Prevalence of Hepatitis B, Hepatitis C, Significant Liver Fibrosis and Its Predictors in Adult Thalassemia Patients who Receive Blood Transfusion

Abstract

Background: Thalassemia is a common hereditary hematologic disease requiring frequent blood transfusion that increases patient vulnerability to viral hepatitis B and C. Objective: To investigate the prevalence of hepatitis B virus (HBV) infection, hepatitis C virus (HCV) infection, and clinically significant liver fibrosis in adult thalassemia patients who have been receiving blood transfusion, and to identify factors associated with liver fibrosis. Materials and Methods: Patients with thalassemia major and thalassemia intermedia were included. HBV and HCV markers were tested, and patients who were anti-HCV-positive were tested for HCV viral load and HCV genotype. All patients underwent liver transient elastography (TE), and the result was classified as significant fibrosis (>7.1 kPa) or cirrhosis (>12.5 kPa). Results: One hundred and fifty-eight patients (36% male, mean age 38 years) were included. All patients had a history of blood transfusion with a mean life-time transfusion of packed red blood cells of 215 units. Prevalence of HBV and HCV was 1.3% and 5.6%, respectively. The mean TE was 7.9 kPa (range 2.4 to 69.1). Fifty-six patients (34%) had significant liver fibrosis, and 18 (11.4%) had cirrhosis. Factors that correlated with significant liver fibrosis were male gender (odds ratio [OR] 3.4, 95% confidence interval [CI] 1.6 to 7.3), serum ferritin >1,000 ng/mL (OR 3.4, 95% CI 1.5 to 7.6), and abnormal aspartate aminotransferase (AST) (OR 2.9, 95% CI 1.3 to 6.4). Presence of HBV or HCV was not significantly associated with significant fibrosis. Conclusion: Prevalence of HBV in thalassemia patients who receive blood transfusion was comparable to general population, but the prevalence of HCV was higher. About half of the patients had significant fibrosis. Factors associated with significant fibrosis were male gender, serum ferritin >1,000 ng/mL, and abnormal AST. Keywords: Blood transfusion, Prevalence, Hepatitis B, Hepatitis C, Liver fibrosis, Thalassemia