Turkiye Klinikleri Journal of Medical Sciences

.: ORIGINAL RESEARCH
Tedavi Almamış HIV Pozitif Yeni Tanı Alan Hastalarda HLA-B57:01 Allel Prevelansının Polimeraz Zincir Reaksiyonu (PCR) Metodu ile Saptanması: Retrospektif Araştırma
Determination of HLA-B57:01 Allele Prevalence By Polymerase Chain Reaction (PCR) Method in Untreated HIV Positive Patients with New Diagnosis: Retrospective Research
Aziz Alper BİTENa , Muhammet Güzel KURTOĞLUb , Tülin DEMİRc
aT.C. Sağlık Bakanlığı Yönetim Hizmetleri Genel Müdürlüğü, Ankara, Türkiye
bBolu Abant İzzet Baysal Üniversitesi Tıp Fakültesi Dekanlığı, Tıbbi Mikrobiyoloji AD, Bolu, Türkiye
cT.C. Sağlık Bakanlığı Halk Sağlığı Genel Müdürlüğü, Ankara, Türkiye
Turkiye Klinikleri J Med Sci. 2024;44(3):141-8
doi: 10.5336/medsci.2023-99247
Article Language: TR
Full Text
ÖZET
 Amaç: HIV tedavisinde Abakavir'in kullanımı için en büyük kontrendikasyonu aşırı duyarlılık reaksiyonudur. Abakavir'e karşı gelişen aşırı duyarlılık reaksiyonu HLA-B57:01 alleli varlığı ile yakın ilişkili olduğu saptanmıştır. Bu çalışmanın yapıldığı tarihlerde ülkemizde bu alanda çok merkezli farklı bir çalışma yapılmamıştı. Bu çalışmada, HIV pozitif yeni tanı almış, henüz tedaviye başlamamış hasta grubundaki HLA-B57:01 allel sıklığının allel spesifik PCR ile taranması amaçlanmıştır. Gereç ve Yöntemler: Retrospektif olan çalışma için Ocak-Aralık 2021 tarihlerinde ''Halk Sağlığı Genel Müdürlüğü, Ulusal HIV-AIDS Doğrulama ve Viral Hepatitler Referans Laboratuvarına'' yeni tanı almış 235 hastaya ait plazma örneklerinden izole edilen DNA örnekleri dâhil edilmiştir. HLA-B57:01 allel sıklığının allel spesifik PCR ile taranması amaçlanmış, pozitif bulunan örnekler için semi-nested PCR yapılmıştır. DNA örneklerinin izlenebilmesi için EDTA 0,5 M, 10XTBE solüsyonları hazırlanmıştır. Verilerin analizi SPSS15 paket programında yapılmıştır. Bulgular: HLA-B57:01 allel varlığı yönünden test edilen toplam 235 örneğin 5'inde (%2,12) allel pozitifliği saptandı. Pozitif bulunan 5 hastanın 35 yaş ve altındaki hasta grubunda olduğu belirlendi. HLA-B57:01 pozitifliği ile cinsiyet arasındaki ilişkide; pozitif hastaların erkek olduğu, tüm erkek hastaların %2,8'inin HLA-B57:01 alleli taşıdığı belirlendi (p=0,371). Coğrafik dağılım değerlendirildiğinde; en sık allel pozitifliği Karadeniz Bölgesinde izlenmiştir. Sonuç: Test edilen örneklerin azlığı sebebiyle, bölgesel temsiliyet sağlanamamıştır. İlerleyen dönemde, tüm bölgeleri temsil edecek düzeyde örneklerin dâhil edildiği, allel varlığı ile birlikte klinik yansımalarının da değerlendirilebileceği, HLA-B57:01 allel ile CD4 Th lenfosit sayısı arasındaki ilişkinin saptanabileceği, aşırı duyarlılık reaksiyonu veya benzeri semptomlarda deri yama testi gibi geniş kapsamlı çalışmaların yapılması gerektiği sonucuna varılmış olup bu çalışmamızın da sonraki çalışmalara ışık tutacağı kanaati oluşmuştur.

Anahtar Kelimeler: HIV; HLA-B57:01 allel pozitif; Abakavir; aşırı duyarlılık sendromu; semi-nested PCR
ABSTRACT
 Objective: The biggest contraindication for the use of Abacavir in HIV treatment is hypersensitivity reaction. Hypersensitivity reactions to abacavir have been found to be closely related to the presence of the HLAB57:01 allele. At the time this study was conducted, no other multicenter study had been conducted in this area in our country. The aim of this study was to screen the frequency of the HLA-B57:01 allele in the patient group newly diagnosed with HIV and not yet started on treatment, using allele-specific PCR. Material and Methods: This retrospective study includes the DNA samples isolated from blood samples which belong to 235 newly diagnosed patients who were sent to ''General Directorate of Public Health, National HIV-AIDS Verification and Viral Hepatitis Reference Laboratories'' between January-December 2021. It was aimed to screen the frequency of the HLA-B57:01allele by allele-specific PCR. EDTA 0.5 M, 10XTBE solutions were prepared to monitor DNA samples. Data analysis was performed using the SPSS 15 software package. Results: Allele positivity was detected in 5 (2.12%) of 235 samples tested for the presence of HLAB57: 01 allele. It was determined that 5 positive patients were in the group of patients aged 35 years and younger. In the relationship between HLA-B57:01 positivity and gender; It was determined that all positive patients were male, and 2.8% of all male patients carried the HLA-B57:01 allele (p=0.371). When evaluating the geographic distribution; allele positivity was most frequently observed in the Black Sea region. Conclusion: Due to the small number of samples tested, regional representation could not be achieved. In the following period, it was concluded that samples representing all regions were included, especially the presence of alleles and the clinical reflections could be evaluated, the relationship between HLA-B57:01 allele and CD4 Th lymphocyte count could be determined, more comprehensive studies such as skin patch tests in hypersensitivity reactions or similar symptoms should be conducted, and it was concluded that this study of ours would shed light on subsequent studies.

Keywords: HIV; HLA-B7:01 allele positive; Abacavir; hypersensitivity syndrome; semi-nested PCR
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