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Review - (2022) Volume 13, Issue 7

Seroprevalence versus active HCV infection in hemophilia and thalassemia patients, Shiraz, Iran

Marzieh Jamalidoust1*, Maryam Eskandari2 and Mazyar Ziyaeyan3
 
1Professor Alborzi Clinical Microbiology Research Center, Shiraz University of Medical Sciences, Namazi Hospital, Shiraz, Iran
2Professor Alborzi Clinical Microbiology Research Center, Shiraz University of Medical Sciences, Namazi Hospital, Shiraz, Iran
3Professor Alborzi Clinical Microbiology Research Center, Shiraz University of Medical Sciences, Namazi Hospital, Shiraz, Iran
 
*Correspondence: Marzieh Jamalidoust, Professor Alborzi Clinical Microbiology Research Center, Shiraz University of Medical Sciences, Namazi Hospital, Shiraz, Iran, Email:

Received: 02-Jul-2022, Manuscript No. ipacm-22-12910; Editor assigned: 04-Jul-2022, Pre QC No. ipacm-22-12910; Reviewed: 19-Jul-2022, QC No. ipacm-22-12910; Revised: 25-Jul-2022, Manuscript No. ipacm-22-12910; Published: 30-Jul-2022, DOI: 10.36648/1989- 8436X.22.13.7.195

Abstract

Hepatitis C virus (HCV) is the one of the major infections transmitted through the bloodstream. Thalassemia and hemophilia patients because of regular blood transfusions are more prone to HCV infection. This study conducts to determine the prevalence of HCV, HCV viral load, genotype pattern and risk factors in thalassemia and hemophilia patients in Iran. Among 4916 suspected HCV infection patients, referred to Prof. Alborzi Clinical Microbiology Research Center, Shiraz, Iran, from 2004 to 2019, the HCV seroprevalence rate and the HCV RNA load and genotypes was determined by the enzyme-linked immunosorbent assay and one-step Taq Man real-time PCR. Among 4916 patients were assessed for the study, 440 were with thalassemia and 162 with hemophilia. The prevalence of HCV-Ab positivity among thalassemia and hemophilia patients was 58.9% and 87%, respectively. The most prevalent genotype was Gt-1, which was detected in 56.81% of the patients whose genotypes were assessed. The HCV viral load was generally higher among HCV seropositive patients compared to HCV seronegative patients. Prevalence of hepatitis C among hemophilia and thalassemia patients was high. Since in these high-risk groups didn’t find any independent risk factor for HCV, it can be concluded that multi-transfusion is the only predictor for hepatitis C.

Keywords

Hepatitis C Virus; Thalassemia; Hemophilia; Risk factors; Blood transfusion; Real-Time PCR

Introduction

Thalassemia is rare hereditary hemoglobin disorders and it’s endemic specially in the Mediterranean Area and South-East Asia [1]. world health organization (WHO) has reported one of the highrisk area for hepatitis C virus (HCV) is South Asia with prevalence rate of 2.1% [2]. Thalassemia is a rare inherited hemoglobin disorder and is endemic primarily in the Mediterranean region and Southeast Asia [1]. In addition, the World Health Organization (WHO) has reported that South Asia is one of the high-risk areas for hepatitis C virus (HCV) with a prevalence rate of 2.1% [2].Two clinical forms of thalassemia according to severity are distinguished: thalassemia major (TM), started during the first year of life and characterized by severe anemia, requiring regular transfusion therapy for survival, thalassemia intermedia (TI), distinguished by later onset and universally milder anemia, without regular transfusion therapy for survival [3]. The most common transfusion-transmitted infectious agents are HCV and HBV [4]. But, the most common cause of post-transfusion hepatitis (PTH) and end-stage liver disease in many countries is HCV, generally. Also, the cause of the second major epidemic of viral infection after human immunodeficiency virus (HIV) is HCV infection [5]. In patients with hereditary hemolytic anemia, especially thalassemia, regular blood transfusion has improved their overall survival, but carries a risk of acquisition of bloodborne virus infections, especially viral hepatitis [6, 7]. Many patients with β-thalassemia are infected with either HCV or HBV because of blood transfusion, especially patients who were received transfusion before the 1990. In reality, serological tests were available for detect infections in blood donors after 1990 [8].

Hemophilia is the result of coagulation factor deficiency. A decisive diagnosis of hemophilia A or B is based on an established family history and presentation of bleeding event in patients that has been confirmed by laboratory tests [9]. Most of children with hemophilia were infected with HCV before the HCV screening of blood products be available [10]. In Iran after implementation of compulsory blood donors screening in 1997, the rate of infection decreased significantly [11]. Hemophilia A is a rare, X-linked bleeding disorder that its prevalence almost is 1 of every 5000 to 10000 live-born males [12]. Hemophilia B is much less common than hemophilia A, with 1 of 25000 births prevalence [13].

While, post-transfusion transmission of HCV is a major health concern in patients with thalassemia; vaccination against hepatitis B efficiently restricts the transmission of hepatitis B virus (HBV) infection. Also, in patients with thalassemia HCV infection have a potentiating effect on hepatic fibrogenesis [14]. In addition, one of the progressive disease is chronic hepatitis C that due to liver failure or hepatocellular carcinoma causes increase of mortality rates among thalassemic patients [15]. Also, HCV is the major cause of chronic liver disease in hemophilic patients [16]. WHO suggested the screening of blood and blood products should be accomplished at least for HCV, HIV, HBV, syphilis and malaria parasites [17, 18]. About 10% to 50% of patients with HCV infection shown to clear infection naturally [11, 19, 20]. Apart from viral characteristics, cellular immune responses have an important role in viral clearance and disease resolution [19]. The prevalence of HCV infection among hemophilia patients that received unsterilized blood products is very high and reaching 90% in many countries [20,21]. According to evidences the prevalence of HCV infection in hemophilic patients is high and the risk of acquisition of HCV infection among hemophilic patients is higher than other hereditary bleeding disorders. HCV seropositive in hemophilic patients is relate with longer history of transfusion [22]. The prevalence of HCV infection among Iranian hemophilic patients has reported 15.6-76.7% [23]. Among hemophilia patients co-infection with HCV and HIV-1 is common [24]. Hemophilia and thalassemia patients are at high risk of transfusion-transmissible viruses (HCV, HBV and HIV). Because of HCV infection have the higher rate in these two groups, any coinfection with other viral hepatitis, particularly A can terminate to liver failure [25].

The aim of current study was to determine the prevalence of HCV among thalassemic and hemophilic patients. Although nowadays the prevalence of HCV in thalassemic and hemophilic patients in all societies has decreased, a new study to follow up the prevalence of this virus in these patients is very important.

Methods

In this cross-sectional study conducted between 2004 to 2019, 440 thalassemia and 162 hemophilia patients referred to the PACMRC, were assessed for HCV serostatus, viral load and genotypes. At first, 5 cc of clot blood sample was obtained by venipuncture at the PACMRC. Then, the samples were centrifuged, and its sera were stored in 1.5 mL vials at -70°C until examination. In the first step, we considered the antibodies against HCV infection for all patients included in the study using the GB anti-HCV V4.0 ELISA kit (Hsinchu science Park-Taiwan). In the next step, we extracted HCV RNAs from 200 μL serum of each specimen using Invitek kit (Berlin- Germany), based on the described guidelines. In the end, the HCV viral load and genotypes among all patients assessed. We used one-step Taq-Man real-time PCR HCV quantification and genotype kits (Genome Diagnostics Pvt. Ltd., Hague, Netherland) to perform HCV quantitative tests and genotyping.

Based on manufacturer’ instructions were used a 7500 real- Time PCR system (Applied Biosystems, USA). In all of patients the serostatus of HIV, HDV and HBV was determined, too. The study was confirmed by the Ethics and Research Committee of CMRC, Shiraz University of Medical Sciences, Shiraz, Iran.

Statistical Analysis

For the statistical analysis in this study, the chi-square test was used. All calculation of the data was performed using SPSS for Windows (Version 16.0, 2007, SPSS Inc., Chicago, IL, United States).

Results

The study included of 440 with thalassemic and 162 with hemophilic, whose samples were collected from 2004 to 2019. Their mean age was 25.88 years (range 2-62 years) and 34.35 years (range 4-74), respectively (Table 1). The HDV serology test was negative in all patients. The prevalence of HCV-Ab and HCVRNA among all patients was 3865 /4916 (78.6%) and 2627/4916 (53.4%), respectively (Chart1). The results of viral serologic markers shown 186 (3.8%) and 5 (0.1%) of patients had HIV and HBV, respectively. But among thalassemia and hemophilia patients, the serology tests for HIV and HBV were negative.

Variables General Patients Thalassemia Patients Hemophilia Patients
Age Average (y) 40.34 25.88 34.35
Age range Jan-98 Feb-62 Apr-74
Sex (male/female) 3838/1077 213/227 133/28
Total 4916 440 162
Variables General Patients Thalassemia Patients Hemophilia Patients
Age Average (y) 40.34 25.88 34.35
Age range Jan-98 Feb-62 Apr-74
Sex (male/female) 3838/1078 213/228 133/29
Table 1. Demographic data of Iranian suspected HCV infection patients.

Of 440 thalassemia patients, 262 (59%) tested seropositive for HCV, of whom only 111 (25.2%) had viremia, while for hemophiliacs, 141 of 162 (87%) patients had a positive serologic test, of which only 83 (51.2%) were positive.

A number of factors, which could be associated with HCV infection, were compared between HCV-seropositive and seronegative patients with thalassemia and hemophilia using the univariate analysis. The results of these are summarized in (Tables 2 and Table 3). According to these tables, none of factors were not associated with HCV infection in thalassemic and hemophilic patients (p > 0.05). Also, some factors such as addiction, injection, tattoo, prisoner, phlebotomy and working in vet didn’t exist among thalassemia patients but other patients with these factors infected with HCV. About hemophilia patients needling, transplant cirrhosis, phlebotomy and pregnancy were factors that didn’t exist in these patients.

From 4916 suspected HCV infection patients 262 (5.32%) had undergone soft organ transplant procedures, of which 173 (66%) were liver transplant, 86 (33%) were kidney transplant, 2 (1%) were bone marrow transplant, and 1 (0.5%) was a heart transplant. Moreover, 4654 (94.7%) had not received any transplant. The HCV response to treatment rate among HCVinfected patients who had organ transplantation was lower than HCV-infected patients without transplantation (1.5 vs. 47.2%).

Finally, the HCV viral load, genotypes and the relationship between HCV antibody and viral load were determined. All the patients were referred between 1 to 9 times for HCV tests and 2627 (5343%) of them showed HCV viremia and genotyping was done in 389 (7.91%) patients.

Factors HCV positive HCV negative P value
Sex - - 0.174
128 (29.1%) 99 (22.5%) -
Female 134 (30.5%) 79 (18%) -
0 2 (0.5%) 0.163
Male 6 (1.4%) 1 (0.2%) 0.25
HIV - - -
Hemophilia - - -
Needling 1 (0.2%) 0 1
Surgery 1 (0.2%) 0 1
Transplant - - -
2 (0.5%) 0 0.517
Liver - - -
Cirrhosis 1 (0.2%) 0 1
Pregnancy 1 (0.2%) 0 1
Table 2. Comparison of factors between HCV-seropositive and HCV-seronegative Iranian thalassemia patients (N=440).
Factors HCV positive HCV negative P value
Sex - - 0.122
22 (13.7%) 6 (3.7%)
Female 119 (73.9%) 14 (8.7%)
Male - -
Dialysis 0 1 (0.6%) 0.123
Addiction 7 (4.3%) 0 0.598
Injection 4 (2.5%) 0 1
Prisoner 1 (0.6%) 0 1
Tattoo 5 (3.1%) 0 1
Vet 2 (1.6%) 1 (0.8%) 0.285
Thalassemia 6 (3.7%) 1 (0.6%) 1
Surgery 15 (9.4%) 1 (0.6%) 0.695
Tattoo 6 (3.1%) 0 0.695
Table 3. Comparison of risk factors between HCV-seropositive and HCV-seronegative Iranian hemophilic patients (N=161).

The lowest and the highest viral loads were 200 and 12,952,483,200 copy/ml, respectively among general population while it was 500 and 500,000 among these patients. The most prevalent genotype was Gt-1, which was determined in 221 (56.81%) patients, followed by Gt-3 in 161 (41.38%), Gt-2 in 3 (0.77%), Gt-4 in 2 (0.51%) and Gt-13 in 2 (0.51%) patients. Among thalassemic (59.37%) and hemophilic (69.76%) patients Gt-1 was the most prevalent genotype, followed by Gt-3 in 12 (37.5%) and 13 (30.23%) thalassemic and hemophilic patients, respectively.

In the end, the results of our study displayed viral load among HCV-seronegative patients is lower than HCV-seropositive patients.

As shown in (Figure 1), a significantly lower percentage of thalassemia patients have active HCV viremic infection compared to hemophiliacs and general HCV-infected patients.

Also, we obtain significant difference between HCV-Ab positive and HCV-RNA positive among thalassemia, hemophilia and all patients (p value <0.005).

archives-clinical-positive

Figure 1: Prevalence of HCV-Ab positive and HCV-RNA positive among thalassemia, hemophilia and all patients. In hemophilia patients the rate of HCV infection was higher than thalassemia patients. Moreover, in all patients which might have other risk factors of HCV infection, the rate of infection was lower than hemophilia patients but it was higher than thalassemia patients.

Discussion

Thalassemia is a hereditary anemia with need of lifelong blood transfusion. This causes patients with thalassemia become vulnerable to viral disease [26,27]. In the other hand, the risk of HCV transmission has not been eliminated while the currently developed prevention protocols [28,29]. So, because of most patients with HCV are asymptomatic, the periodic screening of patients is necessary. Furthermore, information about the immunological status of patients is important [30,31]. Generally, the prevalence of HCV infection in the Iranian population is low but among thalassemia patients is almost high. Therefor these patients are at high risk for developing HCV infection[32,33]. In addition, based on a recent systematic review and meta-analysis, in Iran, the most prevalent HCV genotype is Gt-1 specially subtype 1a (42%), followed by Gt-3 specially subtype 3a (35%) [34]. Worldwide, genotype 1 is the predominant genotype (49.1%), followed by genotypes 3 (17.9%), 4 (16.8%) and 2 (11%) [35]. Keshvari et el, in the previous study reported the most prevalent HCV genotypes among Iranian hemophilic patients was Gt-1a followed by Gt-3a and 1b [36]. This results were similar to Western Europe and different from Middle East region [33]. Also, among thalassemia patients positive for HCV, these genotypes are prevalent (47). Our study indicates the same results, too. One study in Shiraz conducted by Jamalidoust et al, indicated Gt-3 was the most prevalent genotype among high risk group patients such as hemodialysis [37]. So, we concluded among different high-risk groups, common genotype can be different. Significantly, the risk of post-transfusion infection has reduced; for example, in the united states it has reached 1 in 100,000 [38,39]. For identifying subjects who are at risk, advanced screening techniques were effective [40]. In Iran, we observed a decline in the prevalence of HCV in the past years [41]. Iran detected as a country with a low frequency of HCV infection, too [42]. Iran is one of the countries that use of screening techniques has been very effective in decline the transmission of various diseases through blood transfusion [43]. Prior to these developments, the prevalence of HCV (95%) and HBV (68%) infection among hemophilic patients in Poland were high [44]. Whereas in the general population the rates were significantly lower (0.6%) [44,45]. In Shiraz, Southern Iran, 15.7% of thalassemic children with a history of multiple transfusion were positive for anti-HCV (58). Other single-center-studies reported prevalence of HCV infection had wide range (16-64%) on Iranian thalassemic patients [46-47]. Alavian et al, revealed prevalence of positive anti-HCV among Iranian thalassemic patients was 24.2%. The countries with a higher prevalence of HCV infection in general population had a higher prevalence among thalassemia patients, too [48]. For example, in India the HCV prevalence was low among both of blood donors (1.78%) and thalassemia patients (25.5%). Seroprevalence rate of HCV among thalassemia patients was 39.2% in Pakistan [49]. In our study the HCV seropositive among thalassemia pateints was relatively high (58.9%). The prevalence of HCV infection in thalassemic patients in Kuwait was 33% [50]. Also, among thalassemic patients in Bahrain and Jordan the rate of HCV was 40%. Study on hemophilic patients in Tehran from 2003 to 2005 showed the prevalence of positive anti-HCV antibody was 72.3% and accented on the screening of hemophilic patients for HCV infection. HCV infection prevalence among thalassemia and hemophilia patients was high 59.5% and 87.7% in this study. Furthermore, in current study we didn’t find any independent risk factor for HCV among thalassemia and hemophilia patients. Some studies in Iran and other countries reported similar results in hemophilia patients [51]. But other study in Brazil showed some factors such as age were significantly associate to HCV infection among hemophilic patients. Previous study conducted by Ghafourian et al, showed mean age in thalassemic patients with positive HCV antibody was significantly higher than negative subjects. In our study the prevalence of HCV infection among all patients was higher than thalassemic and hemophilic patients. So, we considered data and understand some patients without thalassemia and hemophilia, were affected other risk factors such as addiction, HIV, needling and transplant. For example, 1543 (39.3%) and 1536 (39.1%) of positive HCV patients were addicted without thalassemia and hemophilia respectively. Also, 169 (4.3%) of positive patients were coinfected with HIV and didn’t have hemophilia and thalassemia. Jamalidoust et al, reported patients with HCV infection are prone for infected with HIV and other types of hepatitis. In the other hand, HCV infection is one of the common reasons for liver transplantation in endstage cirrhosis. So it’s important to considered the effect of HCV among the recipients.

Acknowledgement

The authors would like to thank the Hassan Khajehei, Ph.D., for copyediting

Conflict of Interest

The authors declare no conflict(s) of interest.

Ethical Approval statement

The project has been approved by Shiraz University of Medical Sciences

References

  1. Higgs D, Thein S, Woods WJTtsteO (2001) the molecular pathology of the thalassaemias England: Blackwell Science. Am J Hum Genet 133-91.
  2. Google Scholar , Crossref , Indexed at

  3. Saeed U, Manzoor SJGJMR (2014) Risk factors associated with transmission of hepatitis B and hepatitis C virus in Pakistan. HIV AIDS (Auckl) 14: 14-19.
  4. Google Scholar , Crossref

  5. Ahmed S, Saleem M, Modell B, Petrou MJNEjom (2002) Screening extended families for genetic hemoglobin disorders in Pakistan. N Engl J Med 347: 1162-1168.
  6. Google Scholar , Crossref , Indexed at

  7. Cappellini M, Caruso V, Cianciulli P, Filosa A, Galanello R, et al. (2005) Guidelines for beta-thalassemia intermedia. Sett-Dic 3: 37-46.
  8. Google Scholar , Crossref , Indexed at

  9. Chakrabarty P, Rudra S, Hossain MJMmjM (2014) Prevalence of HBV and HCV among the multi-transfused beta thalassemic major patients in a day care centre of blood transfusion. Department of MMCH 23: 235-241.
  10. Google Scholar , Crossref , Indexed at

  11. Sy T, Jamal MMJIjoms (2006) Epidemiology of hepatitis C virus (HCV) infection. Clin Liver Dis (Hoboken) 3: 41.
  12. Google Scholar , Crossref , Indexed at

  13. Alavian S-M, Adibi P, ZALI MR (2005) Hepatitis C virus in Iran: Epidemiology of an emerging infection.
  14. Google Scholar , Crossref , Indexed at

  15. Aach RD, Stevens CE, Hollinger FB, Mosley JW, Peterson DA, et al. (1991) Hepatitis C virus infection in post-transfusion hepatitis An analysis with first-and second-generation assays. N Engl J Med 325: 1325-1329.
  16. Google Scholar , Crossref , Indexed at

  17. Yee T, Griffioen A, Sabin C, Dusheiko G, Lee CJG, et al. (2000) the natural history of HCV in a cohort of haemophilic patients in fected between 1961 and 1985. J Thromb Haemost 47: 845-851.
  18. Google Scholar , Crossref , Indexed at

  19. Wong T, Recht MJD (2011) Current options and new developments in the treatment of haemophilia. Biologics 71: 305-320.
  20. Google Scholar , Crossref , Indexed at

  21. Roberts HR KN, Escobar MA (2010) Hemophilia A and haemophilia B. In: Kaushansky K, Lichtman M, Beutler E, et al, eds. Williams Hematology 2009-2030.
  22. Google Scholar , Crossref

  23. Ardalan FA, Osquei MR, Toosi MN, Irvanloo GJBg (2004) Synergic effect of chronic hepatitis C infection and beta thalassemia major with marked hepatic iron overload on liver fibrosis: a retrospective cross-sectional study. BMC Gastroenterol 4: 1-4.
  24. Google Scholar , Crossref , Indexed at

  25. Tong MJ, El-Farra NS, Reikes AR, Co RLJNEJoM (1995) Clinical outcomes after transfusion-associated hepatitis C. Journal of Hepatology 332: 1463-1466.
  26. Google Scholar , Crossref , Indexed at

  27. Blanchette VS, Vorstman E, Shore A, Wang E, Petric M, et al. (1991) Hepatitis C infection in children with hemophilia A and B.
  28. Google Scholar , Crossref , Indexed at

  29. Neumann-Haefelin C, Blum HE, Chisari F, Thimme RJJoCV (2005) T cell response in hepatitis C virus infection. Emerg Microbes Infect 32: 75-85.
  30. Google Scholar , Crossref , Indexed at

  31. Gerlach JT, Diepolder HM, Zachoval R, Gruener NH, Ulsenheimer A, et al. (2003) Acute hepatitis C: high rate of both spontaneous and treatment-induced viral clearance. Gastroenterology 125: 80-88.
  32. Google Scholar , Crossref , Indexed at

  33. Fried MW, Kroner BL, Preiss LR, Wilhelmsen K, Goedert JJ, et al. (2006) Hemophilic siblings with chronic hepatitis C: Familial aggregation of spontaneous and treatment-related viral clearance. Gastroenterology 131: 757-764.
  34. Google Scholar , Crossref , Indexed at

  35. Alavian S, Ardeshir A, Hajarizadeh BJTT-G (2001) Seroprevalence of anti-HCV among Iranian hemophilia patients 4.
  36. Google Scholar , Crossref , Indexed at

  37. Alavian S, Ardeshiri A, Hajarizadeh B (2003) Prevalence of HCV, HBV and HIV infections among Hemophiliacs.
  38. Google Scholar , Crossref , Indexed at

  39. Daar ES, Donfield S, Gomperts E, Hilgartner MW, Hoots WK, et al. (2001) Relation between HIV-1 and hepatitis C viral load in patients with haemophilia. J Acquir Immune Defic Syndr 26: 466-472.
  40. Google Scholar , Crossref , Indexed at

  41. Koff RSJJocg (2001) Risks associated with hepatitis A and hepatitis B in patients with hepatitis C. J Clin Gastroenterol 33: 20-26.
  42. Google Scholar , Crossref , Indexed at

  43. Sajjad SF, Ahmad W, Hussain Jaffery S, Asif M, Alam Sejjpma, et al. (2017) Treatment of chronic hepatitis C in thalassemia major patients. Clin Liver Dis (Hoboken) 67: 926-928.
  44. Google Scholar , Crossref , Indexed at

  45. Hmaied F, Ben Mamou M, Saune‐Sandres K, Rostaing L, Slim A, et al. (2006) Hepatitis C virus infection among dialysis patients in Tunisia: incidence and molecular evidence for nosocomial transmission. J Med Virol 78: 185-191.
  46. Google Scholar , Crossref , Indexed at

  47. Izopet J, Sandres‐Sauné K, Kamar N, Salama G, Dubois M, et al. (2005) Incidence of HCV infection in French hemodialysis units: a prospective study. J Med Virol 77: 70-76.
  48. Google Scholar , Crossref , Indexed at

  49. Alghamdi AS, Sanai FM, Ismail M, Alghamdi H, Alswat K, et al. (2012) SASLT practice guidelines: Management of hepatitis C virus infection. Saudi J Gastroenterol 18: 1.
  50. Google Scholar , Crossref

  51. Yazdani MR, Kassaian N, Ataei B, Nokhodian Z, Adibi PJIjopm, et al. (2012) Hepatitis C virus infection in patients with hemophilia in Isfahan, Iran. Int J Prev Med 3: 89.
  52. Google Scholar , Indexed at

  53. Ahmed Kiani R, Anwar M, Waheed U, Asad MJ, Abbasi S, et al. (2016) Epidemiology of transfusion transmitted infection among patients with β-thalassaemia major in Pakistan. J Blood Transfus 2016.
  54. Google Scholar , Crossref , Indexed at

  55. Williams T, Wonke B, Donohue SJIp (1992) A study of hepatitis B and C prevalence and liver function in multiply transfused thalassemic and their parents. Indian Pediatr 29: 1119-24.
  56. Google Scholar , Indexed at

  57. Al Kubaisy W, Al Naib K, Habib MJE-EMHJ (2006) Seroprevalence of hepatitis C virus specific antibodies among Iraqi children with thalassaemia. East Mediterr Health J 12: 204-210
  58. Google Scholar , Indexed at

  59. Cario H, Stahnke K, Sander S, Kohne EJAoh (2000) Epidemiological situation and treatment of patients with thalassemia major in Germany: results of the German multicenter β-thalassemia study. Ann Hematol 79: 7-12.
  60. Google Scholar , Crossref , Indexed at

  61. De Montalembert M, Costagliola D, LEFRBRE J, Cornu G, Lombardo T, et al. (1992) Prevalence of markers for human immunodeficiency virus types 1 and 2, human T‐lymphotropic virus type I, cytomegalovirus, and hepatitis B and C virus in multiply transfused thalassemia patients. The French Study Group On Thalassaemia 32: 509-512.
  62. Google Scholar , Crossref , Indexed at

  63. El-Faramawy AAM, El-Rashidy OF, Tawfik PH, Hussein GHJHM (2012) transfusion transmitted hepatitis: Where do we stand now? A one center study in upper Egypt. Hepat Mon 12: 286.
  64. Google Scholar , Crossref , Indexed at

  65. Lee WS, Teh CM, Chan LLJJop, health c (2005) Risks of seroconversion of hepatitis B, hepatitis C and human immunodeficiency viruses in children with multitransfused thalassaemia major. J Paediatr Child Healt 41: 265-268.
  66. Google Scholar , Crossref , Indexed at

  67. Mittal K, Abrol P, Yadav JJIJRMS (2017) Prevalence of transfusion transmitted infections amongst multiple blood transfused patients of β-thalassemia major in a tertiary care hospital. Int J Immunopathol Pharmacol 5: 181-185.
  68. Google Scholar , Crossref

  69. Mollah AH, Nahar N, Siddique MA, Anwar KS, Azam MGJJoH, et al. (2003) Population Common transfusion-transmitted infectious agents among thalassaemic children in Bangladesh. J Health Popul Nutr 67-71.
  70. Google Scholar , Crossref , Indexed at

  71. Al-Naamani K, Al-Zakwani I, Al-Sinani S, Wasim F, Daar SJSQUMJ, et al. (2015) Prevalence of hepatitis C among multi-transfused thalassaemic patients in Oman: Single centre experience. Sultan Qaboos Univ Med J 15: 46.
  72. Google Scholar , Crossref , Indexed at

  73. Sadeghi F, Salehi-Vaziri M, Almasi-Hashiani A, Gholami-Fesharaki M, Pakzad R, et al. (2016) Prevalence of hepatitis C virus genotypes among patients in countries of the eastern Mediterranean regional office of WHO (EMRO): a systematic review and meta-analysis. Hepat Mon 16(4).
  74. Google Scholar , Crossref , Indexed at

  75. Petruzziello A, Marigliano S, Loquercio G, Cozzolino A, Cacciapuoti CJWjog (2016) Global epidemiology of hepatitis C virus infection: An up-date of the distribution and circulation of hepatitis C virus genotypes. World J Gastroenterol 22: 7824.
  76. Google Scholar , Crossref , Indexed at

  77. Keshvari M, Alavian S, Behnava B, Miri S, Tabatabaei S, et al. (2010) Distribution of hepatitis C virus genotypes in iranian patients with congenital bleeding disorders.
  78. Google Scholar , Crossref , Indexed at

  79. Behzadifar M, Gorji HA, Bragazzi NLJAov (2018) the prevalence of hepatitis C virus infection in thalassemia patients in Iran from 2000 to 2017: a systematic review and meta-analysis. BMC Public Health 163: 1131-1140.
  80. Google Scholar , Crossref , Indexed at

  81. Jamalidoust M, Eskandari M, Ziyaeyan MJJJOM (2021) Prevalence of Hepatitis C Infection and its Genotypes in Suspected Hemodialysis Patients, Southwest of Iran. Saudi J Kidney Dis Transpl 14(11).
  82. Google Scholar , Crossref , Indexed at

  83. Organization WH (2010) Screening donated blood for transfusion-transmissible infections: recommendations: World Health Organization.
  84. Google Scholar , Crossref

  85. Velati C, Romanò L, Fomiatti L, Baruffi L, Zanetti AR, et al. (2008) Impact of nucleic acid testing for hepatitis B virus, hepatitis C virus, and human immunodeficiency virus on the safety of blood supply in Italy: a 6‐year survey. Transfusion 48: 2205-2213.
  86. Google Scholar , Crossref , Indexed at

  87. Joshi SR, Al-Bulushi SNS, Ashraf TJAjots (2010) Development of blood transfusion service in Sultanate of Oman. Asian J Transfus Sci 4: 34.
  88. Google Scholar , Crossref , Indexed at

  89. Taherkhani R, Farshadpour, FJWjogW (2015) Epidemiology of hepatitis C virus in Iran. Sci Rep 21: 10790.
  90. Google Scholar , Crossref , Indexed at

  91. Cheraghali AMJHm (2011) Blood safety concerns in the Eastern Mediterranean region. Hepat Mon 11: 422.
  92. Google Scholar , Crossref , Indexed at

  93. Windyga J, Grabarczyk P, Stefańska E, Buczma A, Szczepanik AB, et al. (2008) Prevalence of HCV, HBV and HIV infections among severe Polish haemophiliacs. Przegl Epidemiol 62: 415-423.
  94. Google Scholar , Crossref , Indexed at

  95. Magdzik WJV (2000) Hepatitis B epidemiology in Poland, Central and Eastern Europe and the newly independent states. BMC Infect Dis 18: 13-16.
  96. Crossref , Indexed at

  97. Grabarczyk P, Kopacz A, Sulkowska E, Kubicka-Russel D, Mikulska M, et al. (2015) Blood donors screening for blood born viruses in Poland. Przegl Epidemiol 69: 473-477.
  98. Google Scholar , Indexed at

  99. Karimi M, Ghavanini AJJop, health c (2001) Seroprevalence of hepatitis B, hepatitis C and human immunodeficiency virus Antibodies among multitransfused thalassaemic children in Shiraz, Iran. J Paediatr Child Health 37: 564-566.
  100. Google Scholar , Crossref , Indexed at

  101. Mirmoumen S, Alavian S-M, Hajarizadeh B, Kafaei J, Yektaparast B, et al. (2006) Epidemiology of hepatitis B, hepatitis C, and human immunodeficiency virus infecions in patients with beta-thalassemia in Iran: a multicenter study.
  102. Google Scholar , Indexed at

Citation: Marzieh Jamalidoust, Maryam Eskandari, Mazyar Ziyaeyan, Gasterointestinal Tract Infections with Human Cytomegalovirus and Mycobacterium Tubercolusis Vol: 13 Issue: 07