Prevalence and clinical significance of hepatitis C virus infection in Thai patients with thalassemia

Seroprevalence and geographical distribution of hepatitis C virus in Iranian patients with thalassemia: a systematic review and meta-analysis

Background

Thalassemia as a hereditary hemoglobinopathy is the most common monogenic disease worldwide. Patients with thalassemia require regular blood transfusion, which provides the risk for the transmission of hepatitis C virus (HCV) as the most common post-transfusion infection in such patients, and this rate is very diverse in different parts of the world. We aimed to determine the prevalence of HCV among patients with thalassemia in Iran.

Methods

In this study, we searched for articles on the prevalence of HCV among Iranian thalassemia patients in English and Persian databases up to 2017. Heterogeneities were assessed by using anI-square (I2) test. Prevalence and 95% confidence interval (CI) were calculated using the random effects model.

Results

In total, 37 studies with 9185 patients were included in the meta-analysis. The prevalence of HCV among Iranian thalassemia patients was 17.0% (95% CI: 14.5–19.8). The rate of prevalence among male and female subjects was 17.4% (95% CI: 13.8–21.9) and 16.8% (95% CI: 13.2–21.1), respectively.

Conclusions

We found that the prevalence of HCV among Iranian thalassemia patients declined over time and the Iranian Blood Transfusion Organization has had a reasonable performance in HCV screening.

Evaluation of hepatitis C, hepatitis B, and HIV virus Serology pandemic in thalassemia patients of Shahid Mohammadi Hospital of Bandar Abbas, Iran

Introduction

Thalassemia patients are prone to the hepatitis C, B, and HIV virus, due to their constant need to receive blood transfusions. Therefore, this research was aimed to determine the epidemic of the aforementioned diseases in thalassemia patients of Shahid Mohammadi Hospital of Bandar Abbas, Iran.

Methods

This cross-sectional study was carried out on thalassemia patients visiting the Thalassemia Hospital of Bandar Abbas from March 21, 2014, to March 22, 2015. Checklists were used to collect the data. HBS-Ag, HCV-Ab, and HIV-Ab tests have been registered for hepatitis B, hepatitis C, and HIV virus, respectively. The data were analyzed using SPSS 19 by Mann-Whitney U test, chi-square test, and independent samples t-test.

Results

Among 587 records administered into the research, 280 individuals (47.7 %) were men and (52.3 %) were female. The average age of participants was 18.01 ± 9.31 years. The youngest was 1 years old, and the oldest was 46 years old. Four patients under the study (0.7 %) were positive for HBV; 60 (10.2 %) were HCV positive. However, no one in the study was diagnosed HIV positive. In the case of spread, there was no significant difference regarding age and sex in HBV patients. However, in HCV patients, significant differences were found (p=0.044 for gender and p=0.001 for age).

Conclusion

In thalassemia, hepatitis C had the highest rate of spread. According to the screening, it was much anticipated that the trend should be falling, but the results show the contrary. Hence, it is recommended that more precise methods such as PCR be used.

Trend in Prevalence of Hepatitis C Virus Infection among β-thalassemia Major Patients: 10 Years of Experience in Iran

BACKGROUND

Hepatitis C virus (HCV) is the leading cause of transfusion transmitted infections (TTIs) among patients with β-thalassemia major. A high prevalence of HCV was reported among these patients. The aim of this study is seeking the trend of the prevalence of HCV infection among the patients with b-thalassemia major in Guilan province, Northern Iran over a 10-year period.

METHODS

A retrospective study was conducted on 1113 patients with b-thalassemia major in the Guilan province, northern Iran from 2002 to 2012, using multiple data sources. A blood sample was taken from each patient, and a questionnaire regarding demographic data and risk factors was completed for them. Enzyme-linked immunosorbent assay and recombinant immunoblot assay for HCV were performed in all cases. A stepwise forward logistic regression analysis was done.

RESULTS

The prevalence of hepatitis C infection among β-thalassemia major patients was 13.6%. The risk of hepatitis C among β-thalassemia major patients was greater before screening program for HCV (odds ratio = 9.6, 95% confidence interval: 2.3-40.5). In addition, the prevalence of anti-HCV seropositivity was decreased dramatically among patients who have received transfusions after implementation of blood donor screening for HCV. There were no positive HCV cases in the patients younger than 10 years.

CONCLUSIONS

The risk of TTIs including HCV can be reduced by implementing screening program for healthy blood.

A Pilot Study on Pain and the Upregulation of Myoglobin through Low-frequency and High-amplitude Electrical Stimulation-induced Muscle Contraction

[Purpose] It is well known that, in both in vivo and in vitro tests, muscle fatigue is produced by severe exercise, electrical stimulation, and so on. However, it is not clear whether or not low-frequency and high-amplitude modulation specifically affects serum myoglobin or urine myoglobin. The purpose of the present study was to determine the effect of low-frequency and high-amplitude modulation on serum myoglobin and urine myoglobin. [Methods] The study used whole blood samples and urine produced over 24 hours from the thirteen healthy subjects. [Results] There was a significant increase in serum myoglobin following electrical stimulation at a frequency of 10 Hz compared with the control group. Furthermore, within 24 hours, urine myoglobin also showed a significant increase for the test volunteers subjected to electrical stimulation at the 10 Hz frequency compared with the control group. However, there were no significant differences in the concentrations of hematologic results in subjects treated with electrical stimulation. [Conclusion] These results suggest that increased myoglobin related to muscle fatigue from electrical stimulation, particularly with a current of 10 Hz combined with a high-amplitude, may be partially related to increased muscle damage.

Investigation of Alteration in the Levels of Iron and Copper in Scalp Hair Samples of Patients Having Different Types of Viral Hepatitis

The aim of this study was to measure the alterations of copper and iron contents in scalp hair samples of hepatitis A-E patients of both genders, same age group, and socioeconomic status. For comparative study, the scalp hair samples of healthy individuals of the same age and socioeconomic status were collected. The concentrations of copper and iron were measured using an atomic absorption spectrophotometer, after microwave-assisted acid digestion. The validity and accuracy of methodology was checked using a certified reference material. The results of this study showed that the mean values of copper and iron were higher in scalp hair samples of hepatitis patients than those of age-matched control subjects, while the difference was significant in the cases of patients having viral hepatitis B, C, and D as compared to those who have viral hepatitis A and E (p < 0.001). It was concluded that the overload of copper and iron in the human body may cause lipid peroxidation and eventually damage the hepatic system.

Prevalence and predictors of hepatitis B virus coinfection in a United States cohort of hepatitis C virus-infected patients

There are sparse epidemiologic data on coinfection of hepatitis B (HBV) and hepatitis C (HCV) in the United States. Therefore, the aim of this study was to determine the prevalence and predictors of HBV coinfection in a large U.S. population of HCV patients. We used the National Veterans Affairs HCV Clinical Case Registry to identify patients tested for HCV during 1997-2005. Patients were categorized based on HCV exposure (any two +HCV tests or one test with a diagnostic code), HCV infection (+RNA or genotype), HBV exposure (any +HBV test, excluding +HBsAb only), and HBV infection (+HBsAg, HBV DNA, or HBeAg). The prevalence of HBV exposure among patients with HCV exposure and that of HBV infection among patients with HCV infection were determined. Multivariate logistic regression evaluated potential demographic and clinical predictors of HBV coinfection. Among 168,239 patients with HCV exposure, 58,415 patients had HBV exposure for a prevalence of 34.7% (95% confidence interval [CI] 34.5-35.0). Among 102,971 patients with HCV infection, 1,431 patients had HBV coinfection for a prevalence of 1.4% (95% CI 1.3-1.5). Independent associations with HBV coinfection compared with HCV monoinfection were age ≤ 50 years, male sex, positive HIV status, history of hemophilia, sickle cell anemia or thalassemia, history of blood transfusion, cocaine and other drug use; there was decreased risk in patients of Hispanic ethnicity.

CONCLUSION

This is the largest cohort study in the U.S. on the prevalence of HBV coinfection in HCV patients. Among veterans with HCV, exposure to HBV is common (~35%), but HBV coinfection is relatively low (1.4%). Several possible risk factors were identified.

Distribution of copper, iron, and zinc in biological samples (scalp hair, serum, blood, and urine) of Pakistani viral hepatitis (A-E) patients and controls

The aim of the present study was to compare the level of copper (Cu), iron (Fe) and zinc (Zn) in biological samples (serum, blood, urine, and scalp hair) of patients suffering from different viral hepatitis (A, B, C, D, and E; n = 521) of both gender age ranged 31-45 years. For comparative study, 255 age-matched control subjects, of both genders residing in the same city were selected as referents. The elements in the biological samples were analyzed by flame atomic absorption spectrophotometry, prior to microwave-assisted acid digestion. The validity and accuracy of the methodology was checked by using certified reference materials (CRMs) and with those values obtained by conventional wet acid digestion method on same CRMs. The results of this study showed that the mean values of Cu and Fe were higher in blood, sera, and scalp hair samples of hepatitis patients, while Zn level was found to be lower than age-matched control subjects. The urinary levels of these elements were found to be higher in the hepatitis patients than in the age-matched healthy controls (p < 0.05). These results are consistent with literature-reported data, confirming that the deficiency of zinc and hepatic iron and copper overload can directly cause lipid peroxidation and eventually hepatic damage.

Management of chronic viral hepatitis in patients with thalassemia: recommendations from an international panel

Chelation therapy with new drugs prevents cardiac damage and improves the survival of thalassemia patients. Liver diseases have emerged as a critical clinical issue. Chronic liver diseases play an important role in the prognosis of thalassemia patients because of the high frequency of viral infections and important role of the liver in regulating iron metabolism. Accurate assessment of liver iron overload is required to tailor iron chelation therapy. The diagnosis of hepatitis B virus– or hepatitis C virus–related chronic hepatitis is required to detect patients who have a high risk of developing liver complications and who may benefit by antiviral therapy. Moreover, clinical management of chronic liver disease in thalassemia patients is a team management issue requiring a multidisciplinary approach. The purposes of this paper are to summarize the knowledge on the epidemiology and the risks of transmission of viral infections, to analyze invasive and noninvasive methods for the diagnosis of chronic liver disease, to report the knowledge on clinical course of chronic viral hepatitis, and to suggest the management of antiviral therapy in thalassemia patients with chronic hepatitis B or C virus or cirrhosis.

Metabolic investigations in patients with hepatitis B and C

AIM: To investigate the similarities and dissimilarities in patients with hepatitis B and hepatitis C, clinically and metabolically.

METHODS: Fifty patients with hepatitis B virus and hepatitis C virus infection were included in this study, along with fifty healthy controls for comparison purposes. Intravenous blood (10 mL) samples from patients and healthy subjects were collected and made to clot before serum was separated and immediately levels of the enzymes, alkaline phosphatase (ALK), creatinine phosphokinase (CPK), lactate dehydrogenase (LDH), serum glutamate oxaloacetate transaminase (s-GOT) and serum glutamate pyruvate transaminase (s-GPT) were determined by a kit method. For total content of each metal the serum samples were analyzed using atomic absorption spectrophotometry. Levels of cholesterol, triglycerides, urea, creatinine and uric acid were determined using a kit method on Microlab 300.

RESULTS: Serum magnesium and copper levels remained unchanged, whereas the concentration of zinc decreased and iron increased significantly in both groups of patients. Total antioxidant activity was significantly decreased in both hepatitis B and C. Among the enzymes analyzed, ALK, s-GPT, LDH and s-GOT were all significantly increased in both patients with hepatitis B and C whereas CPK was significantly decreased in patients with hepatitis B and remained unchanged in patients with hepatitis C.

CONCLUSION: The information accumulated by this study will help provide a better understanding of involved metabolic processes in order to design appropriate therapeutic approaches for treating these patients, so they can recover and lead normal lives.

Chronic hepatitis C virus infection in children

The importance of hepatitis C viral infection in the health care of children has grown in recent decades. More is now known about the epidemiology of this infection in children and the progression of disease in the pediatric age group, and the treatment options are increasing. In this review, we update readers on the state of our understanding of hepatitis C infection in children, provide the current recommendations for monitoring and treatment, and discuss emerging therapies.

Severe infections in thalassaemic patients: prevalence and predisposing factors

The incidence of infections among patients with thalassaemia and the role of risk factors for infection are uncertain. We studied the occurrence of infections necessitating hospitalisation in 92 homozygous beta-thalassaemia patients who had been followed longitudinally for decades, and investigated the role of potential risk factors for these infections. Pneumonia accounted for 26% of the infections and fever of unknown origin for 14%. Staphylococcus aureus was the major pathogen possibly related to injections associated with intensive chelation with deferoxamine. There was a significant increase in the rate of infection over time, notably after 15 years. Splenectomy correlated with the incidence of infection (P < 0.001) without being confounded by other variables and with highest frequencies of infections present after 10 years. A direct correlation between iron overload and infection was evident only before the initiation of iron-chelating treatment (P < 0.01). Following initiation of deferoxamine, paradoxically, the infection rate increased (P = 0.046). The combination of splenectomy and deferoxamine treatment was associated with the highest adjusted infection rate. Parathyroid dysfunction and glucose-6-phosphate dehydrogenase deficiency were significantly associated with infection (P = 0.02 and P = 0.04 respectively). The infection rate in thalassaemia is affected mainly by the duration of the disease and is increased by splenectomy and, in the long term, by treatment with deferoxamine.

Seroprevalence of Hepatitis B and Hepatitis C in Patients with Thalassemia and Sickle Cell Anemia in a Long-term Follow-up

BACKGROUND

Transfusion-dependent patients are more prone to acquiring various transfusion-transmitted infections such as hepatitis B (HBV), hepatitis C (HCV) and human immunodeficiency virus (HIV). The aim of the study was to investigate the prevalence of these infections in patients with thalassemia and with sickle cell anemia (SCA) receiving multiple blood transfusions.

METHODS

The subjects of the present study were 399 multi-transfused patients with beta-thalassemia major or intermedia and SCA who have been registered at the two regional hemoglobinopathy centers in Turkey since 1996. Hepatitis B surface antigen (HBsAg), hepatitis C virus antibodies (anti-HCV) and human immunodeficiency virus antibodies (anti-HIV) tests were assayed by a second-generation enzyme-linked immunosorbent assay method.

RESULTS

Of the 399 patients, 3 were HBsAg positive (0.75%), 18 were anti-HCV positive (4.5%), and none was anti-HIV positive. All patients with HBsAg and 14 (77.7 %) patients with HCV received initial blood transfusions before second-generation tests were performed. Patients who were anti-HCV positive had a significantly higher mean number of blood transfusions and peak serum alanine transaminase level than anti-HCV-negative patients.

CONCLUSIONS

These results showed that after introduction of more sensitive screening tests and stringent donor selection procedures, incidence of HCV infection was significantly reduced, but there was still a serious risk for HCV infection, and there was a minor risk for HBV infection in patients with thalassemia and SCA.