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

Abstract

Background: Occult hepatitis C virus infection (OCI) is defined by the presence of HCV RNA in peripheral blood mononuclear cells (PBMCs) and liver tissue cells despite the absence of HCV RNA in plasma. Currently, OCI is classified into two types: seropositive OCI (anti-HCV positive and serum HCV-RNA negative) and seronegative OCI (anti-HCV and serum HCV-RNA negative). Beta-Thalassemia is described as a blood disorder, which decreases the synthesis of hemoglobin. Repeated blood transfusion is the standard treatment for patients with betathalassemia major (BTM) that increases the risk of exposure to infectious agents. This study aimed to investigate the prevalence of OCI among BTM patients.Materials and Methods: plasma and PBMCs were collected from 90 BTM patients and screened for HCV antibody using the ELISA kit commercially as the first step. Then nested-RT PCR was performed on extractions of plasma and PBMC. Positive samples of HCV RNA from PBMCs were sequenced and aligned to construct the HCV phylogenetic tree to assess the homology of sequences compared to the reference sequences retrieved from GenBank.Results: Seventy-nine out of 90 cases (87.8%) indicated negative results for HCV Ab (seronegative), while 11 patients (12.2%) were seropositive. HCV RNA was found in PBMCs samples of four patients (66.66%) with negative HCV Ab (seronegative) and two patients (33.3%) with positive HCV Ab (seropositive). HCV RNA was not detected in plasma samples of these six patients. Overall six out of 90 patients (6.7%) had OCI. HCV genotyping revealed that all six patients infected with HCV subtype 3a. Conclusion:We indicated the high 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.

Detection of hepatitis C virus (HCV) RNA in the peripheral blood mononuclear cells of HCV-infected patients following sustained virologic response

“…They used gene sequence which is a sensitive and accurate method than transcription-mediated amplification (TMA) test to detect presence of occult HCV in plasma and PBMCs. They found that 6.7% patients had OCI [ 26 ]. Mekky et al is a multi-center study that was done in upper Egypt on 1280 genotype-4 HCV-infected patients who received SOF (400 mg) plus DCV (60 mg) once daily ± ribavirin regimen for 12 weeks and achieved SVR 12 weeks posttreatment found that HCV-RNA was detected in PBMCs of 50 (3.9%) of their patients.…”

“…Mekky et al is a multi-center study that was done in upper Egypt on 1280 genotype-4 HCV-infected patients who received SOF (400 mg) plus DCV (60 mg) once daily ± ribavirin regimen for 12 weeks and achieved SVR 12 weeks posttreatment found that HCV-RNA was detected in PBMCs of 50 (3.9%) of their patients. Detection of HCV viral load in the plasma and PBMCs was performed by standardized quantitative real-time PCR [ 26 ]. This study agreed with our study and they used the same method for detection of HCV in the serum and PBMC.…”

“…The finding of HCV RNA negative strands in the PBMCs in our OCI patients may indicate that those patients are candidates for future complications, and this finding agreed with the results of the study by Pawełczyk et al, in which it was reported that the clinical consequences of OCI may have a wide spectrum of presentations. OCI may be responsible for relapses, as it has been suggested that the clearance of identifiable HCV from the liver tissue and/or PBMCs according to highly sensitive reverse transcription and nested polymerase chain reaction assays may be a better indicator of a long-term sustained response than the absence of HCV-RNA in the serum or plasma [ 26 ]. In our opinion the problem is that the techniques of extraction of HCV-RNA from the PBMCs don’t present in all laboratories so, it will not be easily for HCV patients after treatment to be followed by these methods to detect the SVR.…”

Hepatitis C and Thalassemia: A Story with (Almost) a Happy Ending

“…Progressive implementation of nucleic acid-amplification technology (NAT) screening for HIV, HCV, and HBV has reduced the residual risk of infectious-window-period donations, such that per unit risks are <1 in 1,000,000 in the United States and other high-income countries [ 107 ]. The high level of transfusion safety in high-income countries has not been matched in most low-to-middle-income countries with challenges spanning the entire blood-safety chain from donor selection to post-transfusion surveillance [ 108 , 109 , 110 , 111 ]. In India, Biswas et al (2022) reported transfusion-transmitted infections in 25 out of 328 children with transfusion-dependent thalassemia, and hepatitis C was the most common (34.5%) with a significant negative impact on their quality of life [ 112 ].…”