Sero-Occurrence of HBV/HCV Co-infection and Levels of Liver Enzymes among Patients at a Tertiary Care Hospital in Central India: a Pilot Study

Main Article Content

Prabha Desikan
Aseem Rangnekar
Zeba Khan
Nikita Panwalkar
Protiti Bose
Hanni Vasudev Gulwani
Sukhpreet Kaur

Abstract

Introduction: Hepatitis B and C viral infections share common modes of transmission and account for a large proportion of liver disease burden across the globe. Patients with Hepatitis B (HBV) and Hepatitis C virus (HCV) co-infection may have more severe liver disease and are potentially at higher risk for developing hepatocellular carcinoma. The aim of this study was to assess the sero-occurrence of HBV/HCV co-infection by examining the medical records of tertiary care hospital patients in Central India and determine the extent of liver damage based on liver function tests (LFTs).

Methods: Patients with a positive test for HBV surface antigen (HBsAg) over a period of 10 years were identified from laboratory records in a tertiary care facility in central India. Records of 51,075 consecutive non-duplicate blood samples were then screened for a positive HBV and HCV tests. LFT, liver enzymes, and bilirubin data were also extracted. Means and standard deviations were determined for continuous variables, and the difference in means was compared using a independent samples t-test. Associations between HBV/HCV co-infection status and demographic variables were calculated using Pearson’s Chi-squared test. A p-value less than 0.05 was considered statistically significant.

Results: In this study, 1674 (3.27%) screened patients were positive for HBsAg and the sero-occurrence of co-infection with HCV in HBsAg positive patients was reported in 28 individuals (1.67%). There was no significant gender difference for HBV/HCV co-infection (p>0.05). HBV/HCV co-infection was observed more frequently in the 31-60 year old age group (p=0.001). HBV/HCV co-infected patients had significantly higher levels of liver enzymes and bilirubin than those with HBsAg mono-infection (p=0.001).

Conclusion: Liver function tests are potentially important predictors for HBV/HCV coinfection. Screening for HCV co-infection in HBsAg-positive patients is recommended in India. Detection of co-infection may enable timely preventive/therapeutic interventions aimed at preventing progression to hepatocellular carcinoma.

Article Details

How to Cite
Desikan, P., Rangnekar, A., Khan, Z., Panwalkar, N., Bose, P., Gulwani, H. V., & Kaur, S. (2019). Sero-Occurrence of HBV/HCV Co-infection and Levels of Liver Enzymes among Patients at a Tertiary Care Hospital in Central India: a Pilot Study. Central Asian Journal of Global Health, 8(1). https://doi.org/10.5195/cajgh.2019.313
Section
Research
Author Biography

Nikita Panwalkar, Department of Microbiology, Bhopal Memorial Hospital and Research Centre, India

Department of Microbiology and Supervisor

References

Laraba A, Wadzali G, Sunday B, et al., Hepatitis C Virus Infection inNigeriansWith Chronic Liver Disease. Internet J Gastroenterol 2009; 9(1):1-3.

Konstantinou D, Deutsch M. The spectrum of HBV/HCV coinfection: epidemiology, clinical characteristics, viralinteractions and management. Annals of Gastroenterology: Quarterly Publication of the Hellenic Society of Gastroenterology. 2015;28(2):221-228.

Donato F, Boffetta P, Puoti M. A meta-analysis of epidemiological studies on the combined effect of hepatitis B and C virus infections in causing hepatocellular carcinoma. Int J Cancer. 1998;75:347–354.

Shi J, Zhu L, Liu S, Xie WF. A meta-analysis of case-control studies on the combined effect of hepatitis B and C virus infections in causing hepatocellular carcinoma in China. Br J Cancer. 2005;92:607–612.

Cho LY, Yang JJ, Ko KP, et al. Coinfection of hepatitis B and C viruses and risk of hepatocellular carcinoma: systematic review and meta-analysis. Int J Cancer. 2011;128:176–184.

Caccamo G, Saffioti F, Raimondo G. Hepatitis B virus and hepatitis C virus dual infection. World Journal of Gastroenterology : WJG. 2014;20(40):14559-14567.

Malhotra R, Soin D, Grover P, Galhotra S, Khutan H, Kaur N. Hepatitis B virus and hepatitis C virus co-infection in hemodialysis patients: A retrospective study from a tertiary care hospital of North India. Journal of Natural Science, Biology, and Medicine. 2016;7(1):72-74.

Desikan P, Khan Z. Prevalence of hepatitis B and hepatitis C virus co-infection in India: A systematic review and meta-analysis. Indian J Med Microbiol. 2017;35:332-9

Lahariya C, Subramanya B P, Sosler S. An assessment of hepatitis B vaccine introduction in India: Lessons for roll out and scale up of new vaccines in immunization programs. Indian J Public Health 2013;57:8-14.

Bini EJ, Perumalswami PV. Hepatitis B virus infection among American patients with chronic hepatitis C virus infection: prevalence, racial/ethnic differences, and viral interactions. Hepatology. 2010;51:759–766.

Gaeta GB, Stornaiuolo G, Precone DF, et al. Epidemiological and clinical burden of chronic hepatitis B virus/hepatitis C virus infection. A multicenter Italian study. J Hepatol. 2003;39:1036–1041.

Tripathi AK, Khanna M, Gupta N, Chandra M.Low prevalence of hepatitis B virus and hepatitis C virus co-infection in patients with human immunodeficiency virus in Northern India.JAssoc Physicians India. 2007 Jun;55:429-31.

Sagnelli E, Coppola N, Pisaturo M, Masiello A, Tonziello G, Sagnelli C, Messina V, Filippini P. HBV superinfection in HCV chronic carriers: a disease that is frequently severe but associated with the eradication of HCV. Hepatology. 2009 Apr;49(4):1090-7.

Yang S, Wang D, Zhang Y, et al. Transmission of Hepatitis B and C Virus Infection Through Body Piercing: A Systematic Review and Meta-Analysis. Martin. S, ed. Medicine. 2015;94(47):e1893.

Ringehan M, McKeating JA, Protzer U. Viral hepatitis and liver cancer. Philosophical Transactions of the Royal Society B: Biological Sciences.2017;372(1732):20160274.

Sama LF, NganouDjinou OI, Wam EC, Bamou R, Ali IM, et al. (2017) Sero-prevalence of Hepatitis B and C virus and High Risk of Hepatotoxicity amongTB/HIV Positive and HIV Negative Population in Western Cameroon. Glob J Infect Dis Clin Res 3(1): 001-008

Dean AG, Sullivan KM, Soe MM. OpenEpi: Open Source Epidemiologic Statistics for Public Health, Version. www.OpenEpi.com). Accessed on March 29, 2019

National health and nutrition examination survey (NHANES) III. https://wwwn.cdc.gov/Nchs/Nhanes/2007-2008/BIOPRO_E.htm. Accessed on March 29, 2019

Jamil M, Bhattacharya PK, Yunus M, Lyngdoh CJ, Roy A, Talukdar KK. Prevalence of Hepatitis B and Hepatitis C in haemodialysis population in atertiary care centre in north eastern India. International Journal of Biomedical and Advance Research 2016;7(6): 267-269.

Tesfa H, Biadgo B, Getachew F, Tegegne K, Yismaw G and Muluye D. Seroprevalence of hepatitis B and C virus infection among patients attending serology laboratory of Gondar University Hospital. BMC Research Notes 2013, 6:164.

Ray Saraswati L, Sarna A, Sebastian MP, et al. HIV, Hepatitis B and C among people who inject drugs: high prevalence of HIV and Hepatitis C RNA positive infections observed in Delhi, India. BMC Public Health. 2015;15:726.

Arora U and Mann A. Prevalence of Hepatitis B Virus, Hepatitis C Virus, and HIV in Patients of Chronic Liver Disease in Amritsar. JIACM 2007; 8(1): 29-3.

Chowdhury A, Santra A, Chaudhuri S, Ghosh A, Banerjee P, Mazumder DN. Prevalence of hepatitis B infection in the general population: a rural community based study. Trop Gastroenterol. 1999 Apr-Jun;20(2):75-7.

Anbazhagan GK, KS, and Thiyagarajan T Seroprevalence of HCV and its co-infection with HBV and HIV among liver disease patients of South Tamil Nadu. World J Hepatol. 2010 Jan 27; 2(1): 42–48.

Halim M.D, Offor E, Ajayi O.I (1992). Epidemiologic study of the seroprevalence of hepatitis B surface Antigen and HIV-1 in blood donors. Niger. J. Clin. Pract.: 2; 45-55.

Wondimeneh Y, Alem M, Asfaw F, Belyhun Y. HBV and HCV seroprevalence and their correlation with CD4 cells and liver enzymes among HIV positive individuals at University of Gondar Teaching Hospital, Northwest Ethiopia. Virology Journal. 2013;10:171.

KhunteP,Khare RL, Beck P, Kumar S. Prevalence of hepatitis B virus and hepatitis C virus co-infection in human immunodeficiency virus positive patients: a study from tribal area of central India. Int J Res Med Sci. 2015 Sep;3(9):2311-2315.

Ionita G, Malviya A,RajbhandaricR, William W, Schluter G,Sharmae S,Kakchapatic S. Rijalf S, Dixit S. Seroprevalence of hepatitis B virus and hepatitis C virus co-infection among people living with HIV/AIDS visiting antiretroviral therapy centres in Nepal: a first nationally representative study. International Journal of Infectious Diseases. 2017,60:64-69.

Hann H-W, Wan S, Myers RE, et al. Comprehensive Analysis of Common Serum Liver Enzymes as Prospective Predictors of Hepatocellular Carcinoma in HBV Patients. CameronDW, ed. PLoS ONE. 2012;7(10):e47687.

El-Bouzedi A. Investigation and modeling the epidemiology of hepatitis C virus in Libya, PhD Thesis. United Kingdom: University of Glamorgan, Faculty of Advanced Technology; 2012.