Incidence of Hepatitis B and C Viruses in Thalassaemia Major Patients

This cross sectional study was performed between January to September 2016, at the Pakistan Institute of Medical Sciences, Islamabad, the largest tertiary care hospital in federal capital and at the Pakistan Thalassaemia Centre, Pakistan Baitul Mal, Islamabad. The study was approved by the ethical committee of the Department of Bioinformatics and Biotechnology, International Islamic University, Islamabad, Pakistan.

Patients/guardians of the patients gave their written, informed consent to participate in the study, which was conducted in accordance with the principles of the Declaration of Helsinki. Among all patients, β-thalassaemia type major was considered as inclusion criteria, whereas patients with a-thalassemia type minor/major or patients having β-thalassemia type minor were excluded. The registered patients belong to different ethnic groups and the diversity represents the whole Pakistani population. Data was obtained from 1,440 β- thalassemia major patients aged one year or more receiving regular blood transfusions at a major transfusion center in Islamabad Pakistan.

Blood was collected from patients aseptically and serum separated Eppendorf tubes and stored at –20°C. Screening for HBV and HBV were performed through Chemiluminescence Immunoassay (CLIA) technique on Abbott ARCHITECT® i2000 system. CLIA is a method to determine the concentration of samples according to the intensity of the luminescence that the chemical reaction emits. The advantage of CLIA is significantly increased sensitivity and dynamic range, which allows detection of lower analyte concentrations and hence earlier diagnosis of disease. The detection was done by using accurate diagnostic, USA. Statistical analysis was conducted on study variables via the assistance of Statistical Package for Social Sciences (version 17.0) using 95% confidence interval.

Of the total 1,440 patients studied, 930 (64.6%) were males and 510 (35.4%) were females. The patient’s age ranged from 1 to 30 years with mean age of 7.9±4.5 year. The mean age on first transfusion was 9.56±8.0 months. The mean age at 1st transfusion was 8.5 months. Most of the patients (55%) were from age 1 to 12 years while rest of patients (45%) were of more than 12 years. Out of 1440 patients, 44 were positive for HBV, of which 25 (56.8%) were males and 19 (43.2%) were females. Among hepatitis B positive, 26 (59.09%) were of less than 12 years of age while 18 (40.91%) were more than 12 years of age. A total of 61.12% had a family history of thalassaemia. Among 1440 patients, 295 were positive for HCV (20.4%), of which 187 (63.4%) were males and 108 (36.6%) were females. Out of these HCV positive patients, 203 (68.8 %) were of less than 12 years of age while 92 (31.2%) patients were of more than 12 years of age. The results are shown in Table I.

There is a high prevalence of hepatitis B in beta thalassaemia major patients and the blood transfusion is one of major risk factors. In Pakistan, 7–9 million people are living with HBV with an approximate carrier rate of 3%–5% (Saeed et al., 2013). In the current study we have found 3.0 % of HBV in the thalassemia patients, however sero-prevalence studies have been conducted on blood transfusion populations from Peshawar, Rawalpindi, Abbottabad, Multan, Bahawalpur, Quetta, and Karachi, which depicted HBV prevalence rates of 2.51%, 1.9%, 3.3%, 1.55%, 4.93%, 2.69%, and 4.90%, respectively (Mujeeb and Mehmood, 1996; Ahmad et al., 2000, 2004; Khattak et al., 2002; Asif et al., 2004; Fayyaz et al., 2006; Jehangir et al., 2006; Khan et al., 2007).

On the other hand the prevalence of HCV is also at consistent increase. In Islamabad, the prevalence reported in recent years is 33% in selected group of population (Rafaqat et al., 2005). The prevalence of HCV in the general adult population, pediatric population, young popula­tion applying for recruitment, injecting drug users, and multi-transfused population was 4.95%, 1.72%, 3.64%, 57%, and 48.67%, respectively (Luby et al., 1997).

The current study shows 20.4 % of HCV in thalassemia patients. The other studies conducted by Jaiswal et al. (2001) reported 21.0% cases of HCV and Jamal et al. (2005) reported 22.4% cases of HCV. There are studies in contrast to our study as well. Younas et al. (2012) witnessed that 42% of their β-thalassaemia patients had HCV. Moreover, Al-Sheyyab et al. (2001) reported 40.5%, Mansour et al. (2012) and Al-Hawsawi (2000) reported 40% of HCV cases.

The donor blood screening programs need to be reconsidered and effective screening methods are required to prevent the transmission of these viral infections. The donor blood screening method policy should be implemented at national level under strict quality control. Currently in Pakistan, different blood screening methods are prevalent in different public sector hospitals. Strict controls needs to be imposed on quality parameters of detection methods. The professional blood donors are also a great risk as there is no federal policy regarding the registration of donors.

A national health campaign is also obligatory to spread awareness among mass about safe blood transfusion and threat of exposure to viral diseases.

We acknowledge Mr. Rehan Hafeez and Mr. Ikhlaq Wazir for their assistance and contribution during the study.

We declare that there is no conflict of interests regarding the publication of this article.