\u00a0 <\/span>HBV infeksiyonu riski ve akut HBV infeksiyonun kronikle\u015fmesi genel pop\u00fclasyona g\u00f6re daha y\u00fcksektir (2). HIV\/HBV koinfeksiyonunda karaci\u011fer hasar\u0131na ba\u011fl\u0131 morbidite ve mortalite riski, HBV mono-infekte hastalara g\u00f6re daha y\u00fcksektir (2,4,6). Bu nedenle HIV ile ya\u015fayan ki\u015filerde HBV\u2019ye kar\u015f\u0131 a\u015f\u0131lama \u00f6nerilmektedir (5,7,8).<\/p>\n\u00dclkemizde, hepatit B a\u015f\u0131s\u0131 1998\u2019de \u00e7ocukluk \u00e7a\u011f\u0131 a\u015f\u0131 takvimine girmi\u015f ve risk gruplar\u0131na da uygulanmaya ba\u015flanm\u0131\u015ft\u0131r. HIV ile ya\u015fayan ki\u015filere de 0, 1 ve 6. ay olmak \u00fczere standart a\u015f\u0131lama \u015femas\u0131 uygulanmaktad\u0131r (9).<\/p>\n
D\u00fcnya Sa\u011fl\u0131k \u00d6rg\u00fct\u00fc k\u00fcresel HIV\/HBV koinfeksiyonu prevalans\u0131n\u0131 %7.4 olarak bildirmi\u015ftir (3). \u00dclkemizde HIV\/HBV koinfeksiyonu prevelans\u0131n\u0131n %4 oldu\u011fu ama HIV ile ya\u015fayan ki\u015filerin %40\u2019\u0131n\u0131n HBV ile kar\u015f\u0131la\u015ft\u0131\u011f\u0131 bildirilmi\u015ftir (5). Tozun ve arkada\u015flar\u0131n\u0131n (10) \u00fclke genelinde yapt\u0131\u011f\u0131 \u00e7al\u0131\u015fmada, HBsAg pozitifli\u011fi %4, izole anti-HBc IgG pozitifli\u011fi %4.6, ge\u00e7irilmi\u015f HBV infeksiyonu %22 ve a\u015f\u0131lanma oran\u0131 ise %8.4 olarak saptanm\u0131\u015ft\u0131r. Karaosmano\u011flu ve arkada\u015flar\u0131 (11) yapt\u0131klar\u0131 \u00e7al\u0131\u015fmada, HIV ile ya\u015fayan ki\u015filerde anti-HBc IgG pozitifli\u011fini %19.1 bulurken kar\u015f\u0131la\u015ft\u0131rma grubu olarak ald\u0131klar\u0131 kan ba\u011f\u0131\u015f\u00e7\u0131lar\u0131nda bu oran\u0131 %2.4 olarak tespit etmi\u015ftir. \u00c7al\u0131\u015fmam\u0131zda, HIV\/HBV koinfeksiyonu prevalans\u0131 %5.8, izole anti-HBc IgG pozitifli\u011fi %8.2, ge\u00e7irilmi\u015f infeksiyon %19.6 ve a\u015f\u0131lanma oran\u0131 ise %44.6 olarak bulundu. Di\u011fer \u00e7al\u0131\u015fmalar\u0131n y\u00fcr\u00fct\u00fclme tarihleri, zaman aral\u0131\u011f\u0131 ve hasta say\u0131s\u0131n\u0131n farkl\u0131 olmas\u0131 nedeniyle birbirinden farkl\u0131 sonu\u00e7lar bulundu\u011fu d\u00fc\u015f\u00fcn\u00fcld\u00fc.<\/p>\n
Ulusal ve uluslararas\u0131 rehberlerde, kronik HBV infeksiyonu olmayan ve HBV\u2019ye kar\u015f\u0131 ba\u011f\u0131\u015f\u0131k olmayan t\u00fcm HIV ile ya\u015fayan ki\u015filere hepatit B a\u015f\u0131s\u0131 \u00f6nerilmektedir (7,8,12). Rehberlerde y\u0131llar <\/b>i\u00e7inde g\u00fcncellemeler yap\u0131lsa da a\u015f\u0131lama zaman\u0131 ve a\u015f\u0131 dozu ile ilgili tam bir g\u00f6r\u00fc\u015f birli\u011fi halen yoktur. T.C. Sa\u011fl\u0131k Bakanl\u0131\u011f\u0131 HIV\/AIDS Tan\u0131 Tedavi Rehberi\u2019nde a\u015f\u0131n\u0131n \u00e7ift doz olarak 0-1-2 ve 6. aylarda uygulanmas\u0131, CD4+<\/sup> T lenfosit say\u0131s\u0131 >200 h\u00fccre\/mm\u00b3 oluncaya kadar m\u00fcmk\u00fcnse ertelenmesi, de\u011filse a\u015f\u0131n\u0131n yap\u0131l\u0131p CD4+<\/sup> T lenfosit say\u0131s\u0131 >200 h\u00fccre\/mm\u00b3 olduktan sonra tekrarlanmas\u0131, a\u015f\u0131 yan\u0131t\u0131 olu\u015fmayanlarda a\u015f\u0131ya devam edilmesi \u00f6nerilmektedir. Rehberde izole anti-HBc IgG varl\u0131\u011f\u0131nda a\u015f\u0131lama ile ilgili bilgi bulunmamaktad\u0131r (12). Amerika Birle\u015fik Devletleri\u2019nin Sa\u011fl\u0131k ve Sosyal Hizmetler Bakanl\u0131\u011f\u0131 (United States Department of Health and Human Services \u2013 DHHS) Rehberi\u2019nde CD4+<\/sup> T lenfosit say\u0131s\u0131 >350 h\u00fccre\/mm\u00b3 olanlarda a\u015f\u0131 yan\u0131t\u0131n\u0131n daha iyi oldu\u011fu yine de daha d\u00fc\u015f\u00fck CD4+<\/sup> T lenfosit say\u0131s\u0131 olanlarda a\u015f\u0131laman\u0131n ertelenmemesi gerekti\u011fi belirtilmekte ve a\u015f\u0131 0-1 ve 6. aylarda \u00e7ift doz olarak \u00f6nerilmektedir. \u0130zole anti-HBc IgG varl\u0131\u011f\u0131nda standart bir doz hepatit B a\u015f\u0131s\u0131n\u0131n yap\u0131lmas\u0131, anti-HBs <100 \u0130\u00dc\/lt gelirse a\u015f\u0131 serisinin tamamlanmas\u0131 \u00f6nerilmektedir (7). Avrupa AIDS Klinik Derne\u011fi (European AIDS Clinical Society – EACS) Rehberi\u2019nde CD4+<\/sup> T lenfosit say\u0131lar\u0131na bak\u0131lmaks\u0131z\u0131n, ulusal rehber \u00f6nerilerine g\u00f6re anti-HBs \u2265 10-100 \u0130\u00dc\/lt olana kadar a\u015f\u0131laman\u0131n yap\u0131lmas\u0131, a\u015f\u0131 yan\u0131t\u0131 olmayanlarda \u00e7ift doz a\u015f\u0131laman\u0131n d\u00fc\u015f\u00fcn\u00fclmesi \u00f6nerilmektedir. \u0130zole anti-HBc IgG varl\u0131\u011f\u0131nda a\u015f\u0131laman\u0131n etkisine ili\u015fkin veri eksikli\u011fi nedeniyle a\u015f\u0131lama \u00f6nerilmemektedir (8). \u00c7al\u0131\u015fman\u0131n y\u00fcr\u00fct\u00fcld\u00fc\u011f\u00fc merkez olan poliklini\u011fimizde, y\u0131llar i\u00e7inde de\u011fi\u015fen rehberleri takip ederek hastalar\u0131m\u0131za a\u015f\u0131lama \u00f6nerilerinde bulunduk. A\u015f\u0131lanan hastalar\u0131m\u0131z\u0131n t\u00fcm\u00fc standart doz hepatit B a\u015f\u0131s\u0131 ile 0-1 ve 6. aylarda a\u015f\u0131land\u0131.<\/p>\n\u0130svi\u00e7re HIV kohortu \u00e7al\u0131\u015fmas\u0131nda, hepatit B a\u015f\u0131lamas\u0131nda hem\u015fire program\u0131n\u0131n etkisi de\u011ferlendirilmi\u015f ve a\u015f\u0131laman\u0131n hem\u015fireler taraf\u0131ndan takip edildi\u011fi m\u00fcdahale merkezinde ba\u011f\u0131\u015f\u0131kl\u0131k %32\u2019den %76\u2019ya, hekim sorumlulu\u011fundaki kontrol merkezlerinde ise yaln\u0131zca %33\u2019ten %39\u2019a y\u00fckseldi\u011fi (p<\/i>=0.001) g\u00f6sterilmi\u015ftir (13). Hastanemizde a\u015f\u0131 poliklini\u011finin bulunmamas\u0131 nedeniyle, izlemin etkili bir \u015fekilde yap\u0131lamad\u0131\u011f\u0131n\u0131 ve rehber \u00f6nerilerinin de etkili bir \u015fekilde uygulanamad\u0131\u011f\u0131n\u0131 d\u00fc\u015f\u00fcnmekteyiz.<\/p>\n
2009-2012 y\u0131llar\u0131 aras\u0131nda yap\u0131lan bir g\u00f6zlem \u00e7al\u0131\u015fmas\u0131nda, \u00e7al\u0131\u015fma ba\u015flang\u0131c\u0131nda a\u015f\u0131lanmas\u0131 gereken HIV ile ya\u015fayan ki\u015filerin oran\u0131 %44.2 iken \u00e7al\u0131\u015fma bitti\u011finde %36.7, a\u015f\u0131lama oran\u0131n ise %9.6 oldu\u011fu bildirilmi\u015ftir. Yine ayn\u0131 \u00e7al\u0131\u015fmada Ryan White HIV\/AIDS Program\u0131 taraf\u0131ndan finanse edilen tesislerdeki a\u015f\u0131lanma oran\u0131n\u0131n finanse edilmeyenlere g\u00f6re daha y\u00fcksek oldu\u011fu bildirilmi\u015ftir (14). Birle\u015fik Krall\u0131k HIV Kohortu\u2019nda HBV serolojisi negatif olan HIV ile ya\u015fayan ki\u015filerde a\u015f\u0131lanma oran\u0131 1996\u2019da %42 iken 2009\u2019da bu oran\u0131n %58.2\u2019ye y\u00fckseldi\u011fi bildirilmi\u015ftir (15). G\u00fcney Brezilya\u2019da yap\u0131lan bir \u00e7al\u0131\u015fmada, sa\u011fl\u0131kl\u0131 ki\u015filerde a\u015f\u0131lanma oran\u0131 %87.6-97.5 aral\u0131\u011f\u0131ndayken HIV ile ya\u015fayan ki\u015filerde bu oran %57.4 olarak bulunmu\u015ftur (16). Avrupa AIDS Klinik Derne\u011fi\u2019nin a\u015f\u0131lama \u00f6nerilerine uyumu de\u011ferlendirmek i\u00e7in Almanya\u2019da yap\u0131lan bir \u00e7al\u0131\u015fmada, hepatit B a\u015f\u0131lama oran\u0131 %64.3 olarak bulunmu\u015f ve bunun genel pop\u00fclasyondan daha y\u00fcksek oldu\u011fu belirtilmi\u015ftir (17). \u00c7ak\u0131r ve arkada\u015flar\u0131n\u0131n 2013-2021 y\u0131llar\u0131 aras\u0131nda takip ettikleri HIV ile ya\u015fayan 79 ki\u015fiyi irdeledikleri \u00e7al\u0131\u015fmada, a\u015f\u0131lanma oran\u0131 %54.5 olarak saptam\u0131\u015ft\u0131r (18). Daha \u00f6nce yine merkezimizde y\u00fcr\u00fct\u00fclen \u00e7al\u0131\u015fmam\u0131zda (19) a\u015f\u0131lama oran\u0131 %30 iken mevcut \u00e7al\u0131\u015fmada a\u015f\u0131lanma oran\u0131 %44.6 olarak tespit edildi. T\u00fcm bu veriler \u0131\u015f\u0131\u011f\u0131nda a\u015f\u0131lanma oranlar\u0131n\u0131n; y\u0131llara, \u00fclkelerin a\u015f\u0131lama politikalar\u0131na, HIV ile ya\u015fayan ki\u015filere sa\u011fl\u0131k hizmeti verenlerin fark\u0131ndal\u0131klar\u0131na ve sa\u011flanan finansal deste\u011fe g\u00f6re de\u011fi\u015fti\u011fi anla\u015f\u0131lmaktad\u0131r.<\/p>\n
Standart hepatit B a\u015f\u0131lamas\u0131ndan sonra sa\u011fl\u0131kl\u0131 yeti\u015fkinlerde koruyucu anti-HBs titresi %90-95 oran\u0131nda olu\u015furken HIV ile ya\u015fayan <\/span>ki\u015filerde bu oran %17.5-71 aras\u0131nda de\u011fi\u015fmektedir (1). \u00d6zt\u00fcrk ve arkada\u015flar\u0131n\u0131n (20) y\u00fcr\u00fctt\u00fckleri \u00e7al\u0131\u015fmada, 0-1 ve 6. aylarda standart doz a\u015f\u0131lama yap\u0131lanlarda %79 ba\u011f\u0131\u015f\u0131kl\u0131k olu\u015furken \u00e7ift doz ile a\u015f\u0131lama yap\u0131lanlarda bu oran %96 olarak bildirilmi\u015ftir. Uganda\u2019dan yap\u0131lan bir \u00e7al\u0131\u015fmada, standart a\u015f\u0131lama sonras\u0131 a\u015f\u0131 yan\u0131t\u0131n\u0131n %92.1 oldu\u011fu tespit edilmi\u015ftir (21). \u0130nci ve arkada\u015flar\u0131n\u0131n (22) yapt\u0131\u011f\u0131 \u00e7al\u0131\u015fmada ise ba\u011f\u0131\u015f\u0131kl\u0131k oran\u0131 %26.8 olarak bulunmu\u015ftur. Chaiwarith ve arkada\u015flar\u0131n\u0131n (23) \u00e7al\u0131\u015fmas\u0131nda, standart olarak \u00fc\u00e7 kez a\u015f\u0131lama yap\u0131lanlarda ba\u011f\u0131\u015f\u0131kl\u0131k geli\u015fme oran\u0131 %57.1 iken bu oran d\u00f6rt kez a\u015f\u0131lama yap\u0131lanlarda %76.7 ve d\u00f6rt kez \u00e7ift doz a\u015f\u0131lama yap\u0131lanlarda %80.5 olarak bildirilmi\u015ftir. Daha \u00f6nceki \u00e7al\u0131\u015fmam\u0131zda (19) ba\u011f\u0131\u015f\u0131kl\u0131k geli\u015fme oran\u0131 %50 iken mevcut \u00e7al\u0131\u015fmam\u0131zda bu oran %80.5 olarak saptand\u0131. \u00c7al\u0131\u015fmalara dahil edilen hasta pop\u00fclasyonlar\u0131n\u0131n \u00f6zelliklerinde ve a\u015f\u0131 uygulama \u015femalar\u0131ndaki farkl\u0131l\u0131klardan dolay\u0131 HIV ile ya\u015fayan <\/span>ki\u015filerde ba\u011f\u0131\u015f\u0131kl\u0131k yan\u0131t oranlar\u0131n\u0131n de\u011fi\u015fkenlik g\u00f6sterdi\u011fi d\u00fc\u015f\u00fcn\u00fclmektedir.<\/span><\/p>\nHIV ile ya\u015fayan ve izole anti-HBc IgG pozitifli\u011fi olan ki\u015filerin a\u015f\u0131lanmas\u0131 konusunda rehberlerde bir g\u00f6r\u00fc\u015f birli\u011fi yoktur. Yine de bir\u00e7ok merkez hastalar\u0131n\u0131 a\u015f\u0131lamay\u0131 tercih etmektedir. Piroth ve arkada\u015flar\u0131n\u0131n (24) yapt\u0131\u011f\u0131 \u00e7al\u0131\u015fmada, bir doz a\u015f\u0131 sonras\u0131 ba\u011f\u0131\u015f\u0131kl\u0131k oran\u0131 %46 iken anti-HBs titresi olu\u015fmayanlarda \u00fc\u00e7 kez \u00e7ift doz a\u015f\u0131lama sonras\u0131 ba\u011f\u0131\u015f\u0131kl\u0131k geli\u015fme oran\u0131 %89 olarak saptanm\u0131\u015ft\u0131r; s\u00f6z konusu \u00e7al\u0131\u015fmada toplamda %90.7 oran\u0131nda ba\u011f\u0131\u015f\u0131kl\u0131k olu\u015fmu\u015fken 18. ayda hastalar\u0131n %57.4\u2019\u00fcnde koruyuculu\u011fun devam etti\u011fi bildirilmi\u015ftir. Laksananun ve arkada\u015flar\u0131n\u0131n (25) yapt\u0131\u011f\u0131 \u00e7al\u0131\u015fmada, hastalar iki gruba ayr\u0131lm\u0131\u015f, ilk gruba standart \u00fc\u00e7 doz a\u015f\u0131lama yap\u0131l\u0131rken ikinci gruba 0-1-2 ve 6.aylarda tek doz a\u015f\u0131lama yap\u0131lm\u0131\u015ft\u0131r. \u0130lk grupta ilk a\u015f\u0131dan sonra ba\u011f\u0131\u015f\u0131kl\u0131k %25.9, a\u015f\u0131lama tamamland\u0131ktan sonra ise %85.2 iken ikinci grupta ilk a\u015f\u0131dan sonra ba\u011f\u0131\u015f\u0131kl\u0131k %33.3 a\u015f\u0131lama tamamland\u0131ktan sonra ise %88.9 oran\u0131nda saptanm\u0131\u015f, iki grup aras\u0131nda istatiksel olarak anlaml\u0131 d\u00fczeyde fark bulunmad\u0131\u011f\u0131 bildirilmi\u015ftir. \u00c7al\u0131\u015fmam\u0131zda \u00fc\u00e7 doz standart a\u015f\u0131 uygulanmas\u0131 sonras\u0131 ba\u011f\u0131\u015f\u0131kl\u0131k oran\u0131 %90.7 olup sonu\u00e7 literat\u00fcrle uyumluydu.<\/p>\n
A\u015f\u0131 yan\u0131t\u0131n\u0131; saptanabilir HIV-RNA, d\u00fc\u015f\u00fck CD4+<\/sup> T lenfosit say\u0131s\u0131, ya\u015f, HCV koinfeksiyonu, ok\u00fclt HBV infeksiyonu, a\u015f\u0131r\u0131 alkol kullan\u0131m\u0131 ve komorbid durumlar\u0131n etkiledi\u011fi d\u00fc\u015f\u00fcn\u00fclmektedir (1). A\u015f\u0131lama \u015femas\u0131ndaki de\u011fi\u015fikliklerin de a\u015f\u0131 yan\u0131t\u0131n\u0131 etkiledi\u011fi g\u00f6sterilmi\u015ftir (23).<\/p>\nLaunay ve arkada\u015flar\u0131n\u0131n (26) HIV ile ya\u015fayan ve CD4+<\/sup> T lenfosit say\u0131s\u0131 >200 h\u00fccre\/mm\u00b3 olan ki\u015filerin dahil edildi\u011fi \u00e7al\u0131\u015fmalar\u0131nda, \u00fc\u00e7 farkl\u0131 a\u015f\u0131lama \u015femas\u0131 uygulanm\u0131\u015f olup d\u00f6rt kez \u00e7ift doz a\u015f\u0131lama di\u011fer a\u015f\u0131 \u015femalar\u0131na g\u00f6re daha etkin <\/b>bulunmu\u015ftur. Fonseca ve arkada\u015flar\u0131 (27) da \u00e7ift doz a\u015f\u0131laman\u0131n standart a\u015f\u0131lamaya g\u00f6re daha etkili oldu\u011funu g\u00f6stermi\u015ftir. S\u00f6z konusu \u00e7al\u0131\u015fmada, HIV ile ya\u015fayan ve hem CD4+<\/sup> T lenfosit say\u0131s\u0131 <350 h\u00fccre\/mm\u00b3 hem de viral y\u00fck\u00fc >10 000 kopya\/ml olan ki\u015filerde a\u015f\u0131lama \u015femas\u0131n\u0131n ba\u011f\u0131\u015f\u0131kl\u0131k yan\u0131t\u0131na etkisinin istatiksel olarak anlaml\u0131 d\u00fczeyde olmad\u0131\u011f\u0131 bildirilmi\u015ftir. Lara ve arkada\u015flar\u0131 (28) da a\u015f\u0131lama sonras\u0131 ba\u011f\u0131\u015f\u0131kl\u0131k olu\u015fmayanlarda rapel dozlar\u0131n yap\u0131lmas\u0131n\u0131n ba\u011f\u0131\u015f\u0131kl\u0131k yan\u0131t\u0131 ile ili\u015fkili ba\u011f\u0131ms\u0131z tek fakt\u00f6r oldu\u011funu g\u00f6stermi\u015ftir. Poliklini\u011fimizden takipli HIV ile ya\u015fayan ki\u015filerin t\u00fcm\u00fcne ayn\u0131 a\u015f\u0131lama \u015femas\u0131 uyguland\u0131\u011f\u0131 i\u00e7in bu anlamda bir kar\u015f\u0131la\u015ft\u0131rma yap\u0131lamad\u0131.<\/p>\nSeremba ve arkada\u015flar\u0131n\u0131n (21) a\u015f\u0131 yan\u0131t\u0131n\u0131 de\u011ferlendikleri \u00e7al\u0131\u015fmalar\u0131nda, \u00e7ok de\u011fi\u015fkenli analiz sonucunda ba\u011f\u0131\u015f\u0131kl\u0131k i\u00e7in CD4+<\/sup> T lenfosit say\u0131s\u0131n\u0131n >200 h\u00fccre\/mm\u00b3 olmas\u0131 anlaml\u0131 bulunmu\u015ftur. \u00d6zt\u00fcrk ve arkada\u015flar\u0131n\u0131n (20) \u00e7al\u0131\u015fmas\u0131nda da hem tan\u0131 an\u0131nda hem a\u015f\u0131lama an\u0131nda CD4+<\/sup> T lenfosit say\u0131s\u0131n\u0131n >200 h\u00fccre\/mm\u00b3 olmas\u0131 anlaml\u0131 bulunmu\u015ftur. \u00c7al\u0131\u015fmam\u0131zda, CD4+<\/sup> T lenfosit say\u0131s\u0131 <200 h\u00fccre\/mm\u00b3 olan ile >350 h\u00fccre\/mm\u00b3 olan ki\u015filerin a\u015f\u0131 yan\u0131t\u0131 aras\u0131nda literat\u00fcrle uyumlu bir \u015fekilde istatistiksel olarak anlaml\u0131 d\u00fczeyde bir fark saptand\u0131.<\/p>\nSaptanabilir HIV-RNA, a\u015f\u0131 yan\u0131t\u0131n\u0131 olumsuz etkileyen fakt\u00f6rlerden biridir (1,26,29). \u00dclkemizde 2015 y\u0131l\u0131ndan itibaren CD4+<\/sup> T lenfosit say\u0131s\u0131ndan ba\u011f\u0131ms\u0131z olarak herkese tedavi \u00f6nerilmeye ba\u015flanm\u0131\u015ft\u0131r. Bu durumun a\u015f\u0131 yan\u0131t\u0131na yans\u0131yan sonu\u00e7lar\u0131 olmu\u015ftur. Yap\u0131lan istatistik analizinde, tan\u0131 y\u0131l\u0131n\u0131n 2015\u2019ten \u00f6nce ve sonra olma durumuna ba\u011fl\u0131 olarak ba\u011f\u0131\u015f\u0131kl\u0131k yan\u0131t oran\u0131n\u0131n anlaml\u0131 d\u00fczeyde y\u00fckseldi\u011fi g\u00f6r\u00fcld\u00fc.<\/p>\nChaiwarith ve arkada\u015flar\u0131 (23) \u00e7al\u0131\u015fmalar\u0131n\u0131n sonucunda, ba\u011f\u0131\u015f\u0131kl\u0131\u011f\u0131n olu\u015fmas\u0131 i\u00e7in a\u015f\u0131laman\u0131n gen\u00e7 ya\u015fta yap\u0131lmas\u0131n\u0131 \u00f6nermi\u015f olmakla birlikte yap\u0131lan di\u011fer \u00e7al\u0131\u015fmalarda ba\u011f\u0131\u015f\u0131kl\u0131k yan\u0131t\u0131 i\u00e7in ya\u015f istatiksel olarak anlaml\u0131 bulunmam\u0131\u015ft\u0131r (20,21). \u00c7al\u0131\u015fmam\u0131zda da ba\u011f\u0131\u015f\u0131kl\u0131k olu\u015fmas\u0131 i\u00e7in ya\u015f anlaml\u0131 bir fakt\u00f6r olarak bulunmad\u0131.<\/p>\n
Yap\u0131lan \u00e7al\u0131\u015fmalarda, komorbiditelerin ba\u011f\u0131\u015f\u0131kl\u0131k yan\u0131t\u0131na etkisi istatiksel olarak anlaml\u0131 bulunmam\u0131\u015ft\u0131r (23,29). \u00c7al\u0131\u015fmam\u0131zda da komorbiditelerin a\u015f\u0131 yan\u0131t\u0131na etkisi olmad\u0131\u011f\u0131 g\u00f6sterildi. Komorbiditelerin incelendi\u011fi \u00e7al\u0131\u015fmalarda HIV ile ya\u015fayan ki\u015fi say\u0131lar\u0131n\u0131n az oldu\u011fu dikkat \u00e7ekmektedir; bu kapsamda daha \u00e7ok kat\u0131l\u0131mc\u0131yla yap\u0131lacak \u00e7al\u0131\u015fmalara ihtiya\u00e7 vard\u0131r.<\/span><\/p>\nBaz\u0131 \u00e7al\u0131\u015fmalarda anti-HCV pozitifli\u011finin a\u015f\u0131 yan\u0131t\u0131na etkisi olmad\u0131\u011f\u0131 g\u00f6sterilmi\u015f olmakla birlikte hastalarda HCV koinfeksiyonu olup olmad\u0131\u011f\u0131na dair bilgi verilmemi\u015ftir (26,28,29). \u00c7al\u0131\u015fmam\u0131zda HIV ile ya\u015fayan sadece iki ki\u015fide anti-HCV pozitifli\u011fi mevcuttu ve birinde kronik HCV infeksiyonu vard\u0131. \u0130kisinde de ba\u011f\u0131\u015f\u0131kl\u0131k olu\u015fmu\u015ftu. Hasta say\u0131s\u0131n\u0131n yeterli olmamas\u0131 nedeniyle istatistiksel analiz yap\u0131lmad\u0131.<\/p>\n
A\u015f\u0131lanan ya da a\u015f\u0131lanmayan, a\u015f\u0131 yan\u0131t\u0131 olan ya da olmayan hi\u00e7bir HIV ile ya\u015fayan ki\u015fide akut HBV infeksiyonu geli\u015fmedi. Bu durumun, omurga tedavide tenofovir i\u00e7eren ila\u00e7lar\u0131n tercih edilmi\u015f olmas\u0131n\u0131n koruyucu etkisine ba\u011fl\u0131 olabilece\u011fi d\u00fc\u015f\u00fcn\u00fcld\u00fc.<\/p>\n
Sonu\u00e7 olarak; HIV ile ya\u015fayan ve HBV serolojisi negatif olan ki\u015filerdea\u015f\u0131lanma son derece \u00f6nemlidir.\u00a0 <\/span>\u00c7al\u0131\u015fmam\u0131z\u0131n sonucunda, a\u015f\u0131 i\u00e7in en ideal zaman\u0131n CD4+<\/sup> T lenfosit say\u0131s\u0131n\u0131n >200 h\u00fccre\/mm\u00b3 oldu\u011fu ve viral y\u00fck\u00fcn bask\u0131land\u0131\u011f\u0131 s\u00fcre\u00e7 oldu\u011fu g\u00f6r\u00fcld\u00fc. Ayr\u0131ca, a\u015f\u0131lanma durumunu yak\u0131ndan takip edecek sa\u011fl\u0131k personelinin bulundu\u011fu a\u015f\u0131 polikliniklerinin deste\u011fiyle a\u015f\u0131lanma oran\u0131 ve ba\u011f\u0131\u015f\u0131kl\u0131k yan\u0131t\u0131n\u0131n artaca\u011f\u0131 g\u00f6z \u00f6n\u00fcnde bulundurulmal\u0131d\u0131r.<\/p>\n","protected":false},"excerpt":{"rendered":"G\u0130R\u0130\u015e Hepatit B virusu (HBV) infeksiyonu, d\u00fcnya \u00e7ap\u0131nda kronik hepatit, karaci\u011fer sirozu ve hepatosel\u00fcler karsinomun en \u00f6nemli nedenlerinden biridir (1,2). D\u00fcnya Sa\u011fl\u0131k \u00d6rg\u00fct\u00fc (DS\u00d6) k\u00fcresel hepatit raporunda, 2015 y\u0131l\u0131nda d\u00fcnyada HBV infeksiyonu prevalans\u0131n\u0131n %3.5 oldu\u011funu ve\u00a0 yakla\u015f\u0131k 257 milyon ki\u015fide kronik hepatit B infeksiyonu g\u00f6r\u00fcld\u00fc\u011f\u00fcn\u00fc bildirmi\u015ftir. Yine ayn\u0131 raporda, viral hepatitlere ba\u011fl\u0131 1.34 milyon \u00f6l\u00fcm […]<\/p>\n","protected":false},"author":4,"featured_media":0,"comment_status":"closed","ping_status":"closed","sticky":false,"template":"","format":"standard","meta":{"_acf_changed":false,"footnotes":""},"categories":[5129],"tags":[5759,5758,3154,5648],"class_list":["post-27286","post","type-post","status-publish","format-standard","hentry","category-ozgun-arastirma","tag-asi-yaniti","tag-asilama","tag-hepatit-b-asisi","tag-hiv-aids"],"acf":[],"_links":{"self":[{"href":"https:\/\/www.klimikdergisi.org\/tr\/wp-json\/wp\/v2\/posts\/27286","targetHints":{"allow":["GET"]}}],"collection":[{"href":"https:\/\/www.klimikdergisi.org\/tr\/wp-json\/wp\/v2\/posts"}],"about":[{"href":"https:\/\/www.klimikdergisi.org\/tr\/wp-json\/wp\/v2\/types\/post"}],"author":[{"embeddable":true,"href":"https:\/\/www.klimikdergisi.org\/tr\/wp-json\/wp\/v2\/users\/4"}],"replies":[{"embeddable":true,"href":"https:\/\/www.klimikdergisi.org\/tr\/wp-json\/wp\/v2\/comments?post=27286"}],"version-history":[{"count":3,"href":"https:\/\/www.klimikdergisi.org\/tr\/wp-json\/wp\/v2\/posts\/27286\/revisions"}],"predecessor-version":[{"id":27715,"href":"https:\/\/www.klimikdergisi.org\/tr\/wp-json\/wp\/v2\/posts\/27286\/revisions\/27715"}],"wp:attachment":[{"href":"https:\/\/www.klimikdergisi.org\/tr\/wp-json\/wp\/v2\/media?parent=27286"}],"wp:term":[{"taxonomy":"category","embeddable":true,"href":"https:\/\/www.klimikdergisi.org\/tr\/wp-json\/wp\/v2\/categories?post=27286"},{"taxonomy":"post_tag","embeddable":true,"href":"https:\/\/www.klimikdergisi.org\/tr\/wp-json\/wp\/v2\/tags?post=27286"}],"curies":[{"name":"wp","href":"https:\/\/api.w.org\/{rel}","templated":true}]}}
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