Hepatitis B and C among thalassemiac patients in Iran: A multicenter study

Abstract

BACKGROUND/OBJECTIVES: Regular blood transfusions for patients with thalassemia have improved their overall survival but carry a definite risk of being infected with bloodborne viruses, especially hepatitis B and C. Nowadays, this is a major health concern for these patients. We conducted this multicenter study to provide the epidemiologic data of hepatitis B and C among a large number of thalassemic patients in Iran since there is no sufficient and comprehensive data in this issue from Iran. METHODS: We enrolled 732 patients with thalassemia major or thalassemia intermediate in five provinces of Iran, including Tehran (n=410), Kerman (n=100), Ghazvin (n=95), Semnan (n=81), and Zanjan (n=46). The initial data were recorded and the sera were tested for HBs Ag, anti-HCV Ab, and anti-HIV Ab using ELISA 2nd generation and confirmed by RIBA 2nd generation. Second samples tested to measure hemoglobin and serum ferritin levels. RESULTS: The patient group consisted of 413 males and 319 females with a mean age of 17.9 ± 9.0 years. Of these, 141 patients (19.3%) were anti-HCV Ab positive, 11 patients (1.5%) were HBsAg positive, and there was no anti-HIV positive case. Univariate analysis showed that thalassemia major (p=0.01), older age (p=0.001), longer transfusion duration (0.000), HBsAg seropositivity (p=0.01), and higher serum ferritin level (p=0.002) were significantly associated with higher HCV prevalence. Furthermore, HCV prevalence rate has significantly dropped after applying anti-HCV Ab screening in blood donors (22.8% versus 2.6%, p=0.000). Using multivariate analysis, thalassemia major (p=0.002), age (p=0.000), serum ferritin level (p=0.003), as well as consuming unscreened blood (p=0.005) showed up as the factors independently associated with HCV infection. CONCLUSION: HCV infection prevalence rate is much higher among thalassemics compared to HBV and HIV in Iran. Screening of blood donors seems to be able to decrease prevalence and incidence rate of HCV infection effectively.