelihood of reduced bone marrow density was 67% lower among those with regular milk or dairy product intake compared to those without (OR=0.330; 95% CI = 0.12-0.92, p=0.033). CONCLUSION: There is a high prevalence of reduced BMD among PLHIV aged under 50, which is mainly confounded by HIV diagnosis time, ART usage duration and TDF usage. Although virological control has been achieved, these patients should be followed up, considering that they may have decreased BMD.

Adherence to Treatment with Oral Nucleoside/Nucleotide Analogs in Patients with Chronic Hepatitis B.

Objectives: Adherence to antiviral treatment is important for treatment success and prevention of resistance. It was aimed to determine treatment adherence to nucleoside/nucleotide analogs and factors influencing on adherence. Methods: The study included 168 patients who received oral nucleoside/nucleotide analog with diagnosis of chronic hepatitis for at least 1 year. Data regarding demographic characteristics and missed drug were collected using a survey, while list of medication within prior year were extracted from pharmacy registry and Medication Possession Rate (MPR) was calculated. Results: There were 60 women (35.7%) and 108 men (64.3%) in the study. Mean age was calculated as 43.61±10.35 years. It was found that 29.2% of patients were non-adherent based on MPR (MPR<0.90). It was observed that adherence was improved on middle age. Treatment adherence was found to be higher in patients receiving medication due to disorders other than hepatitis B. It was found that there was no significant difference in adherence according to age, gender, occupation status, marital status, smoking or alcohol consumption habits, type of antiviral treatment, time and mode of drug intake, and biopsy finding at time of drug prescription. The most common cause was identified as forgetfulness for missed drug. Other common causes were inoccupation and alteration in daily routine. Conclusion: In our study, the treatment adherence determined by MPR was 70.8%. This rate was lower than those reported for chronic hepatitis B in the literature. It is important to monitor and encourage treatment adherence in patients with chronic hepatitis B by clinicians.

Cognitive Assessment of Young Adults Before and After Initiation of Combination Antiretroviral Therapy.

Objective: In the determination and monitoring of neurocognitive disorders in human immunodeficiency virus (HIV)-positive individuals, there is a need for significantly more practical methods which provide results in a shorter time than the tests that require challenging and specialized expertise. This study aimed to evaluate cognitive functions and the factors affecting them in naïve HIV-positive patients using by Montreal Cognitive Assessment (MoCA) test before and after the initiation of combination antiretroviral therapy. Materials and Methods: HIV-positive, treatment-naïve patients monitored between January-June 2017 were included in the study. The MoCA test was performed at the beginning and the sixth month of the treatment. Results: Forty male patients were included in the study. The mean age was calculated as 29.1±4.0. When the factors affecting the MoCA score were examined, there was a significant relationship between the education level and the MoCA score. Smoking, using alcohol, and substance did not have a significant impact on baseline MoCA values. A significant correlation was found between cluster differentiation 4 (CD4) count and HIV RNA level and attention function. There was a significant increase in the total MoCA score and the MoCA subgroup scores at the end of the sixth month of the treatment. Conclusion: MoCA test is one of the most practical tests that can be applied in a short time period, and it was found useful in evaluating the changes in the cognitive functions of HIV-positive patients during antiretroviral treatment.

Comparison of Risk Factors and Outcomes in Carbapenem-Resistant and Carbapenem-Susceptible Gram-Negative Bacteremia.

BACKGROUND: Carbapenem-resistant Gram-negative bacteremia (CR-GNB) is seen with increasing frequency and result in high mortality. The aim of this study was to compare the risk factors and results of carbapenem-resistant and carbapenem-susceptible Gram-negative bacteremia and to determine the factors related to mortality. METHODS: The study was conducted as a retrospective observational comparative case series between June 2016 and November 2017 in Sisli Hamidiye Etfal Training and Research Hospital. The patients were divided into two groups as carbapenem-susceptible and carbapenem-resistant according to antibiotic susceptibility data of blood cultures. The risk factors for the development of carbapenem resistance, length of hospital stay, mortality rates, and mortality related factors were investigated between these two groups. RESULTS: Two hundred and eleven cases were included in the study. Of these cases, 54 were resistant to carbapenem and 157 were susceptible to carbapenem. Mortality occurred in 60 (28.4%) patients. The 14 and 28 day mortality rates of patients with carbapenem resistance were significantly higher than those without carbapenem resistance. There was no statistically significant difference between two groups in length of stay in the hospital after bacteremia. Pittsburgh bacteremia score, cardiovascular disease, urinary catheterization, and inappropriate empirical antibiotic therapy were the most significant risk factors for mortality. CONCLUSIONS: Carbapenem resistance is associated with increased mortality and inappropriate empirical antibiotic treatment increases mortality. Therefore, patients should be evaluated for risk factors in predicting CR-GNB and treatment for resistant pathogens should be applied in appropriate patients.

What were the changes during the COVID-19 pandemic era concerning occupational risks among health care workers?

BACKGROUND: Accidental exposure to percutaneous needle stick and sharp injuries (NSSIs) and blood and other body fluids is the unintended contact with risky medical instruments or patient secretions during a medical intervention. During the COVID-19 pandemic, the significance of occupational injuries in healthcare professionals was revealed once again. To assess the occupational injuries, we compared rates, distribution and type of exposure to blood and body fluids and NSSIs of health care workers for 2019 (pre-pandemic era) and 2020 (pandemic era) years, respectively. MATERIAL AND METHODS: Our study included data collected by the 'Hospital Infection Control Committee' for the years 2019-2020. Data collected using the active surveillance method were analyzed retrospectively. RESULTS: During 2019 (pre-pandemic period) and 2020 (pandemic period), 112 (27.65%0) and 82 (21.4%0) NSSIs reported, respectively. Of the exposed HCWs in 2019 (pre-pandemic period), 16.8%0 (14) were doctor, 53.6%0 (60) were nurse and 47.4%0 (14) were intern doctors. In the 2020 (pandemic period), NSSIs were observed most frequently in nurses and cleaning staff, 50.24%0 and 33.64%0, respectively. Concerning the total percentage of exposure to blood and other body fluids, a slight increase was revealed from 1.48%0 to 2.62%0 in 2019 and 2020, respectively. A significant decrease in exposure rate was reported among the doctors between the pre-pandemic and pandemic era; 3.6%0 and 1.19%0 at 2019 and 2020, respectively. A significant increase in exposure rate was reported among the nurses between pre-pandemic and pandemic era; 0.8%0 and 6.89%0, respectively. CONCLUSION: In conclusion, the exposure to NSSIs during the pandemic period decreased; however, there was no severe difference at pre-pandemic and pandemic periods concerning exposure to blood and body fluids. Well-designed training and awareness programs can be effective in preventing exposure to NSSIs and blood and other body fluids and exposure to respiratory acquired viruses.

Could we predict the prognosis of the COVID-19 disease?

OBJECTIVES: Coronavirus 2019 disease (COVID-19) lead to one of the pandemics of the last century. We aimed to predict poor prognosis among severe patients to lead early intervention. METHODS: The data of 534 hospitalized patients were assessed retrospectively. Risk factors and laboratory tests that might enable the prediction of prognosis defined as being transferred to the intensive care unit and/or exitus have been investigated. RESULTS: At the admission, 398 of 534 patients (74.5%) were mild-moderate ill. It was determined that the male gender, advanced age, and comorbidity were risk factors for severity. To estimate the severity of the disease, receiver operating characteristic analysis revealed that the areas under the curve which were determined based on the optimal cut off values that were calculated for the variables of values of neutrophil to lymphocyte ratio (NLR > 3.69), C-reactive protein (CRP > 46 mg/L), troponin I ( > 5.3 ng/L), lactate dehydrogenase (LDH > 325 U/L), ferritin ( > 303 ug/L), d-dimer ( > 574 µg/L), neutrophil NE ( > 4.99 × 109 /L), lymphocyte (LE < 1.04 × 109 /L), SO2 ( < %92) were 0.762, 0.757,0.742, 0.705, 0.698, 0.694,0.688, 0.678, and 0.66, respectively. To predict mortality, AUC of values for optimal cutoff troponin I ( > 7.4 ng/L), age ( > 62), SO2 ( < %89), urea ( > 40 mg/dL), procalcitonin ( > 0.21 ug/L), CKMB ( > 2.6 ng/L) were 0.715, 0.685, 0.644, 0.632, 0.627, and 0.617, respectively. CONCLUSIONS: The clinical progress could be severe if the baseline values of NLR, CRP, troponin I, LDH, are above, and LE is below the specified cut-off point. We found that the troponin I, elder age, and SO2 values could predict mortality.

Prevalence and mortality of cancer among people living with HIV and AIDS patients: a large cohort study in Turkey.

BACKGROUND: Cancer is responsible for elevated human immunodeficiency virus (HIV)-related mortality but there are insufficient data about cancer in HIV-positive patients in Turkey. AIMS: We aimed to investigate the prevalence and mortality of cancer among people living with HIVand AIDS patients in Istanbul, Turkey. METHODS: Between January 1998 and December 2016, people living with HIVand AIDS patients were enrolled in this study by the ACTHIV-IST Study Group, which consists of 5 centres to follow-up HIV-positive patients in Istanbul. The cancer diagnoses included AIDS-defining cancers (ADCs) and non AIDS-defining cancers (NADCs). RESULTS: Among 1872 patients, 37 (1.9%) were diagnosed with concurrent cancer. Eleven patients were diagnosed during follow-up; the prevalence of cancer among people living with HIVand AIDS patients was 2.6%. Among 48 cancer patients, 35 patients had ADCs, and 32 of them were diagnosed at their first hospital admission. There were 1007 late presenters and 39 of them had cancer (29 were ADCs). The most prevalent NADCs were gastrointestinal, genitourinary, and pulmonary cancers. NADCs were mostly diagnosed during follow-up of patients. The mortality of this group was significantly higher than that of patients with ADCs (53.9% vs 22.9%). CONCLUSIONS: These results indicate the importance of cancer screening at diagnosis and during follow-up of HIV infection. A detailed physical examination contributes to diagnosis of the most prevalent ADCs (Kaposi's sarcoma and non-Hodgkin's lymphoma), especially in late presenters. For NADCs, individual risk factors should be considered.

Late presentation among patients with human immunodeficiency virus infection in Turkey.

OBJECTIVE: Late presentation of the patients with human immunodeficiency virus (HIV) infection is associated with less favourable treatment responses, more accelerated clinical progression, and a higher mortality risk. Although HIV prevalence is low in Turkey, it is steadily increasing and the information about late presentation among HIV-positives is limited. We aimed to analyze the status of late presentation among HIV-positive patients in Turkey. METHODS: All newly diagnosed HIV/AIDS patients from 2003 to 2016 were enrolled in this study by five dedicated centres in Istanbul, Turkey. Demographic data, CD4+ counts, and HIV RNA were collected from medical records and were transferred to a HIV database system. Late pre- sentation was defined as presentation for care with a CD4 count < 350 cells/mm3 or presentation with an AIDS-defining event, regardless of the CD4 cell count. A medical literature search was done for the analysis of late presentation in Turkey. RESULTS: The cohort included 1,673 patients (1,440 males, median age 35 years). Among them, 847 (50.6%) had an early diagnosis, with a CD count of more than 350 cells/mm3. The remaining 826 were late presenters. Among late presenters, 427 (25.5% of all, 51.7% of late presenters) presented with advanced HIV disease. Late presenters were more elderly and less educated. The gender seemed comparable between groups. Late presentation was more likely among married patients. Early presenters were more likely among homosexuals, those diagnosed in screening studies, and in lower HIV-RNA viral load category. There has been a decreasing trend among late presenters in 2011-2016 when compared to 2003-2011 period. CONCLUSION: Current data suggest that half of HIV-infected patients present late in Turkey. In our cohort, those presented late were more elderly, less educated, married and had heterosexual intercourse. On admission, late presenters had more HIV-related diseases and were more likely in higher HIV-RNA category. In the cohort, men having sex with men were less likely late presenters. Efforts to reduce the proportion of late presentation are essential for almost every country. The countries should identify the risk factors of late presentation and should improve early diagnosis and presentation for HIV care.

Serum soluble urokinase-type plasminogen activator receptor and interferon-γ-induced protein 10 levels correlate with significant fibrosis in chronic hepatitis B.

BACKGROUND: Hepatitis B virus (HBV) presents an important public health problem. Liver biopsy is currently the gold standard for assessing the degree of intrahepatic inflammation and for staging liver fibrosis. However, the value of liver biopsies is limited by sampling errors, understaging and interobserver variability in interpretation. There is, therefore, a need to identify novel, non-invasive serologic biomarkers for the development of new predictive models of fibrosis. METHODS: We enrolled patients with chronic hepatitis B infection (CHB) and examined the relationships between serum soluble urokinase plasminogen activator receptor (suPAR) and interferon-induced protein-10 (IP-10), and the results of liver biopsies. Healthy volunteers with normal aminotransferase levels and negative serological results for HBV, hepatitis C virus and human immunodeficiency virus were recruited as controls. RESULTS: Mean platelet volume, serum suPAR and IP-10 were significantly elevated in patients with CHB compared with controls. Median serum suPAR and IP-10 levels were significantly higher in patients with liver fibrosis compared with patients with mild fibrosis. There was no significant difference in mean platelet volume or aspartate aminotransferase-to-platelet ratio index scores between patients with mild and significant fibrosis. CONCLUSION: suPAR and IP-10 were able to distinguish between significant and mild fibrosis with good sensitivity and specificity, and may thus represent useful biomarkers for identifying patients with significant fibrosis.

Comparison of brucellar and tuberculous spondylodiscitis patients: results of the multicenter "Backbone-1 Study".

BACKGROUND CONTEXT: No direct comparison between brucellar spondylodiscitis (BSD) and tuberculous spondylodiscitis (TSD) exists in the literature. PURPOSE: This study aimed to compare directly the clinical features, laboratory and radiological aspects, treatment, and outcome data of patients diagnosed as BSD and TSD. STUDY DESIGN: A retrospective, multinational, and multicenter study was used. PATIENT SAMPLE: A total of 641 (TSD, 314 and BSD, 327) spondylodiscitis patients from 35 different centers in four countries (Turkey, Egypt, Albania, and Greece) were included. OUTCOME MEASURES: The pre- and peri- or post-treatment spinal deformity and neurologic deficit parameters, and mortality were carried out. METHODS: Brucellar spondylodiscitis and TSD groups were compared for demographics, clinical, laboratory, radiological, surgical interventions, treatment, and outcome data. The Student t test and Mann-Whitney U test were used for group comparisons. Significance was analyzed as two sided and inferred at 0.05 levels. RESULTS: The median baseline laboratory parameters including white blood cell count, C-reactive protein, and erythrocyte sedimentation rate were higher in TSD than BSD (p<.0001). Prevertebral, paravertebral, epidural, and psoas abscess formations along with loss of vertebral corpus height and calcification were significantly more frequent in TSD compared with BSD (p<.01). Surgical interventions and percutaneous sampling or abscess drainage were applied more frequently in TSD (p<.0001). Spinal complications including gibbus deformity, kyphosis, and scoliosis, and the number of spinal neurologic deficits, including loss of sensation, motor weakness, and paralysis were significantly higher in the TSD group (p<.05). Mortality rate was 2.22% (7 patients) in TSD, and it was 0.61% (2 patients) in the BSD group (p=.1). CONCLUSIONS: The results of this study show that TSD is a more suppurative disease with abscess formation requiring surgical intervention and characterized with spinal complications. We propose that using a constellation of constitutional symptoms (fever, back pain, and weight loss), pulmonary involvement, high inflammatory markers, and radiological findings will help to differentiate between TSD and BSD at an early stage before microbiological results are available.

Low Prevalence of Hepatitis C Virus Infection Among HIV-Positive Patients: Data From a Large-Scale Cohort Study in Istanbul, Turkey.

BACKGROUND: Rate of coinfection with human immunodeficiency virus (HIV) and hepatitis C virus (HCV) varies in different countries. This may be attributable to common transmission routes as well as social, economic, and cultural factors. OBJECTIVES: The purpose of this study was to investigate the prevalence and risk factors of HCV infection among HIV-positive patients in Istanbul, Turkey. PATIENTS AND METHODS: Since January 2006 to November 2013, 949 HIV-positive patients that were enrolled in this study by ACTHIV-IST (Action Against HIV in Istanbul) Study Group, which consists of five centers to follow up HIV-positive patients in Istanbul. Epidemiologic and clinical data were collected retrospectively from medical records and were transferred to an HIV database system. RESULTS: Among 949 patients, 84% were men and the mean age was 37.92 ± 11.54 years (range, 17-79). The most frequent route of transmission was heterosexual intercourse (48.8%), followed by men having sex with men (30.5%). Only nine patients (0.9%) had history of injection drug use (IDU). The prevalence of HIV/HCV coinfection was 0.9% (9:949). The IDU rate was 44.4% (4:9) in patients with HIV/HCV coinfection (three of them were not Turkish citizens), whereas this rate was only 0.6% (5:881) in patients with only HIV infection (P < 0.01). Genotypes 1b, 2a/2c, and 3 were determined in five, one, and two patients, respectively. Genotype could not be determined in one patient. History of residence in a foreign country (P < 0.01) and imprisonment (P < 0.01) were also considered as risk factors in terms of HIV/HCV coinfection. CONCLUSIONS: Prevalence of HIV/HCV coinfection is considerably low in Turkey. The extremely rare prevalence of IDU might have a role in this low prevalence.