ABSTRACT

CORRESPONDING AUTHOR
Dr. N. Poddar,
Department of Microbiology,
Kalinga Institute of Medical Sciences,
Odisha, India.
E-mail: drnirmalapoddar@gmail.com
Ph: 0091 9437017785

ABSTRACT: Hepatitis C virus (HCV) continues to be a major disease burden affecting about 200 million people in world. Using blood donors as a prevalence   source may underestimate the real prevalence of the virus because the donors are highly selected population.  Presently more evidences support intravenous drug use as leading risk factor for the spread of virus. OBJECTIVES: The study aims at finding out the seroprevelance of Hepatitis C virus in high risk individuals as well as healthy blood donors. SETTINGS AND DESIGN: The  study group comprise of 350 subjects which included 150 healthy  voluntary donors as control group and 200 subjects taken from  different  high  risk  population  like  intravenous drug abuser (50), patients  on long term haemodialysis (40), patients  with chronic liver disease (50), HIV positive cases (30), health care workers (30). STATISTICAL ANALYSIS USED: Percentage. RESULTS: Seropositivity for anti HCV antibody was found to be 12% (24/200) among high risk population and 0.66 % (1/150) in   healthy voluntary blood donors. Among different high risk groups, maximum prevalence rate 28% (14/50) was found in I.V drug abusers. Fifty percent (7/14) of the seropositive parenteral drug abusers were male in the age group of 21-30 years followed by 35.7% (5/14) in 31-40 years of age group. Only one female (7.14%) between 21-30 years was found to be sero-reactive for antiHCV antibody. In HIV co-infected cases 13.33 % (4/30) were seropositive for antiHCV antibody. In chronic liver disease (two hepatocellular carcinoma, one cirrhosis and one chronic hepatitis) and long standing haemodialysis, the prevalence rate   for anti HCV was found to be 8% (4/50) and 5% (2/40) respectively. None of the health workers (0/30) found to be sero-reactive for antiHCV antibody. CONCLUSIONS: HCV poses a serious worldwide health problem affecting people from all walks of life in every country. In the present study 12% and 0.66% HCV prevalence was noticed in high risk group and healthy blood donors respectively. Among high risk group maximum prevalence (58.33%) was found in IV drug abusers. Prevention should target the reduction of virus transmission by health education, risk reduction counseling and thorough HCV screening following the suggestion of CDC, Atlanta, USA.
KEY WORDS: Hepatitis C virus, Intravenous drug use, Blood transfusion, Liver disease.

INTRODUCTION: Hepatitis-C is a global disease. It has been estimated that the global prevalence of Hepatitis-C virus (HCV) infection is around  3.3% with  200 million persons chronically infected  with the  virus  and  3 to 4 million persons newly infected   added  every  year[1]   Where as  in 2011, it was found that the global prevalence  of HCV was found  to be  2.35% affecting  160 million  chronically infected individuals[2].  Hepatitis-C, in combination  with  hepatitis-B, now accounts for  75% of all cases of  liver disease around the  world.
HCV can lead to chronic liver disease causing cirrhosis, hepatocellular carcinoma and end stage  liver  disease  among 5-20% of infected persons.[2] India  is estimated  to  have  168,000-1.1 million  IDUs (intravenous drug users) with  HCV antibody prevalence ranging  from  5 to 93%; among  HIV+ IDUs it is as high as 100percent.[3,4,5,6,7,8]
India’s blood banking system has serious short comings. Professional blood donation continues to flourish despite stringent law. Improperly sterilized needles are reused for drawing blood or pushing drugs. It has been well documented that the dialysis patients have a higher rate of HCV infection. The rate of seroconversion among haemodialysis patients with no other risk factors has been reported 1.38-1.9%/year.[9, 10]
The present study aims at finding out the seroprevelance of Hepatitis-C virus in high risk individuals as well as healthy blood donors.

MATERIALS AND METHODS: A prospective case control study was carried out in the department of Microbiology, S.C.B. medical college and hospital, Cuttack in collaboration with departments like Gastroenterology, Nephrology, Drug de-addiction cum rehabilitation centre and ICTC (Integrated counseling and testing centre) for a period of 15 months from march 2005 to June 2006.
The study group comprise of 350 subjects which included 150 healthy voluntary blood donors as control groups and 200 subjects taken from different high risk population like IV drug abuser (50), patient on long term haemodialysis (40), with chronic liver disease (50), HIV positive cases (30), Health care workers exposed to HCV positive blood by accidental needle stick injuries or sharp exposure (30). The informed consent was obtained from the patients before collecting the sample.
3.5 ml of venous blood was collected from each patient using disposable needle and syringe in a sterile dry and labelled vial and was allowed to clot. The blood samples were centrifuged at 1000 rpm for 15 minutes and the separated serum was preserved at 4-8° C for one week.
                   Micro well ELISA was done by using third generation HCV microlisa (J. Mitra and Co. ltd.) for the detection of antibodies to hepatitis C viral antigens such as Core, NS3, NS4 and NS5 in human serum. All the samples and reagents were brought to room temperature (20-30° C) before use.

STATISTICAL ANALYSIS USED: Percentage

RESULTS: Out of 150 healthy voluntary blood donors screened, only 01 (0.66%) male in the age group of 31-40 was found to be positive for antiHCV antibody. (Table-1)
      Amongst 200 high risk individuals screened, 24 (12%) were found to be positive for antiHCV antibody. Amongst the positive cases  for  HCV antibody, the seropositivity in  IV  drug abusers,  patients with  chronic liver disease, HIV positive individuals and  haemodialysis cases were found to be  58.33% (14/24),16.66%(4/24),16.66% (4/24) and 8.33%(2/24) respectively. Health care personnel were negative for antiHCV antibody 0% (Table 2). Seropositivity, among IV drug users, was seen more in males in the age group of 21-30 (50%) and 31-40 years (35.7%). Only one female in the age group of 31-40 was positive for antiHCV antibody (Table 3). Co-infection of HCV with HIV was found to be 13.33%. Out of which 10% had the history of parenteral drug abuse and the rest with multiple sexual contact. (Table-4)
                      
DISCUSSION: Transfusion of blood and blood products has been a leading cause of transmission of HCV, however due to improved screening, transmission through transfusion decreased in developed countries. The incidence of  transfusion  related  hepatitis C infection  dropped from  4.9% to 1.9%  in Japan, 3.84% to 0.57% in USA.[11] However, the highest incidence (54%) of transfusion related HCV infection was found in a study of 147 Chilean patients with chronic hepatitis- C.[12] In New  Delhi and  Kolkata, in India, the prevalence  of  antiHCV antibody in   healthy blood donors was  1.85% and 2% respectively .[13],[14] In a previous study in early  2002 at cuttack, the  prevalence of  antiHCV antibody in   healthy  voluntary blood donor was  2.12%.[15] In contrary to this  result, in the present study the seroreactivity for HCV was  0.66%(1/150) only. The low  prevalence  in the present  study  may be  due to  mandatory screening for HCV infection  introduced in  late 2002.In 2010,a study at Kolkata, revealed still lower  prevalence 0.35% for  HCV antibody.[16]
             Out of the total  200 high risk group 12% (24/200) were  ELISA positive for  antiHCV Ab. Parenteral drug abusers showed a  higher infection  rate  of  58.33% (14/24) followed by patients with chronic liver disease 16.66% (4/24) and 16.66% (4/24) in  HIV co-infected  cases. Transmission of Hepatitis C virus has been strongly associated with intravenous and percutaneous drug and needle use. Reported cases of Hepatitis C from intravenous drug use are on the rise in different parts of the globe. Study at Baltimore in Maryland and Antwerp & Limburg in  Belgium reported a  prevalence of HCV in IV drug abuser is 30.3%, 71% and 46% respectively.[17],[18] A recent study in  London  England, on 428 IV drug  abusers, revealed 44%  seroreactivity  for HCV antibody  compared to 4% for HIV.[19] Seroprevelance of HCV  among IV drug abusers was an alarming 92% and 71.2% at Manipur and Mizoram of India, respectively .[20][21] In a recent study at  Chennai, HCV antibody  prevalence was 5.5% (63/1158) among  Intravenous  drug  users(10/15) [22]. The importance of intravenous drug use cannot be over- emphasized. The prevalence of HCV among people who acquired HIV through intravenous drug use reaches 90%. [23] Co-infection of the two viruses can make treatment more difficult. In our  study co-infection  of  HCV with HIV is  found to be  13.33% (4/30), out of  which 10.3% (3/40) had history of  parenteral  drug  abuse and  3.3% (1/30) with history of  multiple contact.
The  seroprevelance of hepatitis C  in chronic liver  disease in  India has ranged  from 3-31% .[24 ]The studies at  Chandigarh and Tamilnadu reported seroreactivity  for antiHCV antibody to be 48% and 5.6% respectively.[25],[26] In the present study, the seroreactivity for antiHCV antibody in  patients with chronic liver disease was found to be  8%(4/50). Equal number of males and females (two each) had antiHCV antibody. Both the females were diagnosed as hepatocellular carcinoma. A significantly high prevalence of co-infection (HCV and HBV) rate of 24.7% was also reported   from Punjab.[27]
        Patients on haemodialysis are at an increased risk for acquiring hepatitis C   infection, as a result of cross contamination from the dialysis circuits. In the 90’s at many places of the world the prevalence rate of HCV infection in dialysis patients was 10-50%.[28], [29], [30]Previously in Europe the prevalence  rate was  as high as 20-30%. By  2000, the rate  of  seroconversion among haemodialysis patients with no other risk factors has been reported  1.38-1.9% /year.[31],[32] In India  there is  much variation  in the  prevalence  rate of  HCV, in dialysis patients varying from 4.3% at Delhi to as high as 13.23% and 46% at  Hyderabad.[33],[34],[35]  Stringent blood testing and isolation of dialysis machines have  helped in  reduction of hepatitis C  transmission. In present study, 5% (2/40) patients with chronic renal failure on long term haemodialysis were found to be positive for anti HCV antibody.
        Health care workers are at a higher risk for acquiring hepatitis infection as they come in contact with potentially infected subjects. Prevalence of hepatitis C among health workers range from 0-4% in this population.[36],[37] In our study none out of 30  health workers,  found to  be  seroreactive  for  antiHCV antibody.
         Hepatitis C is an emerging infection whose long term implications will be felt in the decades to come. In the absence of vaccine, primary prevention of hepatitis C should target reduction of the transmission of the virus.
Prevention should target those at risk of acquiring virus and therefore should involve   providing education, risk reduction counseling, substance abuse treatment and HCV screening following  the   centre  of  disease control (CDC) guidelines such as  screening  drug  abusers, receiver of blood and its products(clotting factor concentrates) and organs, screening  persons with  long  term  dialysis,  children of HCV positive women, health  care workers and persons with  evidence of  chronic  liver disease. [27]

ACKNOWLEDGEMENT: I express my heartfelt thanks to Mr. Dilip Barik, for his technical support during this study. I also like to thank with deep sense of appreciation to Mr. Prasanta Kumar Pradhan for his computer assistance in preparing this manuscript.

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Table-1: Seroprevelance of antiHCV Ab in control group

Table-2: Seroprevelance of antiHCV Ab in different high risk group

Table-3: ELISA positive cases of IV drug abusers in relation to age and sex

Table-4: Coinfection of HIV and HCV