In this study, we revealed that 8% of beta-thalassemic patients were HCV infected. Previous studies on Iranian beta-thalassemic patients reported a wide range of 7-64% for HCV prevalence.[11
] Alavi et al
] in Tehran showed the prevalence of HCV positive in beta-thalassemic patients as 11% in 2005. In Kerman, the prevalence was 31%.[10
] It has been reported 64% in Rasht,[13
] 28.1% in Khuzestan,[14
] 25% in Shiraz,[15
] 9% in Yazd,[16
] 40% in Semnan,[17
] 17% in Mazandaran,[18
] 13% in Sistan and Baluchistan,[19
] and 7% in Markazi[20
] as well.
Therefore, the rate we found in this study does not appear to be very high, when compared with the HCV infection prevalence among beta-thalassemic patients in other provinces in Iran.
It can be due to our patients were transfused at the thalassemia management center of Seyed o Shohada hospital, where pre-transfusion screening of the transfused is regularly performed.
In 2006, Hariri et al
] in Isfahan revealed that the prevalence of HCV positive among thalassemic patients is 11%. In comparison with our study that reports prevalence of 8%, there is significance reduction in last 5 years.
The other studies from some countries reported an HCV infection rate of 40.5% in Jordan,[22
] 30% in India,[23
] 35% in Pakistan[24
] and 33% in Kuwait.[25
The reason of this wide range can be due to difference in type and sensitivity of testes, the prevalence of HCV in the relevant population and the time of screening. In comparison with other developing countries, the prevalence of HCV infection among beta-thalassemic patients is lower in Iran. The countries with a higher HCV prevalence in general population had a higher prevalence rate among thalassemia patients, too. For instance, in a study in Egypt the prevalence of HCV among thalassemic patients has been reported as 75% considering the fact that the prevalence in their blood donor population was 14.5%.[26
] In Iran, HCV infection prevalence in general population is estimated to be less than 1%.[27
] Furthermore, introduction of tests for screening of blood donors after 1995 has markedly reduced the risk of HCV transmission through blood product transfusion in our country.
This study also evaluated risk factors for HCV infection among beta-thalassemic patients. The results of univariate analysis demonstrated history of surgery, history of dental procedure, number of units transfused per month, number of transfusion per month and duration of transfusion had significant association with HCV seropositivity.
In accordance with other studies,[14
] in this study mean age ± SD (23.73 ± 7.33) was significantly higher in patients with positive HCV-Ab compared to negative patients (17.46 ± 8.32). The results of our study showed HCV positive patients had a significantly more number of units transfused and more number of transfusion per month. These findings are in agreement with some earlier studies.[13
] In addition, similar to other HCV seroprevalence studies among beta-thalassemic patients,[13
] we found HCV positive patients had a significantly longer duration of transfusion compared with HCV negative cases.
Our findings highlighted blood transfusion as the main risk factors for HCV infection among beta-thalassemic patients. The higher rate of HCV infection in older patients, as well as patients with more number of units transfused, more number of transfusions per month and longer duration of transfusion display the importance of providing safe blood to decrease the incidence of HCV infection in thalassemia population and confirm the important role of blood donors screening in the prevention of viral transmission[30
Remarkably, in our study history of surgery and dental procedure had significant association with HCV prevalence that has not been found in previous studies. Differences in quality of hospital care and health facilities or differences between education and training could attribute to difference in results.
In conclusion, beta-thalassemic patients are at risk of acquiring HCV infection and progression to liver failure and hepatocellular cancer. Therefore, blood donor screening protocol and effective screening techniques are likely to be needed to prevent speared of HCV infection among beta-thalassemic patients.