Abstract
The high rate of hepatitis C virus (HCV) infection among transfusion related risk groups such as patients with inherited bleeding disorders highlighting the investigation on prevalent subtypes and their epidemic history among this group. In this study, 166 new HCV NS5B sequences isolated from patients with inherited bleeding disorders together with 29 sequences related to hemophiliacs obtained from a previous study on diversity of HCV in Iran were analyzed. The most prevalent subtype was 1a (65%), followed by 3a (18.7%),1b (14.5%),4(1.2%) and 2k (0.6%). Subtypes 1a and 3a showed exponential expansion during the 20th century. Whereas expansion of 3a started around 20 years earlier than 1a among the study patients, the epidemic growth of 1a revealed a delay of about 10 years compared with that found for this subtype in developed countries. Our results supported the view that the spread of 3a reached the plateau 10 years prior to the screening of blood donors for HCV. Rather, 1a reached the plateau when screening program was implemented. The differences observed in the epidemic behavior of HCV-1a and 3a may be associated with different transmission routes of two subtypes. Indeed, expansion of 1a was more commonly linked to blood transfusion, while 3a was more strongly associated to drug use and specially IDU after 1960. Our findings also showed HCV transmission through blood products has effectively been controlled from late 1990s. In conclusion, the implementation of strategies such as standard surveillance programs and subsiding antiviral treatments seems to be essential to both prevent new HCV infections and to decline the current and future HCV disease among Iranian patients with inherited bleeding disorders.
Highlights
The history of blood transfusion in Iran dates back to the 1940s
Our findings showed hepatitis C virus (HCV) transmission through blood products has effectively been controlled from late 1990s
The present study aims to both determine the HCV genotype distribution among Iranian patients with inherited bleeding disorders based on sequencing of NS5B region followed by phylogenetic analysis and to conduct a molecular study on these NS5B sequence data
Summary
The history of blood transfusion in Iran dates back to the 1940s. In 1961, this Society started providing locally single blood donor products. The Iranian Blood Transfusion Organization (IBTO) was formally established in 1974, through which all blood transfusion activities were centralized including donor recruitment, production of blood components, and delivery of blood and blood products[3]. Blood units in Iran were screened for common infectious agents, HCV screening started from 1996. Over the period of 1970 to 1986, the majority of patients with hemophilia were treated with locally provided fresh frozen plasma and cryoprecipitate. A small proportion of these patients were sometimes receiving untreated factor concentrates. Non-virally inactivated factor concentrates were only produced between 1994 and 1997 in Iran[4]
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