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Background Patients with cancer with hepatitis B virus (HBV) or hepatitis C virus (HCV) infection are excluded from many cancer clinical trials of immune checkpoint inhibitors (ICIs). Therefore, data are limited regarding the management of HBV and HCV infections in patients with cancer treated with ICIs. To address this gap, we reviewed the literature on management of HBV and HCV infections in patients with cancer receiving ICIs. Methods We searched MEDLINE and PubMed for all original research articles, case reports, and systematic reviews published in English between Jul 2013 and Jul 2023 on patients with cancer with HBV or HCV infection receiving ICIs. Results We found 28 studies (three prospective clinical trials, seven retrospective cohort studies, nine retrospective case series, and nine case reports) that evaluated the safety of ICI therapy in patients with HBV infection and cancer. The overall rate of HBV reactivation was 1.4% (38/2799), and no HBV-related deaths were reported. The frequency of HBV reactivation in patients with chronic and past HBV infections was 2% (35/1667) and 0.3% (3/1132), respectively. The risk of HBV reactivation was significantly higher among patients with chronic HBV infection not receiving antiviral prophylaxis than among those receiving antivirals (17% vs 1%, p < 0.05). Based on high-quality evidence, for patients with chronic HBV infection, antiviral prophylaxis is recommended before ICI therapy initiation. For patients with past HBV infection, monitoring and on-demand antiviral treatment are sufficient. We found 11 studies (five clinical trials, five retrospective studies, and one prospective observational study) that evaluated the safety of ICI therapy in patients with HCV infection and cancer. The overall rate of HCV reactivation was 0.5% (2/387), and no HCV-related deaths were reported. HCV reactivation occurs primarily in patients receiving immunosuppressants for ICI-related toxic effects. ICIs are safe for HCV-infected patients with solid tumors. Conclusions Chronic HBV or HCV infection should not be considered a contraindication for ICI therapy. Specific risk assessment, monitoring, and management strategies are necessary to reduce the risk of ICI-related liver injury in patients with cancer and chronic HBV or HCV infection. [ABSTRACT FROM AUTHOR]

Objective: Early diagnosis and treatment of candidemia in intensive care units (ICUs) remain a significant challenge globally because of the lack of well-established non-culture-based diagnostic methods. This study aimed to evaluate risk factors in critically ill ICU patients, develop a unique Candida score, and create a real-time polymerase chain reaction (PCR) assay for the early diagnosis of candidemia., Materials and Methods: The study was conducted in three phases: 1) Retrospective analysis of 100 ICU patients from İstanbul University-Cerrahpaşa between January 2017 and December 2018 to identify risk factors for invasive candidiasis, 2) development of Cerrahpaşa Candida score based on these findings, and 3) prospective evaluation of 75 ICU patients, applying the newly created Cerrahpaşa Candida score and implementing a rapid PCR-based test on whole blood samples. The PCR assay was part of a development study and was not used for scoring or clinical diagnostic evaluation. Specific primer pairs and EvaGreen® dye (Biotium Inc., USA) were used to differentiate between Candida albicans and Candida parapsilosis isolates through melting curve analysis of real-time PCR amplicons. The PCR test demonstrated a detection limit of 10 CFU/mL., Results: In the retrospective analysis, key risk factors for candidemia were identified, including sepsis, intra-abdominal infections, hospitalization within the last three months, prolonged antibiotic use (>1 week), Candida colonization, percutaneous endoscopic gastrostomy, central venous catheter, and acute kidney injury ( p< 0.05). During the prospective phase, which evaluated 75 ICU patients, a Cerrahpaşa Candida score cutoff value of ≥4 points was established as significantly associated with an increased risk of candidemia ( p <0.05). The Cerrahpaşa Candida score and PCR assay, targeting the internal transcribed spacer (ITS) and D1/D2 regions, showed clinical utility for early diagnosis., Conclusion: The Cerrahpaşa Candida score and real-time PCR test developed in this study offer promising tools for guiding antifungal therapy in ICU patients, potentially reducing unnecessary antifungal use. However, improvements in PCR sensitivity are necessary. Further multicenter studies with larger patient cohorts are recommended to validate the clinical effectiveness of these diagnostic tools., Competing Interests: The authors declare no conflict of interest., (Copyright © 2024 Infectious Diseases and Clinical Microbiology.)