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Proceeding S.Z.P.G.M.I. vol: 19(1): pp. 33-36, 2005. Frequency of Hepatitis B, C and Human Immunodeficiency Virus in Blood Donors at Shaikh Zayed Hospital, Lahore Ghazanfar Ali Sirhindi, Anwaar A. Khan, Saadia Shahzad Alam, Muhammad Akram Ghori, Riaz-urRehman, Niaz Ahmed Soomro, Zubair Ahn1ed, Maj. (R) Muhammad Shahid Naeem, Waqar H. Shah, Akbar Hussain. Razzaq Ahmed Chohan Department ofPathology and Department of Urzstroenterology & Hepatology, Shaikh Zayed Hospital.Lahore SUMMARY Objectives: To find o ut the frequency of hepatitis B, C and human immunodefic iency vi rus (HIV) in blood donors at Shaikh Zayed Hospital, Lahore. Design: This is a non-interventional study. Study Period: Period of this study is from 1-1-2005 to 30-6-2005. Setting: Study was conducted at the Blood Bank of Shaikh Zayed Hospital, Lahore. Subjects and Methods: In this study 18216 young healthy voluntary blood donors (age 16-50 years) comprising of 16611 males and 1605 females were included and tested for HBsAg, Anti-HCV and HIV by Accu check one step test (chromatographic immunoassay) in serum. Results: Frequency of hepatitis B, C and HIV infection was 3.36%, 4. l 6% and 0% respectively. Conclusion: We can get representative prevalence values of HBV, HCV and HIV infection in general population by collecting data from all blood transfusion centers of Pakistan. This is also helpful to create public awareness regarding hepatiti s and HIV transmission through blood transfusion. Key Words: Hepatitis B virus, Hepatitis C virus, Human immunodeficiency virus, Blood donors. INTRODUCTION H epatitis B is a major health problem worldwide. Approximately two billion people in the world have been infected by hepatiti,; B virus. 1 Hepatitis C virus poses a more difficult health problem than hepatitis B virus. 85% of people with HBV infection resolve their infection and only 15% become chronically infected. This is just the opposite in case of HCV infection due to many HCV genotype variants.2 Unfortunately, there has been marked under-reporting of the HIV infection and the report issued by the National AIDS Control Programme of Pakistan has shown a total of 1262 cases of HIV infection with 142 cases of AIDS by October I 997. There is an urgent need for screening of HIV cases for effective control of the disease.3 Viral hepatitis is a common public health problem in Pakistan. 4 Approximately I 0 million people are infected with HCV in Pakistan. Regarding hepatitis C in childhood, infection is us ually a very benign illness, but chronic infection often leads to cirrhosis and hepatocellular cancer after many years. 5 One hundred and seventy million people are infected with hepatitis C out of which 70% have chronic hepatitis and 15 to 20% will develop cirrhosis and its consequences. 6 In Pakistan, hepatitis B virus and hepatitis C virus infections are due to unsatisfactory hygiene, poor socioeconomic condition and low literacy rate. The carrier rate of HBs Ag is quoted to be around I 0% in general population while the prevalence of HCV in blood 7 donors is 4.8%. Five to ten percent individuals infected with HBV and app roximately half of patients infected with HCV progress to chronic stage. 8 Cirrhosis is the most common cause of hepatitis B related chronic liver diseases in Pakistan accounting for 58% cases followed by hepatocell ular carcmoma (22%) and chronic G. Sirhindi et al. hepatitis (20%) .9 Data regarding the prevalence of hepatitis B and C virus infections among healthy blood donors is well established in big cities of Pakistan, but similar data regarding the epidemiology of HIV infection among blood donors is not available at most of the blood transfusion centers. The purpose of this study is to determine the prevalence of hepatitis B, hepatitis C and HIV infections in the blood donors and to create public awareness regarding hepatitis and HIV. Table I: Frequency of Hepatitis B in blood donors. Sex HBsAg +vc HBsAg-vc Male (n= l661 I) Female (n= 1605) Total (n= 1821 6) 543 69 612 (3.36%) 16068 1536 17604 (96.64%) Table 2: Frequency of Hepatitis C in blood donors Subject Male (n= l661 l ) Female (n= 1605) Total (n= l821 6) SUBJECTS AND METHODS In this study 18216 consecutive young healthy volunta1y blood donors of either sex com ing to Blood Bank of Shaikh Zayed Hospital, Lahore were examined. The clinical details of these subjects were recorded on a proforma. The blood samp les were collected by venepuncture using sterile disposable syringes. Fresh serum samples were tested for the presence of hepatiti s B surface antigen. Anti-HCV antibodies and anti-HIV antibodies by commercially available kits with Accu one step test (a rapid chromatographic immunoassay). Procedure was strictly followed as given in the manual of kit. Negative and positive controls were run with each batch of samples. Anti-HCV +vc Anti-HCV -ve 471 18 759 (4. 16%) 15870 1587 17457 (95.84%) Table 3: Frequency of HIV in blood donors Subject Male (n= 166 11 ) Female (n= 1605) Total (n= l 8216) Anti-HIV +ve Anti-HIV -vc 0 0 0 166 1I 1605 18216 ( 100%) In this study, 18216 voluntary blood donors were included. Frequency of hepatitis B, C and HIV infection were 3 .3 6%, 4.16% and 0% respectively . In nine studies'°- 18 on the prevalence of HBV and HCV in healthy b lood donors, 3 addressed HBV on ly, 3 focused on HCV while 3 highlighted both B and C prevalence. Fortunately all the 18216 subjects were HIV negative. The exact prevalence of HIV in the general population of Pakistan is not known. As HIV test is being routinely done at the blood transfusion centers, it is recommended that data from all the centers should be collected and published and we recommend the pol icy of routine screening in the following c ircumstances. RESULTS A group of 18216 young healthy vo luntary blood donors (age 16-50 years) comprising of 16611 males and 1605 females were tested for hepatitis B, C and HIV infections. Frequency of hepatitis B, C and HIV infection were 3 .36%, 4.16% and 0% respectively (Tables 1-3). .. _ • • • • • • DISCUSSION It is important to assess the problem in the community and to understand the methods to control its transmission. Hepatitis B, C and HIV infection have been the cause of s ignificant morbidity and mortality worldwide, but more in the developing countries like Pakistan. Studies to determine the prevalence of HBV, HCV and HIV infection have been done on healthy blood donors. • • 34 Persons on hemodialysis Those who inject illegal drugs Persons receiving clotting factors Unexplained skin infections Persons with organ transplants Children of HCV, HBV or HIV positive mothers Health care workers, medical and public safety staff after needle injury Close contacts of HCV, HBV o r HIV pos itive Frequency of Hepatitis B, C and Human Immunodeficiency Virus in Blood Donors • patients Persons undergoing any surgical intervention chronic hepatitis B with recombinant interferon alpha therapy. J Coll Physician Surg Pakistan 1997; 17: 145-47. However, prevalence studies of healthy blood donors for HBV, HCV and HIV may be regarded as near estimates of the prevalence in the general population. As mandatory testing for HBsAg, antiHCV and HIV along with blood grouping is being done in the blood transfusion centers, this facility should be utilized for prevalence studies. 9. Mansoor SA, Mal ik IA, Tariq WZ, Butt SA, Luqman M, Ahmad N. Hepatitis B related liver disease in Rawalpindi, c hro nic Islamabad area. J Col l Physician Surg Pakistan 1997; 7: 43-47. 10. Bhatti FA, Shaheen N, Tariq W, Amin M, Saleem M. Epidemiology of hepatitis C virus in blood donors of northern Pakistan. Pak Armed Forces Med J 1996; 46: 91 -92. 11. Chaudry N T, Khan SJ, Khan TA, Saeed M, Iqba l J, Hayder Z, et al. Prevalence of hepatitis B carrier and blood group frequency in voluntary blood donors. J Ayub Med Coll 1996; 8: 29-32. 12. Tanwani AK, Abbas KA. Comparative evaluation of serodia and ELISA techniques in the study of prevalence of HBsAg in healthy blood donors at Is lamabad. J Col l Phys Surg Pakistan 1996; 6: 187-88. 13. Re hman N, Hashmi KZ. Hepatitis in volunteer blood donors: a local experience. Infectious Dis Pak 1996; 3: 24. 14. Bukhari SM, Khatoon N, Iqbal A, Naeem S, Shafqat S, Lone A, et al. Prevalence of hepatitis B virus antigengenem ia in Mayo Hospital, Lahore. Byomedica, 1999; 15: 8891. I 5. Hashmi ZY, C haudary A, Ahmed M, Ashraf M. healthy voluntary blood donors; incidence of a nti-HCV antibodies. Prof Med J 1999; 6: 551-55. I 6. Hashmi ZY, Chaudry A, Ahmed M, Ashraf M. Hepatitis B antigengenem ia in healthy blood donors at Faisalabad. Prof Med J 1999; 6: 547-50. I 7. Rehman K, Khan AA, Hayder S, Shehzad A, Iqbal A, Khan R, et al. Prevalence of seromarkers of HBV and HCV in health care personnel and apparently healthy blood donors. JPM 1996; 46: 152-54. 18. Jadoon HA, Ahmed Z. Prevalence of antiHCV in blood donors of Hazara (NWFP). PJMR 1999; 38: 7-9. CONCLUSION Awareness is necessary regarding safe blood transfusion practice, and if data from all the blood transfusion centers of o ur country is collected and published, we can get representative prevalence values of HBV, HCV and HIV in general population of Pakistan. REFERENCES 1. World Health Report. 2001: Annex. Geneva: WHO, 200 I. 2. B ukh J, Miller RH, Purcell RH. Genetic heterogene ity of hepatit is C virus: quasi species and genotypes. Sem in Liver Dis 1995; 15: 4 1-63. Statistical 3. Malik IA, Tariq WUZ. AIDS: Current Paki stani Perspective. Editorial. JCPSP 1998; 8: 2-4. 4. Zuberi SJ, Lodhi TZ, A lam SE. Spectrum of viral hepatitis. JPMA I 991; 41: 288. 5. L isa BZ. Infectious Hepatitis Paediatrics Infectious D isease Secrets. 2003 Edi, 144148. 6. Tsai JF, Chang WY, Jeng JE, Ho MS, Lin ZY, Tsai JH. Hepatitis B and C virus infection as risk factors for liver cirrhosis and cirrhotic hepatoce llular carcinoma: a case controlled study. Liver I 994; ·I 4: 98- 102. 7. Ali L, Malik H, Shah MA. Hepatitis C in chronic liver disease. Pak J Med Sci 2000; 16: 98- 102. 8. Sheikh WM, Shah SR, Jatoi N, Muhammad G, Khan A. Results of 6 months treatment of 35 G. Sirhindi et al. Zubair Ahmed, Medical Officer Pakistan Medical Research Council Shaikh Zayed Hospital, Lahore The Authors: Ghazanfar Ali Sirhindi , Demonstrator Department of Pathology, Shaikh Zayed Hospital, Lahore Maj. (R) Muhammad Shahid Naeem, Shaikh Zayed Hospital, Lahore Anwaar A. Khan, Professor Department of Gastroenterology & Hepatology Shaikh Zayed .Hospital, Lahore Waqar H. Shah, Medical Officer Department of Gastroenterology & Hepatology Shaikh Zayed Hospital, Lahore. Saadia Shahzad Alam, Assistant Professor Department of Pharmacology Shaikh Zayed Hospital, Lahore Akbar Hussain. Shaikh Zayed Hospital, Lahore Muhammad Akram Ghori, Shaikh Zayed Hospital, Lahore Razzaq Ahmed Chohan Radioimmunoassay Lab. Shaikh Zayed Hospital, Lahore Riaz-ur-Rehman, Shaikh Zayed Hospital, Lahore Address for Correspondence: Niaz Ahmed Soomro, Shaikh Zayed Hospital, Lahore Ghazanfar Ali Sirhindi, Demonstrator Department of Pathol ogy, Shaikh Zayed Hospital, Lahore 36