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Year : 2014 | Volume : 2 | Issue : 2 | Page : 92 - 93  


Short Communications
Seroprevalence Of Isolated HBV, HBV And HCV Co - infection At MRIMS, Hyderabad.

Assistant Professor, Department of Microbiology, Malla Reddy Institute of Medical Sciences, Hyderabad.

 

Summary:

Vital Hepatitis due to Hepatitis B Virus (HBV) and Hepatitis C virus (HCV) are important causes of cirrhosis and HCC which results in increased morbidity and mortality. In this retrospective study, total 3071 patients were enrolled, out of which 2198 & 873 patients were asked for detection HBsAg alone and anti HCV Ab Plus HBs Ag respectively. Out of total 3071 patients, 43 patients (1.43%) showed HBsAg positively, whereas none of the patients (0%) showed dual infection with HCV.

Keywords: Hepatitis, HBsAg, Anti-HCV antibodies, co-infection.

Corresponding Author: Dr. Grishma Kulkarni, G-5, A Block, PBR Estates, Padma Colony, Nallakunta, Hyderabad. Email: drgrishmak@gmail.com

Introduction:

            Vital Hepatitis causes acute infection and chronic sequel and is recognized as an important health problem globally. [1 & 2] Various studies have shown that Hepatitis B Virus (HBV) and Hepatitis C virus (HCV) are endemic in India and have etiological role in acute hepatitis, 50 – 70% of which lead to chronic liver disease. [1, 3 & 4] As these two hepatotrophic viruses share common modes of transmission, co-infection with these two viruses is not uncommon especially, in the areas with high prevalence of HBV and among people at high risk for parental infection. [5] Treatment of viral hepatitis due to HBV & HCV infection represents a challenge. In view of this, the present study was designed to determine the prevalence of infection of HBV and HCV in the patients attending Malla Reddy Hospital.

 

Methods:

This retrospective study was carried out from 05-08-2013 to 31-12-2013 on total blood samples of 3071 at Malla Reddy Hospital, Hyderabad.

The blood samples in plain vacutainers were received at microbiology lab. Out of total samples, 2198 and 873 samples were asked for detection of hepatitis B surface antigen (HBsAg) alone and HBsAg plus anti-HCV antibodies respectively. Serum was immediately separated from blood and was subjected to respective rapid tests such as HBsAg and anti-HCV antibodies immediately. For HBV, Hepacard (Diagnostic enterprises, H.P. India) one step Ag capture assay (Immuno-Chromatography) and for HCV (Diagnostic enterprises) – third generation dot immune assay were done as per manufacturer’s instructions. The results were noted down.

 

Results:

Out of 3071 samples, 43 samples (1.4%) were positive for HBsAg. Out of this, 17 were males (39.5%) and 26 were females (60.5%) as shown in table 1.

 

 

 

Table 1: Gender distribution of HBs Ag positivity.

Total No. of HBs Ag+

Female

Male

43 (1.4%)

26 (60.5%)

17 (39.5)

 

Among positive samples, 10 samples from pregnant women were positive for HBsAg. Females (30.23%) and males (13.95%) from age group 21-30 years shared higher percentage of HBsAg positivity as shown in table 2.

Table 2: Age-wise distribution of HBs Ag

Age Group

Male

Female

 

No.

%

No.

%

10 – 20

1

2.3

5

11.62

21 – 30

6

13.95

13

30.23

31 – 40

4

9.3

12

4.6

41 – 50

3

6.9

3

6.9

51 – 60

2

4.6

3

6.9

61 – 70

1

2.5

-

-

 

None of the sample was reactive for anti HCV antibodies.

 

Discussion:

HBV and HCV are a major public health problem throughout the world. Detection of these infection markers is a major challenge for laboratories. Conventional enzyme linked immune sorbent assay (ELISA) is regarded the mostly used sensitive screening technique but because of involvement of costly instruments, time taking procedure and requirement of skilled personnel for interpretation, rapid test are gaining more importance and demands comparison. [6]

In our study, the percentage of HBsAg as sole indicator of sero – prevalence of HBV was 1.4%. Out of it, the female group showed higher percentage (60.5%) of HBsAg positivity than male group (39.53%). Maximum number of positive cases belonged to age group 21 – 30 years. Similar results are reported by other study. [1]        

In our study, rapid test (Hepacard) result revealed positive sero prevalence of HBV as 1.4%. This figure might reflect the correct percentage of prevalence of HBV or it could be the underestimated score because as per another study 40.8% of people had occult hepatitis B which was detectable by DNA PCR only. [5] In other comparative study, 5.7% of subjects were positive (HBV) by immune-chromatography whereas 10.8% of individuals were positive by ELISA. [7] As per Mumbai based study, the sensitivity and specificity of rapid test was 43.3% & 56.6% respectively. [8] Besides this it also showed positive predictive value (PPV) as 100% and negative predictive value (NPV) 63.8%. An India based promising study showed 100% sensitivity, specificity, PPV and NPV of ELISA from different companies. [6]

None of the sample was positive for anti HCV antibody by rapid test in our study. In similar study, none of the sample was positive by immune-chromatography while 0.6% of subjects were positive with ELISA. [7] As per Mumbai based study, rapid test results showed 0% sensitivity and 100% specificity along with 100% PPV and NPV. [8] One India based rapid test study showed a little promising result of sensitivity 95.5% but failed to detect (resistant) low positive sera. [6]

In our study, dual infection was not seen even in a single case. It could be true negative case or it could be possibly because of use of low sensitive rapid test or presence of occult infection. But almost similar results are reported in non dialysis group in which infection was observed only in one patient (0.09%). [9] Other study displayed co-infection with same-agents in only 6% of patient whereas 22 patients in the similar study were labeled a cryptogenic where authors were not able to detect markers by ELISA alone which might have been identified by polymerase chain reaction (PCR). [10]
A northern India based study shared higher percentage of dual infection (79.41%).

Conclusion:

Though rapid tests, for HBV, HCV give the results immediately, ELISA is still a good screening test for detection of the infection markers. Kits able to capture Igm and IgG needed to be developed to reduce false negative results of recent infections.

Rapid test supplemented with ELISA, PCR may be able to detect infection in low positive sera and occult infection and thus would help to report the exact sero-prevalence in the population under study.

 

References:

  1. Devi KS, Singh NB, Mara J, Singh TB, Singh YM. Sero prevalence of Hepatitis B virus and Hepatitis C virus among Hepatic disorders and injecting drug users in Manipur – A preliminary report. Indian J Med Microbiol. 2004 Apr-Jun;22(2):136-7.
  2. Preston H, Wright TL. Interferon therapy for Hepatitis C. 1996 Oct 12;348(9033):973-4.
  3. Dharmadhikari CA, Kulkarni RD, Kulkarni VA, Udgaonkar US, Pawar SG. Incidence of Hepatitis-B surface Antigen in liver disease and voluntary blood donors. J Indian Med Assoc. 1990 Mar;88(3):73-5.
  4. Abraham P, John TJ. Hepatitis C: A review with particular reference to the Indian scenario. Indian J Med Microbiol. 1995;13(1):5-14.
  5. Liu Z, Hou J. Hepatitis B virus (HBV) and Hepatitis C virus (HCV) dual infection. Int J Med Sci. 2006;3(2):57-62.
  6. Maity S, Nandi S, Biswas S, Sadhukhan SK, Saha MK. Performance and diagnostic infections of commercially available enzyme linked immunosorbent assay and rapid kits for detection of HIV, HBV and HCV in India. Virol J. 2012 Nov 26;9:290.
  7. Adeyemi AA, Omolade OA, Raheem–Ademore RR. Immuno-chromatographic testing method for HBV, HCV in blood donors. J antivir antiretrovir 2013;S3-005.
  8. Torane VP, Shastri JS. Comparison of ELISA and rapid screening tests for the diagnosis of HIV, Hepatitis B and Hepatitis C among healthy blood donors in a tertiary Care Hospitals in Mumbai. Indian J Med Microbiol. 2008 Jul-Sep;26(3):284-5.
  9. Reddy GA, Dakshinamurthy KV, Neelaprasad P, Gangadhar T, Lakshmi V. Prevalence of HBV and HCV dual infection in patients on haemodialysis. Indian J Med Microbiol. 2005 Jan;23(1):41-3.
  10. Singh V, Katyal R, Kochhar RK, Bhasin DK, Aggarwal RP. Study of hepatitis B and C viral markers in patients of chronic liver diseases Indian J Med Microbiol. 2004 Oct-Dec;22(4):269-70.
  11. Chakravarthi A, Varma V. Prevalence of hepatitis C and B viral markers in patients with chronic liver disease: A study from northern India. Indian J Med Microbiol. 2005 Oct;23(4):273-4.
  12. Kaur H, Dhanao J, Oberoi A. Evalution of rapid kits for detection of HIV, HBsAg and HCV infections. Indian J Med Sci. 2000 Oct;54(10):432-4.

Source of Support: Nil.

Conflict of Interest: None.

 

 

Cite this article as: Kulkarni G. Seroprevalence Of Isolated HBV, HBV And HCV Co - infection At MRIMS, Hyderabad. MRIMS J Health Sciences 2014;2(2):92-93.

 

 

 

 

 

 

 

 





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