Deniz Gökengin | Ege University (original) (raw)

Papers by Deniz Gökengin

Research paper thumbnail of Role of Line Immunoassay in the Diagnosis of Early HIV Infection: A Diagnostic Case

Mikrobiyoloji Bulteni, 2013

Combined p24 antigen-HIV antibody fourth-generation assays that identify most of the early HIV in... more Combined p24 antigen-HIV antibody fourth-generation assays that identify most of the early HIV infections have been used extensively worldwide for several years. This poses challenges for the traditional algorithm of line immunoassay (LIA) confirmation. LIA tests are useful methods with their high specificity and their ability to differentiate HIV-1 from HIV-2, but they are reactive days after the fourth generation enzyme immunoassays. With acute HIV infection, high levels of infectious virus are detectable in serum and genital secretions. The rate of transmission during acute HIV infection is higher than the established HIV infection, for this reason, new HIV testing strategies need to focus on sensitivity, especially for this highly contagious phase immediately after infection. Serum sample of a patient sent to Ege University Hospital Clinical Virology Laboratory was repeatedly reactive with low signal/cutoff ratios with two different commercial fourth generation enzyme immunoassays (Architect HIV Ag/Ab Combo Reagent Kit, Abbott, Germany and Vidas HIV Duo Quick, Biomerieux, France). The sample was non-reactive with the LIA (INNO-LIA HIV I/II Score, Innogenetics, Belgium) and HIV RNA (RealTime HIV-I Amplification Reagent Kit, Abbott, USA) result was positive (4.1 x 10(5) copies/ml). With the presentation of this case, the role of LIA in the diagnosis of early HIV infection and its place in test algorithms were questioned.

Research paper thumbnail of Hepatic adverse events during highly active antiretroviral therapy containing nevirapine: a case report

Annals of clinical microbiology and antimicrobials, Jan 16, 2002

Hepatotoxicity is one of the most serious complications of highly active antiretroviral therapy (... more Hepatotoxicity is one of the most serious complications of highly active antiretroviral therapy (HAART). The aim of this report is to analyse an HIV infected patient on HAART including nevirapine and taking antidepressive agents, with acute toxic hepatitis. A 39 year old patient diagnosed as HIV positive one month ago administered to the clinical ward of the Department of Infectious Diseases and Clinical Microbiology in Ege University Medical School with high fever, malaise, nausea, diarrheae and elevated liver enzymes (ALT 1558 U/L, AST 4288 U/L). He has been using HAART including zidovudine+lamivudine (2 x 1/day) and nevirapine (2 x 200 mg/day, following dose escalation) for 22 days, sertralin and diazepam for 12 days and lithium for 10 days. The patient was hospitalized. Antiretroviral and antidepressant treatments were stopped. The day after admission, his fever dropped and his symptoms improved. Clinical improvement continued on the following days. The patient was discharged up...

Research paper thumbnail of 2014 European Guideline on HIV testing

International journal of STD & AIDS, 2014

Testing for HIV is one of the cornerstones in the fight against HIV spread. The 2014 European Gui... more Testing for HIV is one of the cornerstones in the fight against HIV spread. The 2014 European Guideline on HIV Testing provides advice on testing for HIV infection in individuals aged 16 years and older who present to sexually transmitted infection, genito-urinary or dermato-venereology clinics across Europe. It may also be applied in other clinical settings where HIV testing is required, particularly in primary care settings. The aim of the guideline is to provide practical guidance to clinicians and laboratories that within these settings undertake HIV testing, and to indicate standards for best practice.

Research paper thumbnail of HIV‑1 molecular epidemiology in the Balkans: a melting pot for high genetic diversity

AIDS reviews

The Balkans is a gateway between Europe, Asia, and the African continent, a fact with potential i... more The Balkans is a gateway between Europe, Asia, and the African continent, a fact with potential important consequences on the epidemiology of HIV‑1 infection in the region. The duration of the HIV‑1 epidemics in many countries of the Balkans is similar to the one in the Western European countries. However, striking differences exist in several countries of the region in both the epidemic situation and, even more so, in our knowledge about it. In particular, the molecular epidemiology of HIV in the Balkans is largely unknown. In order to gain some preliminary insight into HIV‑1 diversity in the region, we reviewed the available molecular epidemiology data about HIV‑1 diversity in 10 countries of the region: Albania, Bulgaria, Croatia, Greece, Montenegro, Romania, Slovenia, Serbia, Turkey, and Hungary, a neighboring country to four Balkan countries. The data were obtained either from published studies or in direct communication with the participating members. The existing molecular ep...

Research paper thumbnail of Attitudes towards HIV/AIDS and other sexually transmitted diseases in secondary school students in Izmir, Turkey: changes in time

Tropical doctor, 2007

The aim of this study was to evaluate the changes in the sexual attitudes of young people in a pe... more The aim of this study was to evaluate the changes in the sexual attitudes of young people in a period of 7 years (1997-2004). The participants in the first and the second surveys were 633 and 654 grade 10 students from six high schools located in the central district of Izmir, Turkey, chosen randomly according to the stratified sampling method. The rate of having had sexual experience was 11.3% and 22.8% in the first and second surveys, respectively (chi(2) P < 0.001).

Research paper thumbnail of Outcomes of initial antiretroviral treatment (ART) among recently diagnosed HIV patients in HIV-TR cohort, 2011–2012

Journal of the International AIDS Society, 2014

HIV-TR is a recently established (2012) multicentre cohort in Turkey. The aim of this study is to... more HIV-TR is a recently established (2012) multicentre cohort in Turkey. The aim of this study is to analyze epidemiological, immunologic and virologic data of recently diagnosed HIV patients. Epidemiologic, clinical and laboratory data of all patients diagnosed in 2011 and 2012 were recorded by a web-based data collection system, retrospectively. A total of 693 patients (561 male, 132 female) at 24 sites were enrolled. The median age at first presentation for HIV care was 36. The proportion of patients presenting with advanced HIV disease (CD4 count&amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;lt;200/mm(3) or presenting with an AIDS-defining event) was 30.6%; and 52.4% of patients were late presenters (CD4 count&amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;lt;350/mm(3) or presenting with an AIDS-defining event). Median CD4 counts at presentation and before treatment were 344 (IQR: 175-540) and 295 (IQR: 150-430), respectively. Pretreatment CD4 count was &amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;gt;500 copies/mL in 18.5% of patients. Of 531 patients receiving ART, initial combinations consist of tenofovir/emtricitabine (TDF/FTC) plus efavirenz (EFV) in 48.2% and TDF/FTC plus lopinavir/ritonavir (LPV/r) in 37.5% and other combinations in 14.3% of the patients. Pre-treatment HIV-RNA was over 100.000 copies/mL in 52.3% of patients. At Weeks 24 and 48, HIV-RNA were&amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;lt;50 copies/mL in 63,4% of 385 patients and 82% of 311 patients reported to be still on ART and had a viral load measurement, respectively. Median pretreatment CD4 count was lower for TDF/FTC+LPV/r recipients than TDF/FTC+EFV recipients (250 vs 316) (p&amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;lt;0.05). The median increase from baseline CD4 cell count was 230 in TDF/FTC+LPV/r group, 193 in TDF/FTC+EFV group and 216 among all treated patients. Of 531 patients receiving ART, 11 had died and 19 were lost to follow-up. Despite 52.4% of recently diagnosed patients were late presenters; a high rate of virologic suppression was achieved in HIV-TR Cohort. A national HIV testing strategy targeting subpopulations with higher risk is urgently needed.

Research paper thumbnail of In vitro Activities of Various Antimicrobials against <i>Brucella melitensis</i> Strains in the Aegean Region in Turkey

Medical Principles and Practice, 2005

To study in vitro activities of three quinolones (ciprofloxacin, levofloxacin, moxifloxacin), fou... more To study in vitro activities of three quinolones (ciprofloxacin, levofloxacin, moxifloxacin), four macrolides (erythromycin, dirithromycin, azithromycin, clarithromycin) and doxycycline against 44 clinical isolates of Brucella melitensis. Forty-four B. melitensis strains were isolated from blood cultures of adult patients with acute brucellosis who were hospitalized in the clinical ward of the Department of Clinical Microbiology and Infectious Diseases. The minimum inhibitory concentrations (MICs) of the tested antimicrobials were measured by the agar dilution method. MIC90 and MIC50 values were defined as the lowest concentration of the antibiotic at which 90 and 50% of the isolates were inhibited, respectively. Doxycycline (MIC50: 0.25 microg/ml, MIC90: 0.50 microg/ml) had the lowest MIC in vitro against the B. melitensis strains. Among the quinolones, ciprofloxacin and levofloxacin had similar activities (MIC50: 0.5 microg/ml, MIC90: 2 microg/ml), whereas MIC of moxifloxacin (MIC50: 1 microg/ml, MIC90: 8 microg/ml) was higher than both antibiotics in this group. Clarithromycin and azithromycin were the most active macrolides (MIC50: 8 microg/ml and MIC90: 32 microg/ml), followed by erythromycin (MIC50: 16 microg/ml, MIC90: 32 microg/ml) and dirithromycin (MIC50: 64 microg/ml and MIC90: 64 microg/ml). The results indicate that the conventional agent doxycycline is more active than quinolones and macrolides against the B. melitensis in vitro.

Research paper thumbnail of Sexual Knowledge, Attitudes, and Risk Behaviors of Students in Turkey

Journal of School Health, 2003

This survey produced baseline information about student knowledge of sexually transmitted disease... more This survey produced baseline information about student knowledge of sexually transmitted diseases (STDs), their sexual attitudes, and their behavior to help establish control and education programs. The study was conducted at Ege University, Izmir, Turkey, during the 1999-2000 A total of 2,217first-and fourth-year students determined by stratified sampling constituted the study group. All students who volunteered to participate completed a questionnaire assessing sociodemographic and knowledge factors, sexual attitudes, behavior, and history of STDs. The rate of students having had sexual experience was 36.6%. Males were more sexually active than females, Most students (71.4%) began sexual activity at ages 15-19 without any difference by gender. Males reported significantly more sexual partners than females. Similarly, the rate of male students never using condoms was significantly higher than females. Condom was the most frequent contraception method, followed by oral contraceptives and withdrawal. Mean score on the knowledge questions was 16.29 (highest score 30). The most widely known STD was H N infection and AIDS. Students' knowledge of transmission routes. signs and symptoms, and risk groups of STDs was insuffcient. Main sources of knowledge were visual and print media, and fiiends. Most students (84.7%) viewed prevention from STDs as a person's own responsibility. Young people in Turkey are sexually active and tend to engage in high-risk behavior. However, their knowledge on sexual health and sexually transmitted diseases is insufficient. Study results suggest a need for implementation of STD control programs and provision of school sexuality education for adolescents and young adults. (J Sch Health. 2003;73(7):258-263) exually transmitted diseases (STDs) rank among the ~~ ~ ~ ~~~~~ ~~~ ~

Research paper thumbnail of Efficacy of oral levofloxacin and dirithromycin alone and in combination with rifampicin in the treatment of experimental murine Brucella abortus infection

International Journal of Antimicrobial Agents, 2004

The efficacy of levofloxacin and dirithromycin, alone and in combination with rifampicin in the t... more The efficacy of levofloxacin and dirithromycin, alone and in combination with rifampicin in the treatment of experimental brucellosis was investigated. Seventy adult white male mice were infected intraperitoneally with Brucella abortus S544 standard strain. Four of the animals were sacrificed on the 21st day of inoculation for infection control. The remaining 66 mice were randomised into treatment and control groups. Following 14 days of treatment the animals were sacrificed and spleen cultures were made. The cure rates were 36.4% for levofloxacin, 27.3% for dirithromycin, 72.7% for rifampicin, 72.7% for levofloxacin + rifampicin and 81.8% for dirithromycin + rifampicin. The results of this study indicate that levofloxacin and dirithromycin are ineffective in the treatment of experimental murine brucellosis as monotherapy or in combination with rifampicin.

Research paper thumbnail of The features of infectious diseases departments and anti-infective practices in France and Turkey: a cross-sectional study

European Journal of Clinical Microbiology & Infectious Diseases, 2014

The aim of this study was to assess the infectious diseases (ID) wards of tertiary hospitals in F... more The aim of this study was to assess the infectious diseases (ID) wards of tertiary hospitals in France and Turkey for technical capacity, infection control, characteristics of patients, infections, infecting organisms, and therapeutic approaches. This cross-sectional study was carried out on a single day on one of the weekdays of June 17-21, 2013. Overall, 36 ID departments from Turkey (n=21) and France (n=15) were involved. On the study day, 273 patients were hospitalized in Turkish and 324 patients were followed in French ID departments. The numbers of patients and beds in the hospitals, and presence of an intensive care unit (ICU) room in the ID ward was not different in both France and Turkey. Bed occupancy in the ID ward, single rooms, and negative pressure rooms were significantly higher in France.

Research paper thumbnail of Transmission route and reasons for HIV testing among recently diagnosed HIV patients in HIV-TR cohort, 2011–2012

Journal of the International AIDS Society, 2014

Routes of transmission and reasons for HIV testing are important epidemiologic data to analyze th... more Routes of transmission and reasons for HIV testing are important epidemiologic data to analyze the epidemic and to tailor the response to AIDS. The aim of this study was to analyze reasons for testing and transmission ways of HIV among recently diagnosed HIV patients registered in the multicenter HIV-TR cohort in Turkey. Transmission ways and reasons for testing of all patients diagnosed in 2011 and 2012 were recorded on a web-based data collection system and were analyzed retrospectively. The study included 693 patients (561 male, 132 female) from 24 sites. Reason for HIV testing was available in 640 patients (92%). The most common reason for HIV testing was diagnostic workout for other conditions or illness followed by patient-initiated testing. The reasons for testing were listed in Table 1. The most common routes of HIV transmission were heterosexual intercourse (62.7%) and sex among men who have sex with men (MSM) (22.6%). At the time of HIV diagnosis, the mean CD4 lymphocyte cell count was 355/mm(3) (3-1433/mm(3)). Primary HIV infection was determined in 42/693 (6%) patients and 9/693 (% 1, 2) cases were considered &amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;quot;probable primary HIV infection.&amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;quot; The majority of the cases presented to a clinic for follow-up right after the diagnosis. On the other hand 32/616 (5.2%) patients delayed their presentation for more than 3 months. The longest delay was 11 months. The results of the database suggest that targeted testing is lacking in the country. The shift toward homosexual transmission during the last 2 years emphasizes the need for targeted interventions. Patients present relatively late and HIV infection could only be diagnosed when immunosuppression related findings appeared. Patient-initiated testing,an indicator of awareness, was very low suggesting a need to scale-up awareness raising interventions.

Research paper thumbnail of Role of Line Immunoassay in the Diagnosis of Early HIV Infection: A Diagnostic Case

Mikrobiyoloji Bulteni, 2013

Combined p24 antigen-HIV antibody fourth-generation assays that identify most of the early HIV in... more Combined p24 antigen-HIV antibody fourth-generation assays that identify most of the early HIV infections have been used extensively worldwide for several years. This poses challenges for the traditional algorithm of line immunoassay (LIA) confirmation. LIA tests are useful methods with their high specificity and their ability to differentiate HIV-1 from HIV-2, but they are reactive days after the fourth generation enzyme immunoassays. With acute HIV infection, high levels of infectious virus are detectable in serum and genital secretions. The rate of transmission during acute HIV infection is higher than the established HIV infection, for this reason, new HIV testing strategies need to focus on sensitivity, especially for this highly contagious phase immediately after infection. Serum sample of a patient sent to Ege University Hospital Clinical Virology Laboratory was repeatedly reactive with low signal/cutoff ratios with two different commercial fourth generation enzyme immunoassays (Architect HIV Ag/Ab Combo Reagent Kit, Abbott, Germany and Vidas HIV Duo Quick, Biomerieux, France). The sample was non-reactive with the LIA (INNO-LIA HIV I/II Score, Innogenetics, Belgium) and HIV RNA (RealTime HIV-I Amplification Reagent Kit, Abbott, USA) result was positive (4.1 x 10(5) copies/ml). With the presentation of this case, the role of LIA in the diagnosis of early HIV infection and its place in test algorithms were questioned.

Research paper thumbnail of Hepatic adverse events during highly active antiretroviral therapy containing nevirapine: a case report

Annals of clinical microbiology and antimicrobials, Jan 16, 2002

Hepatotoxicity is one of the most serious complications of highly active antiretroviral therapy (... more Hepatotoxicity is one of the most serious complications of highly active antiretroviral therapy (HAART). The aim of this report is to analyse an HIV infected patient on HAART including nevirapine and taking antidepressive agents, with acute toxic hepatitis. A 39 year old patient diagnosed as HIV positive one month ago administered to the clinical ward of the Department of Infectious Diseases and Clinical Microbiology in Ege University Medical School with high fever, malaise, nausea, diarrheae and elevated liver enzymes (ALT 1558 U/L, AST 4288 U/L). He has been using HAART including zidovudine+lamivudine (2 x 1/day) and nevirapine (2 x 200 mg/day, following dose escalation) for 22 days, sertralin and diazepam for 12 days and lithium for 10 days. The patient was hospitalized. Antiretroviral and antidepressant treatments were stopped. The day after admission, his fever dropped and his symptoms improved. Clinical improvement continued on the following days. The patient was discharged up...

Research paper thumbnail of 2014 European Guideline on HIV testing

International journal of STD & AIDS, 2014

Testing for HIV is one of the cornerstones in the fight against HIV spread. The 2014 European Gui... more Testing for HIV is one of the cornerstones in the fight against HIV spread. The 2014 European Guideline on HIV Testing provides advice on testing for HIV infection in individuals aged 16 years and older who present to sexually transmitted infection, genito-urinary or dermato-venereology clinics across Europe. It may also be applied in other clinical settings where HIV testing is required, particularly in primary care settings. The aim of the guideline is to provide practical guidance to clinicians and laboratories that within these settings undertake HIV testing, and to indicate standards for best practice.

Research paper thumbnail of HIV‑1 molecular epidemiology in the Balkans: a melting pot for high genetic diversity

AIDS reviews

The Balkans is a gateway between Europe, Asia, and the African continent, a fact with potential i... more The Balkans is a gateway between Europe, Asia, and the African continent, a fact with potential important consequences on the epidemiology of HIV‑1 infection in the region. The duration of the HIV‑1 epidemics in many countries of the Balkans is similar to the one in the Western European countries. However, striking differences exist in several countries of the region in both the epidemic situation and, even more so, in our knowledge about it. In particular, the molecular epidemiology of HIV in the Balkans is largely unknown. In order to gain some preliminary insight into HIV‑1 diversity in the region, we reviewed the available molecular epidemiology data about HIV‑1 diversity in 10 countries of the region: Albania, Bulgaria, Croatia, Greece, Montenegro, Romania, Slovenia, Serbia, Turkey, and Hungary, a neighboring country to four Balkan countries. The data were obtained either from published studies or in direct communication with the participating members. The existing molecular ep...

Research paper thumbnail of Attitudes towards HIV/AIDS and other sexually transmitted diseases in secondary school students in Izmir, Turkey: changes in time

Tropical doctor, 2007

The aim of this study was to evaluate the changes in the sexual attitudes of young people in a pe... more The aim of this study was to evaluate the changes in the sexual attitudes of young people in a period of 7 years (1997-2004). The participants in the first and the second surveys were 633 and 654 grade 10 students from six high schools located in the central district of Izmir, Turkey, chosen randomly according to the stratified sampling method. The rate of having had sexual experience was 11.3% and 22.8% in the first and second surveys, respectively (chi(2) P < 0.001).

Research paper thumbnail of Outcomes of initial antiretroviral treatment (ART) among recently diagnosed HIV patients in HIV-TR cohort, 2011–2012

Journal of the International AIDS Society, 2014

HIV-TR is a recently established (2012) multicentre cohort in Turkey. The aim of this study is to... more HIV-TR is a recently established (2012) multicentre cohort in Turkey. The aim of this study is to analyze epidemiological, immunologic and virologic data of recently diagnosed HIV patients. Epidemiologic, clinical and laboratory data of all patients diagnosed in 2011 and 2012 were recorded by a web-based data collection system, retrospectively. A total of 693 patients (561 male, 132 female) at 24 sites were enrolled. The median age at first presentation for HIV care was 36. The proportion of patients presenting with advanced HIV disease (CD4 count&amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;lt;200/mm(3) or presenting with an AIDS-defining event) was 30.6%; and 52.4% of patients were late presenters (CD4 count&amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;lt;350/mm(3) or presenting with an AIDS-defining event). Median CD4 counts at presentation and before treatment were 344 (IQR: 175-540) and 295 (IQR: 150-430), respectively. Pretreatment CD4 count was &amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;gt;500 copies/mL in 18.5% of patients. Of 531 patients receiving ART, initial combinations consist of tenofovir/emtricitabine (TDF/FTC) plus efavirenz (EFV) in 48.2% and TDF/FTC plus lopinavir/ritonavir (LPV/r) in 37.5% and other combinations in 14.3% of the patients. Pre-treatment HIV-RNA was over 100.000 copies/mL in 52.3% of patients. At Weeks 24 and 48, HIV-RNA were&amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;lt;50 copies/mL in 63,4% of 385 patients and 82% of 311 patients reported to be still on ART and had a viral load measurement, respectively. Median pretreatment CD4 count was lower for TDF/FTC+LPV/r recipients than TDF/FTC+EFV recipients (250 vs 316) (p&amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;lt;0.05). The median increase from baseline CD4 cell count was 230 in TDF/FTC+LPV/r group, 193 in TDF/FTC+EFV group and 216 among all treated patients. Of 531 patients receiving ART, 11 had died and 19 were lost to follow-up. Despite 52.4% of recently diagnosed patients were late presenters; a high rate of virologic suppression was achieved in HIV-TR Cohort. A national HIV testing strategy targeting subpopulations with higher risk is urgently needed.

Research paper thumbnail of In vitro Activities of Various Antimicrobials against <i>Brucella melitensis</i> Strains in the Aegean Region in Turkey

Medical Principles and Practice, 2005

To study in vitro activities of three quinolones (ciprofloxacin, levofloxacin, moxifloxacin), fou... more To study in vitro activities of three quinolones (ciprofloxacin, levofloxacin, moxifloxacin), four macrolides (erythromycin, dirithromycin, azithromycin, clarithromycin) and doxycycline against 44 clinical isolates of Brucella melitensis. Forty-four B. melitensis strains were isolated from blood cultures of adult patients with acute brucellosis who were hospitalized in the clinical ward of the Department of Clinical Microbiology and Infectious Diseases. The minimum inhibitory concentrations (MICs) of the tested antimicrobials were measured by the agar dilution method. MIC90 and MIC50 values were defined as the lowest concentration of the antibiotic at which 90 and 50% of the isolates were inhibited, respectively. Doxycycline (MIC50: 0.25 microg/ml, MIC90: 0.50 microg/ml) had the lowest MIC in vitro against the B. melitensis strains. Among the quinolones, ciprofloxacin and levofloxacin had similar activities (MIC50: 0.5 microg/ml, MIC90: 2 microg/ml), whereas MIC of moxifloxacin (MIC50: 1 microg/ml, MIC90: 8 microg/ml) was higher than both antibiotics in this group. Clarithromycin and azithromycin were the most active macrolides (MIC50: 8 microg/ml and MIC90: 32 microg/ml), followed by erythromycin (MIC50: 16 microg/ml, MIC90: 32 microg/ml) and dirithromycin (MIC50: 64 microg/ml and MIC90: 64 microg/ml). The results indicate that the conventional agent doxycycline is more active than quinolones and macrolides against the B. melitensis in vitro.

Research paper thumbnail of Sexual Knowledge, Attitudes, and Risk Behaviors of Students in Turkey

Journal of School Health, 2003

This survey produced baseline information about student knowledge of sexually transmitted disease... more This survey produced baseline information about student knowledge of sexually transmitted diseases (STDs), their sexual attitudes, and their behavior to help establish control and education programs. The study was conducted at Ege University, Izmir, Turkey, during the 1999-2000 A total of 2,217first-and fourth-year students determined by stratified sampling constituted the study group. All students who volunteered to participate completed a questionnaire assessing sociodemographic and knowledge factors, sexual attitudes, behavior, and history of STDs. The rate of students having had sexual experience was 36.6%. Males were more sexually active than females, Most students (71.4%) began sexual activity at ages 15-19 without any difference by gender. Males reported significantly more sexual partners than females. Similarly, the rate of male students never using condoms was significantly higher than females. Condom was the most frequent contraception method, followed by oral contraceptives and withdrawal. Mean score on the knowledge questions was 16.29 (highest score 30). The most widely known STD was H N infection and AIDS. Students' knowledge of transmission routes. signs and symptoms, and risk groups of STDs was insuffcient. Main sources of knowledge were visual and print media, and fiiends. Most students (84.7%) viewed prevention from STDs as a person's own responsibility. Young people in Turkey are sexually active and tend to engage in high-risk behavior. However, their knowledge on sexual health and sexually transmitted diseases is insufficient. Study results suggest a need for implementation of STD control programs and provision of school sexuality education for adolescents and young adults. (J Sch Health. 2003;73(7):258-263) exually transmitted diseases (STDs) rank among the ~~ ~ ~ ~~~~~ ~~~ ~

Research paper thumbnail of Efficacy of oral levofloxacin and dirithromycin alone and in combination with rifampicin in the treatment of experimental murine Brucella abortus infection

International Journal of Antimicrobial Agents, 2004

The efficacy of levofloxacin and dirithromycin, alone and in combination with rifampicin in the t... more The efficacy of levofloxacin and dirithromycin, alone and in combination with rifampicin in the treatment of experimental brucellosis was investigated. Seventy adult white male mice were infected intraperitoneally with Brucella abortus S544 standard strain. Four of the animals were sacrificed on the 21st day of inoculation for infection control. The remaining 66 mice were randomised into treatment and control groups. Following 14 days of treatment the animals were sacrificed and spleen cultures were made. The cure rates were 36.4% for levofloxacin, 27.3% for dirithromycin, 72.7% for rifampicin, 72.7% for levofloxacin + rifampicin and 81.8% for dirithromycin + rifampicin. The results of this study indicate that levofloxacin and dirithromycin are ineffective in the treatment of experimental murine brucellosis as monotherapy or in combination with rifampicin.

Research paper thumbnail of The features of infectious diseases departments and anti-infective practices in France and Turkey: a cross-sectional study

European Journal of Clinical Microbiology & Infectious Diseases, 2014

The aim of this study was to assess the infectious diseases (ID) wards of tertiary hospitals in F... more The aim of this study was to assess the infectious diseases (ID) wards of tertiary hospitals in France and Turkey for technical capacity, infection control, characteristics of patients, infections, infecting organisms, and therapeutic approaches. This cross-sectional study was carried out on a single day on one of the weekdays of June 17-21, 2013. Overall, 36 ID departments from Turkey (n=21) and France (n=15) were involved. On the study day, 273 patients were hospitalized in Turkish and 324 patients were followed in French ID departments. The numbers of patients and beds in the hospitals, and presence of an intensive care unit (ICU) room in the ID ward was not different in both France and Turkey. Bed occupancy in the ID ward, single rooms, and negative pressure rooms were significantly higher in France.

Research paper thumbnail of Transmission route and reasons for HIV testing among recently diagnosed HIV patients in HIV-TR cohort, 2011–2012

Journal of the International AIDS Society, 2014

Routes of transmission and reasons for HIV testing are important epidemiologic data to analyze th... more Routes of transmission and reasons for HIV testing are important epidemiologic data to analyze the epidemic and to tailor the response to AIDS. The aim of this study was to analyze reasons for testing and transmission ways of HIV among recently diagnosed HIV patients registered in the multicenter HIV-TR cohort in Turkey. Transmission ways and reasons for testing of all patients diagnosed in 2011 and 2012 were recorded on a web-based data collection system and were analyzed retrospectively. The study included 693 patients (561 male, 132 female) from 24 sites. Reason for HIV testing was available in 640 patients (92%). The most common reason for HIV testing was diagnostic workout for other conditions or illness followed by patient-initiated testing. The reasons for testing were listed in Table 1. The most common routes of HIV transmission were heterosexual intercourse (62.7%) and sex among men who have sex with men (MSM) (22.6%). At the time of HIV diagnosis, the mean CD4 lymphocyte cell count was 355/mm(3) (3-1433/mm(3)). Primary HIV infection was determined in 42/693 (6%) patients and 9/693 (% 1, 2) cases were considered &amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;quot;probable primary HIV infection.&amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;quot; The majority of the cases presented to a clinic for follow-up right after the diagnosis. On the other hand 32/616 (5.2%) patients delayed their presentation for more than 3 months. The longest delay was 11 months. The results of the database suggest that targeted testing is lacking in the country. The shift toward homosexual transmission during the last 2 years emphasizes the need for targeted interventions. Patients present relatively late and HIV infection could only be diagnosed when immunosuppression related findings appeared. Patient-initiated testing,an indicator of awareness, was very low suggesting a need to scale-up awareness raising interventions.