Background: Rapid initiation of antiretroviral therapy (ART) reduces the transmission of HIV infection in the community. This study aimed to determine whether rapid ART initiation is effective compared to standard ART treatment in our country. Methods: Patients were grouped based on time to treatment initiation. HIV RNA levels, CD+4 T cell count, CD4/CD8 ratio, and ART regimens were recorded at baseline and follow-up visits for 12 months. Results: There were 368-ART naive adults (treatment initiated at the time of HIV diagnosis; 143 on the first day, 48 on the secondseventh day, and 177 after the seventh day). Although virological suppression rates at 12th months were higher in all groups, over 90% on average, there were no statistically significant differences in HIV-1 RNA suppression rates, CD+4 T cell count, and CD4/CD8 ratio normalization in the studied months but in multivariate logistic regression analysis; showed a significant correlation between both virological and immunological response and those with CD4+ T <350 cells/mL at 12th month in total patients. Conclusion: Our findings support the broader application of recommendations for rapid ART initiation in HIV patients.

INTRODUCTION: It has been reported that short-term and low-dose intravenous corticosteroids prevent the progression of the disease and reduce mortality during the hyperinflammation period caused by the virus in COVID-19 disease. The aim of our study is to evaluate the clinical course, hospital readmission and mortality rates of patients with mild to moderate COVID-19 pneumonia, who do not need oxygen and for whom we started outpatient corticosteroid treatment. METHODS: Patients over the age of 18 who applied to our hospital with the diagnosis of mild-to-moderate COVID-19 pneumonia and were treated with outpatient oral systemic corticosteroid were included in the study.Inclusion criteria were pneumonia finding consistent with mild to moderate COVID-19 involvement in lung computerized tomography, seven days or more from symptom onset, and oxygen saturation of 93 and above. The patients were given dexamethasone 8 milligrams (mg) methylprednisolone 32 mg, methylprednisolone 40 mg as oral systemic corticosteroid. RESULTS: The median age (min-max) of the patients was 49.24 (22-91), and 60% of them were male. The median steroid duration was 6.6 (1-10) days. Due to ongoing symptoms, 56% of the patients were admitted to the hospital again, 12% were hospitalized due to clinical and laboratory deterioration, the intensive care hospitalization rate was 3% and the mortality rate was 2% (2/100). DISCUSSION AND CONCLUSION: As a result, the effectiveness of oral corticosteroids on mortality and morbidity has not been demonstrated in mild to moderate COVID-19 pneumonia. Well-designed randomized controlled studies are needed on this subject.

Background: The number and proportion of elderly patients living with chronic hepatitis C are expected to increase in the coming years. We aimed to compare the real-world efficacy and safety of direct-acting antiviral treatment in elderly and younger Turkish adults infected with chronic hepatitis C. Methods: In this multicenter prospective study, 2629 eligible chronic hepatitis C patients treated with direct-acting antivirals between April 2017 and December 2019 from 37 Turkish referral centers were divided into 2 age groups: elderly (>= 65 years) and younger adults (<65 years) and their safety was compared between 2 groups in evaluable population. Then, by matching the 2 age groups for demographics and pretreatment risk factors for a non-sustained virological response, a total of 1516 patients (758 in each group) and 1244 patients (622 in each group) from the modified evaluable population and per-protocol population were included in the efficacy analysis and the efficacy was compared between age groups. Results: The sustained virological response in the chronic hepatitis C patients was not affected by the age and the presence of cirrhosis both in the modified evaluable population and per-protocol population (P =.879, P =.508 for modified evaluable population and P =.058, P =.788 for per-protocol population, respectively). The results of the per-protocol analysis revealed that male gender, patients who had a prior history of hepatocellular carcinoma, patients infected with non-genotype 1 hepatitis C virus, and patients treated with sofosbuvir + ribavirin had a significantly lower sustained virological response 12 rates (P <.001, P =.047, P =.013, and P =.025, respectively). Conclusion: Direct-acting antivirals can be safely used to treat Turkish elderly chronic hepatitis C patients with similar favorable efficacy and safety as that in younger adults.

Objective: Multiple factors have been studied in association with disease severity in COVID-19. The cycle threshold (Ct) value of polymerase chain reaction (PCR) can reflect viral load in the specimens. In this study, we aimed to evaluate the effect of the Ct value on clinical course and mortality in COVID-19 patients. Methods: Adult patients who tested positive for SARS-CoV-2 with PCR test and who were hospitalized with COVID-19-related symptoms between August 1, 2020, and November 30, 2020, were included in the study. In addition, Ct value, demographic and clinical data (length of hospital stay, need for admission to intensive care unit (ICU), need for mechanical ventilation (MV), and mortality) were reviewed retrospectively. Results: 117 patients were included in the study. The mean Ct value was 22.37±4.72 (11.07-34.06). There was no significant difference in the mean Ct values between the patients who needed ICU admission and those who did not. When the patients were evaluated by dividing them into three groups according to their Ct values, as < 20, between 20-24 and >24; there was no significant difference between these three groups in terms of severity of pneumonia, laboratory parameters (D-dimer, Neutrophil/Lymphocyte ratio, C-reactive protein, lymphocyte count), length of hospital stay, need for ICU admission, need for MV and mortality. When the patients were divided into two groups with Ct values as <23.3 and ≥23.3, no significant difference was found between the groups regarding ICU need, MV need, and 28-day mortality rates. Conclusion: Most of the studies in the literature about Ct value and its effect on clinical course indicate that lower Ct values are potentially associated with worse outcomes in COVID-19. However, there are also studies reporting that the Ct value does not reflect the severity of the disease. We did not find a correlation between Ct value and laboratory markers, length of hospital stay, the severity of pneumonia, need for ICU admission or MV, and mortality in COVID-19 patients in this presented study. Keywords: Ct value, cycle threshold, COVID-19, clinical course, mortality

Introduction: People who inject drugs (PWID) should be treated in order to eliminate hepatitis C virus (HCV) in the world. Aims: The aim of this study was to compare direct acting antivirals (DAAs) treatment of HCV for PWID and non-PWID in real life setting. Materials and methods: We performed a prospective, non-randomized, observational multi-center cohort study in 37 centers. All patients treated with DAAs therapy between April 1, 2017 to February 28, 2019 were included. In total, 2,713 patients were included in the study among which 250 were PWID and 2,463 were non-PWID. Besides patient characteristics, treatment response, follow-up and side effects of treatment were also analyzed. Results: Genotype 1a and 3 were more prevalent in PWID infected patients (20.4% vs 9.9% and 46.8% vs 5.3%). The number of naïve patients was higher in PWID (90.7% vs 60.0%), while the number of patients with cirrhosis was higher in non-PWID (14.1% vs 3.7%). The loss of follow up was higher in PWID (29.6% vs 13.6%). There was no difference in the sustained virologic response at 12 weeks after treatment (98.3% vs 98.4%), but the end of treatment response was lower in PWID (96.2% vs 99.0%). In addition, the rate of treatment completion was lower in PWID (74% vs 94.4%). Conclusion: DAAs were safe and effective in PWID. Primary measures should be taken to prevent the loss of follow-up and poor adherence in PWID patients in order to achieve World Health Organization’s objective of eliminating viral hepatitis.

Introduction:The optimal duration of nucleos(t)ide analogues (NAs) therapy is unknown for hepatitis B e antigen (HBeAg)-negative chronic hepatitis B (CHB) patients.The European Association for the Study of the Liver (EASL) recommends the cessation of NAs in selected non-cirrhotic HBeAg-negative patients achieving long-term (at least three years) virological suppression under treatment if close monitoring can be guaranteed after the cessation of NAs.This study aimed to test this "cut-off rule" in HBeAg-negative CHB patients treated with NAs. Materials and Methods: Seventy-one non-cirrhotic patients were treated with NAs for an average of nine (3-14) years before treatment was discontinued, and patients' hepatitis B virus (HBV) DNAs were negative for an average of seven (3-13) years.After treatment cessation, serum HBV-DNA and alanine aminotransferase levels were monitored every four weeks for the first six months and every three months from six months to 12 months.The patients were followed-up for 48 weeks after treatment cessation.Results: In 48 weeks after NA treatment cessation, 30 of 71 patients (42.3%) experienced relaps.Hepatitis B e antigen seroreversion in two consecutive visits was observed in one patient (3.4%), HBV-DNA >20,000 IU/ml twice was observed in 23 patients (76.6%), and both virological and biochemical relapses were observed in six patients (20%).Median retreatment time was 21.6 (4-48) weeks.There were no significant differences between relapsers and non-relapsers in terms of baseline features. Conclusion:Although the viral suppression time in NA treatment of HBeAg-negative CHB patients was longer than the EASL recommendation, the relapse rate was found to be similar to that in other studies.Our study has shown that applying EASL recommendations in patients meeting the suitable criteria who can be closely followed up is appropriate.

Introduction: The optimal duration of nucleos(t)ide analogues (NAs) therapy is unknown for hepatitis B e antigen (HBeAg)-negative chronic hepatitis B (CHB) patients. The European Association for the Study of the Liver (EASL) recommends the cessation of NAs in selected non-cirrhotic HBeAg-negative patients achieving long-term (at least three years) virological suppression under treatment if close monitoring can be guaranteed after the cessation of NAs. This study aimed to test this "cut-off rule" in HBeAg-negative CHB patients treated with NAs.Materials and Methods: Seventy-one non-cirrhotic patients were treated with NAs for an average of nine (3-14) years before treatment was discontinued, and patients' hepatitis B virus (HBV) DNAs were negative for an average of seven (3-13) years. After treatment cessation, serum HBV-DNA and alanine aminotransferase levels were monitored every four weeks for the first six months and every three months from six months to 12 months. The patients were followed-up for 48 weeks after treatment cessation.Results: In 48 weeks after NA treatment cessation, 30 of 71 patients (42.3%) experienced relaps. Hepatitis B e antigen seroreversion in two consecutive visits was observed in one patient (3.4%), HBV-DNA >20,000 IU/ml twice was observed in 23 patients (76.6%), and both virological and biochemical relapses were observed in six patients (20%). Median retreatment time was 21.6 (4-48) weeks. There were no significant differences between relapsers and non-relapsers in terms of baseline features.Conclusion: Although the viral suppression time in NA treatment of HBeAg-negative CHB patients was longer than the EASL recommendation, the relapse rate was found to be similar to that in other studies. Our study has shown that applying EASL recommendations in patients meeting the suitable criteria who can be closely followed up is appropriate.

: In chronic hepatitis C treatment, direct acting antivirals have a strong effect and are well tolerated since 2014, yet it is unclear whether resource-constrained countries have the same achievement. This study aimed at evaluating direct acting antivirals used to treat Turkish chronic hepatitis C patients between the years of 2016 to 2017. Within the one-year period, 101 out of 105 patients reached a sustained virological response rate. The type of direct acting antivirals and treatment length were chosen according to the Health Implementation Guideline of Turkey. The analyses of effectiveness according to therapeutic regimes showed the following sustained virological response rate: Ledipasvir/sofosbuvir and +/-; ribavirin (97%), ombitasvir/paritepravir/dasabuvir and +/-; ribavirin (100%) and sofosbuvir + ribavirin (100%). One patient had virological relapse on the 12th week by the end of the therapy. In this patient, cross-resistance mutation Y93H was specified for the NS5A region. On the other hand, amino acid changes, S282G and C316S, were determined in the NS5B region. The adverse effects were 22% in all patients. Most of them were mild or moderate. The researchers concluded that the results of the highly efficient and well-tolerated therapy with direct acting antivirals could be examples in resource-constrained countries. In addition, resistant variants should be detected after unsuccessful treatment in the management of new therapy options.

Objective: Coinfection of HIV and syphilis, especially in men who have sex with men has been increasing all over the world in recent years. We evaluated the seropreyalence of HIV/syphilis coinfections in patients followed by our clinic for the control of these diseases. Methods: A total of 384 HIV-infected patients followed between June 2015 and August 2018, and their sociodemographic characteristics such as age, gender, nationality, marital status, educational level, HIV and syphilis transmission routes, laboratory parameters such as CD4 T lymphocyte count, HIV viral load, semiquantitative rapid plasma reagin and Treponema pallidum hemaglutination assay were evaluated. Results: Of 384 HIV-infected patients, 97 (25%) were diagnosed with syphilis coinfection. 85% of the infected with HIV were male, and 93% of those with HIV/syphilis coinfection were male (p=0.023). Among those with HIV infection 40% had heterosexual intercourse, 34% had homosexual intercourse, those with HIV/syphilis coinfection had 37% heterosexual intercourse and 55% homosexual intercourse (p=0.000). Conclusions: Syphilis screening should be performed in HIV-infected patients and screening for HIV should be performed in syphilis patients. Homosexual intercourse is a risk factor especially in HIV/syphilis coinfection. The risk of syphilis is also high in older ages and therefore increasing the screening of HIV and syphilis in all age groups is necessary for early diagnosis and prevention of transmission.

In this report, we present a case of cryptococcal meningitis with acute onset and multiple organ involvement.A 44-yearold male was hospitalized with complaints of nausea, vomiting, headache and deterioration in general condition one month after the initiation of antiretroviral therapy (ART) for HIV infection.Empirical antibiotic treatment was started for the diagnosis of pneumonia, retinitis and meningitis according to the clinical findings and examination results.India ink preparation of cerebrospinal fluid (CSF) revealed budding capsulated yeast cells.Cryptococcal antigen test was positive in CSF and C. neoformans was isolated from CSF culture.Liposomal amphotericin B and fluconazol was added to the treatment schedule.Histopathologic examination of the tissue obtained with renal biopsy revealed extensive parenchymal cryptococcal involvement.Antifungal therapy was continued as oral fluconazole after 40 days.Fluconazol was discontinued when CD4+ T cell count increased over 100/mm 3 after 12 months.The patient had persistently elevated creatinin levels under ART without antifungal therapy.Last creatinine value was 2.4 mg/dL after a one-year follow-up.Especially in newly diagnosed HIV-positive cases, cryptococcal antigen test should be performed in CSF as stated in the guidelines, if the CD4+ T cell count is <100/mm 3 and the serum cryptococcal antigen is positive.In addition, cryptococcal infection should be considered in differential diagnosis of HIV-positive patients with impaired renal function and kidney biopsies should be performed as soon as possible.Early diagnosis will help to reduce mortality and morbidity.It should be kept in mind that cryptococcal infections in HIV-infected patients may be present with multiple organ involvement.

Objectives: Pegylated-interferon (Peg-IFN) alpha 2a/2b and nucleoside and/or nucleotide analogues (NAs) are currently the only two treatment approaches approved for the chronic hepatitis B (CHB). To date, few studies have compared Peg-IFN with NAs in the treatment of CHB. We aimed in this study to evaluate the effectiveness of Peg-IFN and potent NAs (entecavir and tenofovir disoproxil) and to compare cumulative virological and serological resnonses in Turkish CHB patients treated between 2006 and 2016. Materials and Methods: In this observational retrospective study, we divided a total of 331 patients, who were diagnosed with CHB, into 3 groups: Peg-IFN treatment group (n=62), entecavir treatment group (n=131) and tenofovir disoproxil treatment group (n=138). Results: Virologic response rate in the Peg-IFN treatment group (90%) at 12 months was higher than in the NAs treatment groups (80% for entecavir and 76% for tenofovir disoproxil) (p<0.05). Sustained virologic response (SVR) rate at 24 months was 61% in the Peg-IFN group (p<0.001). The rate of hepatitis B e antigen seroconversion was significantly higher in the Peg-IFN group (25%) than in the NAs groups (16% for entecavir, 13% for tenofovir disoproxil). Hepatitis B surface antigen (HBsAg) seroconversion rate was also higher in the Peg-IFN than in the NAs treatment groups (7.9% vs. 0.9% and 0%, respectively) (p<0.001). After HBsAg seroconversion, the titers of anti-HBs were retained for over six months. Conclusion: Peg-IFN treatment was found to be effective with high SVR and hepatitis B e antigen and HBsAg seroconversion rates than NAs treatment in long-term follow-up of patients with CHB. Peg-IFN appears to be the first-choice treatment approach in patients with CHB until a new era in which hepatitis B is cured.

In chronic hepatitis C (CHC) treatment, direct acting antiviral agents (DAAs) are strongly effective and well tolerated, whereas with new DAAs, virological failures are common. At present, no data exists for RAVs of DAAs in Turkey. Genotypic resistance testing was performed by viral population sequencing of the NS3, NS5A and NS5B regions using plasma samples. The patient treatment-experienced with pegylated interferon- ribavirin was treated with 12-week course of ledipasvir/sofosbuvir and ribavirin. Three months after completing the treatment, virological relapse was occurred. Molecular analysis demonstrated that Y93H as a cross - resistant mutation for NS5A region related resistance mutation was determined. In addition, S282G and C316S were determined as amino acid substitution for NS5B region. This case shows that resistance testing for RAVs after virological failure with DAAs must be performed for the new DAA regime for CHC patients