Seroprevalence of anti-HCV Ab associated with demography and consanguinity of Thalassemia patients in Rawalpindi/Islamabad region - A single centre study

Abstract

In Pakistan consanguineous marriages are contributing an increase of diseases of genetic disorders including thalassemia. According to an estimate, each year approximately 5000 newborns are affected due to thalassemic genetic disorder. Whereas the management of thalassemia minor is being taken care of through medication but major and intermedia is primarily based on regular blood transfusions. However, mediocre transfusion services in developing countries result in iron overload and transfusion transmitted infectious diseases primarily hepatitis B and C. The aim of study was to elucidate current status of HCV seroprevalence in betathalassemic population from Rawalpindi/Islamabad region. A total 95 subjects were observed; beta-thalassemia major (96%) and betathalassemia intermedia (4%). Among these, 47 (49%) were detected positive for antiHCV antibodies. The patient data were divided in two groups, thalassemic only (n=48) and thalassemic plus hepatitis (n=47). Both groups were then observed for ferritin levels and no clear difference of ferritin level was seen in both groups. All recruited subjects were observed for chelation therapy/medication and behavioral complications; 83 (87%) patients were on chelation therapy, whereas 38 (38%) patients were found vaccinated for hepatitis B. Overall complications (Hepatomegaly, Splenomegaly and Splenectomy) were observed in (n=61) 64% individuals.In our study 51 (54%) subjects were males and 44 (46%) females (M: F ratio= 1.2:1). Seropositivity of anti-HCV was observed to be greater in males (53%) than the females (45%). The distribution of disease status (thalassemia and hepatitis) was not significantly associated with gender and age (p>0.05). Geographically the data showed highest representation of subjects from Punjab (n=76; 80%) and Khyber Pakhtunkhwa (n=11; 11.6%), while subjects from other regions of Pakistan have insignificant representation. Among the recruited subjects, the majority belonged to ‘low socio-economic status’ (45.3%), while there were 28.4% and 26.3% individuals belonging to ‘middle’ and ‘high’ socioeconomic status, respectively. Thalassemic subjects were distributed with respect to their sporadic and familial presentations. Among the familial cases, a total of 93 subjects were found to be affected. Among the sporadic cases, the affected male to female ratio was 1.36:1, while in the familial cases there was equal number of affected males and females (2 =0.7581; df.1; NS). Parity was scored for all the recruited subjects and parity orders from first to eights were observed. Majority of the subjects belonged to second parity (n=27, 29%), followed by first and third parity (n=24, 25% and 14, 15%, respectively). In each parity order, the sib ship size was increasing with increasing parity level. In order to assess TTIs in educated blood donors, 44 subjects were recruited at Quaid-i-Azam University. All of them were screened for TTI i.e. HBV, HCV and HIV. None of them was screened positive for any of the mentioned infections. Despite the fact that in many countries standardized screening procedures for the blood related products are placed since 1990; higher prevalence rates of HCV among thalassemic patients requires greater attention in Pakistan.