Occult hepatitis C virus infection in patients with beta‐thalassemia major: Is it a neglected and unexplained phenomenon?

Abstract

Occult hepatitis C virus (HCV) infection (OCI) is described as the presence of viral genome in both hepatocytes and peripheral blood mononuclear cells (PBMCs) despite constant negative results on serum HCV RNA tests. Betathalassemia major (BTM) describes a group of inherited blood diseases. Patients with BTM require repeated blood transfusions, increasing the risk of exposure to infectious agents. We aimed to assess the prevalence of OCI in Iranian BTM patients and to identify the role of host factors in OCI positivity. A total of 181 BTM patients with HCV negative markers were selected. HCV RNA was tested in PBMCs using nested polymerase chain reaction assay. The positive samples were then genotyped via restriction fragment-length polymorphism (RFLP) and 5′-untranslated region sequencing. Six (3.3%) out of 181 BTM patients had viral HCV genomes in PBMC samples. Three (50.0%), two (33.3%), and one (16.7%) out of these six patients were infected with HCV-1b, HCV-1a, and HCV-3a, respectively. OCI positivity was significantly associated with the serum level of uric acid (P = 0.045) and ABO blood group (P = 0.032). Also, OCI patients had unfavorable IFNL3 rs12979860 TT, IFNL3 rs8099917 GG, IFNL3 rs12980275 GG, and IFNL4 ss469415590 ΔG/ΔG genotypes. In conclusion, we indicated the low frequency of OCI in BTM patients. Nevertheless, more attention is warranted considering the importance of this infection. Also, further studies are necessary to determine the actual prevalence of OCI among BTM patients in Iran.

Prevalence of occult hepatitis C virus infection in beta-thalassemia major patients in Ahvaz, Iran

“…In this way, Kahyesh-Esfandiary and co-workers and Bastani et al in another study from Iran showed there was no significant association between ALT, AST, and the presence of OCI among beta thalassemia major patients (33,27). Ayadi et al reported bet -thalassemia major patients with OCI had normal levels of ALT and AST, although one and two cases were at the upper limits of AST and ALT, respectively and triglyceride and LDL levels were higher in patients with OCI, compared with non-OCI patients (32).…”

“…HCV infection is one of the most important causes of mortality in BTM patients, as it can lead to hepatic failure in these patients (32). The present work assessed the prevalence of OCI among the Iranian subjects with beta-thalassemia major who had negative results for HCV RNA in their serum samples with or without the presence of anti-HCV Abs.…”

Occult hepatitis C virus infection in the Middle East and Eastern Mediterranean countries: A systematic review and meta-analysis

“…Likewise, our review indicated a high frequency of OCI among patients with LDs, including individuals with unexplained elevated liver enzymes and cryptogenic hepatitis as well as those with a history of exposure to HCV in the past (12.04%, 95%CI: 5.87%-23.10%); the highest rate was observed in patients with cryptogenic LDs (20.81%; 95%CI: 6.87%-48.35%). High rates of OCI among LD patients have been reported from countries with both low and high HCV endemicity in the community[ 21 , 22 , 41 , 48 ]. Consistently, our analysis revealed that the rate of OCI among LD patients in Egypt (16.08%; 95%CI: 5.81%-37.35%) did not significantly ( P = 0.178) differ from Iranian patients (11.46%; 95%CI: 3.64%-30.73%).…”

Prevalence of Occult Hepatitis C Virus Infection in Beta-Thalassemia Major Patients in Ahvaz, Iran

“…study from Iran showed there was no significant association between ALT, AST, and the presence of OCI among beta thalassemia major patients (33,27). Ayadi et al reported bet -thalassemia major patients with OCI had normal levels of ALT and AST, although one and two cases were at the upper limits of AST and ALT, respectively and triglyceride and LDL levels were higher in patients with OCI, compared with non-OCI patients (32).…”

“…1000 bootstrap replicates measured the tree's precision. In black circles the isolations obtained in this study are shown (•).In the black square, the reference sequence is shown.DiscussionHCV infection is one of the most important causes of mortality in BTM patients, as it can lead to hepatic failure in these patients(32). The present work assessed the prevalence of OCI among the Iranian subjects with beta-thalassemia major who had negative results for HCV RNA in their serum samples with or without the presence of anti-HCV Abs.…”