|Year : 2015 | Volume
| Issue : 2 | Page : 70-73
Prevalence of human immunodeficiency virus and hepatitis B among multi-transfused thalassemia children
Jagdish Prasad Goyal, Palak T Hapani, Harsha Gagiya
Department of Pediatrics, KT Children Hospital and PDU Government Medical College, Rajkot, Gujarat, India
|Date of Web Publication||7-Jul-2015|
Jagdish Prasad Goyal
Department of Pediatrics, All India Institute of Medical Sciences, Rishikesh, Uttarakhand
Source of Support: None, Conflict of Interest: None
Background: Thalassemia is an inherited disorder of the blood. It is best treated with regular blood transfusion and chelation in developing countries which carries the risk of acquisition of blood-borne viral infection. Though hepatitis B infection can be effectively prevented by vaccine, yet no such vaccine is available for human immunodeficiency virus (HIV). The only strategy to prevent HIV infection is effective screening of blood products. There is a lack of sufficient reported data on transfusion transmitted infections in β-thalassemia major from India. Moreover, data on risk factors associated with HIV transmission in thalassemia children are scanty. Subjects and Methods: This retrospective study was conducted at pediatric thalassemia ward of KT Children Hospital, Rajkot. Case records of patients were retrieved from July 2011 to August 2012. Information regarding age, sex, the number of transfusions, place of transfusion, immunization against hepatitis B, the status of HIV, and hepatitis B surface antigen (HBsAg) were recorded in standard performa. HIV and HBsAg were tested by using patient sera with enzyme-linked immunosorbent assay. Results: Study subject consisted of 237 children. There were 160 males and 77 females. Of 237 children 8 (3.37%) children were found to be HIV positive and 3 (1.26%) children found to be HBsAg positive. Univariate analysis showed that incomplete immunization for hepatitis B was significantly associated with increased risk of HIV (P = 0.00). Conclusion: The prevalence of HIV and hepatitis B is significant in our study. Routine hepatitis B immunization and HIV screening by more stringent method are required.
Keywords: Hepatitis B virus, human immunodeficiency virus, risk factors, thalassemia
|How to cite this article:|
Goyal JP, Hapani PT, Gagiya H. Prevalence of human immunodeficiency virus and hepatitis B among multi-transfused thalassemia children. J Appl Hematol 2015;6:70-3
|How to cite this URL:|
Goyal JP, Hapani PT, Gagiya H. Prevalence of human immunodeficiency virus and hepatitis B among multi-transfused thalassemia children. J Appl Hematol [serial online] 2015 [cited 2018 May 23];6:70-3. Available from: http://www.jahjournal.org/text.asp?2015/6/2/70/160204
| Introduction|| |
Thalassemia is an inherited disorder of the blood. It is best treated with regular blood transfusion and chelation in developing countries which carries the risk of acquisition of blood-borne viral infection. Though hepatitis B virus (HBV) infection can be effectively prevented by vaccine, yet no such vaccine is available for human immunodeficiency virus (HIV). The only strategy to prevent HIV infection is effective screening of blood products. ,, There is lack of sufficient reported data on transfusion transmitted infections (TTI) in β-thalassemia major from India. We analyzed the prevalence of HIV and HBV and also the risk factors for HIV among multi-transfused thalassemia children.
| Subjects and methods|| |
This retrospective observational study was conducted at the Department of Pediatrics, KT Children Hospital and PDU Medical College, Rajkot from July 2011 to August 2012. Multiple blood transfusion dependent patients of beta thalassemia coming to the thalassemia ward were included in the study. They were receiving regular transfusion in order to maintain the hemoglobin level above 9.5 g%. Information regarding age, sex, the number of transfusions, place of transfusion, immunization against hepatitis B, the status of HIV, and hepatitis B surface antigen (HBsAg) were recorded in standard proforma. Patients were receiving transfusions from the Government blood bank, which was hospital based and also from private blood banks. These blood banks were accredited by the State Blood Transfusion Council. Donors were screened by using standard donor screening questionnaire after taking written consent, and they could withdraw or recall their consent. Serological screening had been done for malaria, syphilis, HIV, hepatitis B virus (HBV), and hepatitis C virus infection by enzyme-linked immunosorbent assay (ELISA). Information regarding serostatus of HIV and HBV infection was obtained from their case records. In the thalassemia ward, all patients were regularly tested for HIV and HBV infection every 3 months. Tests for HIV and HBV were done by ELISA. HIV status was detected by microwell ELISA test for detection of antibodies to HIV-1 and HIV-2 in human serum/plasma (COMBAIDS-RS Advantage-ST test kit, which is dot immunoassay indented for the qualitative detection of immunoglobulin M/immunoglobulin G). HBV status is detected by Qualisa or HEPALISA (micro well enzyme immunoassay, ELISA for the detection of HBsAg in human serum or plasma). The blood sample used in the study was obtained just before packed red blood cells transfusion. All information and test results were kept confidential. Permission from Ethical Committee for this study was obtained.
Known cases of β-thalassemia major who had been transfused more than 20 units of blood.
Patients who were having incomplete records, positive for HBV and HIV before starting transfusion.
Data were recorded on a predesigned proforma and entered in Excel spreadsheet. All the entries were double checked for any possible keyboard error. The proportion was estimated as a percentage and 95% confidence interval. Association of each of the categorical variable with HIV (outcome variables) was assessed with Chi-square test or Fischer's exact test, and the strength of their association was computed by unadjusted odds ratio (95% confidence interval). Variables are showing statistically significant association with the outcome variables (P < 0.05) were considered as potential risk factors of HIV infection. All statistical analysis were performed by the social package for statistical science (SPSS) version 16.0. Chicago, SPSS Inc. A P < 0.05 was considered as statistically significant.
| Results|| |
Study subjects consisted of 237 children. There were 160 males and 77 females. The mean age of patients was 11.2 ± 5.6 years. All the patients were seronegative at baseline except one patient who was seropositive for HIV which was excluded from the study. Of 237 children 8 (3.37%) children were found to be HIV positive, and 3 (1.26%) children found to be HBsAg positive [Table 1]. Univariate analysis showed that incomplete immunization for hepatitis B was significantly associated with increased risk of HIV (P = 0.00) while age, gender, number of transfusion, and HBV sero-positivity was not found to be significantly associated with HIV (P > 0.05) [Table 2]. The multivariate analysis was not done as only one factor was found to be significant in univariate analysis.
|Table 2: Comparison of factors between HIV positive and negative patients|
Click here to view
| Discussion|| |
We present the prevalence of HBV and HIV among multi-transfused β-thalassemia major patients from a tertiary care hospital of Western India.
The prevalence of HIV and HBV in India is respectively, about 0.91% and 4%, respectively, in the community while the prevalence of HIV and HBV in blood donor population is 0.6% and 1.4%, respectively. ,, The proportion of voluntary and replacement donors were around 65% and 35%, respectively, in our population. In India, seroprevalence of HBsAg among pregnant women varies between 0.9 and 11.2% while HIV prevalence varies from 0.56% to 0.77%. ,,,,
Prevalence of HBV was 1.26% in multi-transfused β-thalassemia major patients in our study. The reported prevalence of HBV was 2-5.7% in recent studies from India. , Our study reported lower prevalence of HBV, which might be due to the free availability of hepatitis B vaccine and better understanding of parents about HBV vaccination.
Prevalence of HIV was 3.37% in multi-transfused β-thalassemia major patients in our study. Almost similar prevalence was reported by other authors from India , while reported prevalence is less in study from Italy and Turkey, , which might be due to use of strict criteria for donor selection and use of more sophisticated techniques like polymerase chain reaction (PCR) for HIV detection.
In our study, we did not find age, gender, number of transfusion, and HBV sero-positivity as risk factors for HIV, though the increase number of transfusion is found to be a risk factor for HIV in various studies. , However, it was not found to be a risk factor in our studies, which may be due to small sample size and different screening methods in our study.
In the present study, incomplete immunization for age was found to be a risk factor for HIV. The higher prevalence of HIV among patient incomplete immunization against HBV revealed the fact that a patient who vaccinated was more literate and adhere to the standard blood bank for blood transfusion.
There were some limitations of our study. It was retrospective and single centre study. Moreover, causal relationship is not established for risk factors as we were not having a control group (nontransfused patients). In spite of these limitations, we are able to generate some evidence for resource poor country like ours where thalassemia is still prevalent.
| Conclusions|| |
HIV and HBV are still prevalent in multi-transfused β-thalassemia patients. Strict donor selection, education of patients about benefit of HBV vaccine and standard serological techniques for screening of blood product such as nucleic acid amplification test (NAAT) and PCR by blood bank might reduce the prevalence of TTI. At present, the majority of blood banks including ours in this country are not using NAAT due to the cost, which is 5-6 times as compared to ELISA. We think it is a nationwide issue and needs urgent attention. The government should take measures to cut down the cost of NAAT and make it mandatory for all blood banks in this country so that a patient requiring chronic transfusion will have a minimum risk of TTI.
Financial Support and Sponsorship
Conflicts of Interest
There are no conflicts of interest.
| References|| |
Vidja PJ, Vachhani JH, Sheikh SS, Santwani PM. Blood transfusion transmitted infections in multiple blood transfused patients of beta thalassaemia. Indian J Hematol Blood Transfus 2011;27:65-9.
Ansari SH, Shamsi TS, Khan MT, Perveen K, Farzana T, Erum S, et al.
Seropositivity of hepatitis C, hepatitis B and HIV in chronically transfused ß-thalassaemia major patients. J Coll Physicians Surg Pak 2012;22:610-1.
Rezvan H, Abolghassemi H, Kafiabad SA. Transfusion-transmitted infections among multitransfused patients in Iran: A review. Transfus Med 2007;17:425-33.
Pahuja S, Sharma M, Baitha B, Jain M. Prevalence and trends of markers of hepatitis C virus, hepatitis B virus and human immunodeficiency virus in Delhi blood donors: A hospital based study. Jpn J Infect Dis 2007;60:389-91.
Joshi SR. Seropositivity status for HIV infection among voluntary and replacement blood donors in the city of Surat from Western India. Indian J Hematol Blood Transfus 1988;16:20-1.
Karmakar PR, Shrivastava P, Ray TG. Seroprevalence of transfusion transmissible infections among blood donors at the blood bank of a Medical College of Kolkata. Indian J Public Health 2014;58:61-4.
Tandon BN, Acharya SK, Tandon A. Epidemiology of hepatitis B virus infection in India. Gut 1996;38 Suppl 2:S56-9.
Dwivedi M, Misra SP, Misra V, Pandey A, Pant S, Singh R, et al.
Seroprevalence of hepatitis B infection during pregnancy and risk of perinatal transmission. Indian J Gastroenterol 2011;30:66-71.
Prakash C, Sharma RS, Bhatia R, Verghese T, Datta KK. Prevalence of North India of hepatitis B carrier state amongst pregnant women. Southeast Asian J Trop Med Public Health 1998;29:80-4.
Mandal S, Bhattacharya RN, Chakraborty M, Pal PP, Roy SG, Mukherjee G. Evaluation of the prevention of parent to child transmission program in a rural tertiary care hospital of west bengal, India. Indian J Community Med 2010;35:491-4.
Nagdeo N, Thombare VR. Prevention of parent-to-child transmission of HIV: An experience in rural population. Indian J Med Microbiol 2007;25:425.
Singh H, Pradhan M, Singh RL, Phadke S, Naik SR, Aggarwal R, et al.
High frequency of hepatitis B virus infection in patients with beta-thalassemia receiving multiple transfusions. Vox Sang 2003;84:292-9.
Choudhury N, Saraswat S, Naveed M. Serological monitoring of thalassaemia major patients for transfusion associated viral infections. Indian J Med Res 1998;107:263-8.
Kapoor C, Muhammad H, Muhammad I. Poly transfused thalassaemia patients; prevalence of viral markers and malaria parasite. Prof Med J 2007;14:177-81.
Daniele P, Carmen C, Paolo R, Fulvio M, Patrizia B, Claudia M, et al
. The current risk of retroviral infections transmitted by transfusion in patients who have undergone multiple transfusions. Arch Intern Med 1998;158:1566-9.
Ocak S, Kaya H, Cetin M, Gali E, Ozturk M. Seroprevalence of hepatitis B and hepatitis C in patients with thalassemia and sickle cell anemia in a long-term follow-up. Arch Med Res 2006;37:895-8.
Calderón GM, González-Velázquez F, González-Bonilla CR, Novelo-Garza B, Terrazas JJ, Martínez-Rodríguez ML, et al.
Prevalence and risk factors of hepatitis C virus, hepatitis B virus, and human immunodeficiency virus in multiply transfused recipients in Mexico. Transfusion 2009;49:2200-7.
Katabuka M, Mafuta ME, Ngoma AM, Beya PM, Yuma S, Aketi L, et al.
Prevalence and risk factors for hepatitis C virus, hepatitis B virus, and human immunodeficiency virus in transfused children in Kinshasa. Indian J Pediatr 2013;80:659-62.
[Table 1], [Table 2]
|This article has been cited by|
||Multi-institutional, retrospective review of blood transfusion practices and outcomes in a large cohort of thalassemia patients in South India
| ||Rajat Kumar Agarwal,Amit Sedai,Kumari Ankita,Lalith Parmar,Rakesh Dhanya,Sunil Dhimal,Dr Reshma Shriniwas,Dr Sumithra P,Dr Hemanth V Iyer,Ashwini Gowda,Dr Pooja Gujjal,Dr Pradeep R,Pushpa H,Dr Suman Jain,Dr Saroja Kondaveeti,Dr J. Dasaratha Ramaiah,Dr Raviteja,Dr Hariharanatha Sharma,Dr Sujata Jali,Shrikant Viragi,Dr Shreedevi Bobati,Neelavva Rayappa Tallur,Dr Stalin Ramprakash,Dr Lawrence Faulkner |
| ||Pediatric Hematology Oncology Journal. 2017; |
|[Pubmed] | [DOI]|