Prevalence of Hepatitis B and C in Sickle-Cell disease patients at University Teaching Hospital, Lusaka, Zambia

Abstract

Background: Sickle Cell Disease (SCD) is highly prevalent in Africans. The SCD trait is 18% in the general population in Zambia and University Teaching Hospital in Lusaka has under its care over 1500 SCD patients. SCD causes high morbidity and mortality. Patients with SCD often have pathologies that require a blood transfusion. Specific indications for blood transfusion in SCD include acute splenic sequestration, aplastic crises, cardiopulmonary symptoms or signs (e.g. high-output heart failure or hypoxemia), preoperative use, priapism, and life-threatening events that would benefit from improved oxygen delivery such as sepsis, severe infection, acute chest syndrome, stroke, and acute organ ischemia. In addition, blood transfusion remains the first-line therapy for primary and secondary stroke prevention in children with SCD. Transfusion is usually performed when haemoglobin is less than five g/dL. Both hepatitis B and C are blood-borne and therefore can be transmitted by blood transfusion. SCD patients are a special population that requires frequent blood transfusions. Thus, they are prone to acquiring hepatitis B and C. Screening services have greatly reduced the risk of infection via blood transfusion, but transmissions still occur. Methods: A cross-sectional study was done to determine the prevalence of hepatitis B (HBV) and / or hepatitis C (HCV) infection in the SCD population at UTH in Lusaka. Basic demographic characteristics, medical information and laboratory data were collected and used to determine the predictors for hepatitis B and HCV infections in SCD children and adults. A total of 138 patients were screened for Hepatitis B surface antigen, which is a marker for HBV infection, as well as for hepatitis C antibody, the surrogate marker for HCV infection. Human-immuno-deficiency virus or HIV testing was done on all the samples.Findings: Fifty-nine percent of the participants enrolled were female. The mean age at diagnosis was 2years 9 months ± 2.5. The mean haemoglobin level was 7.2g/dL. Only 37% had confirmation of SCD diagnosis on their medical record. HBV prevalence amongst the SCD is 2.2%. Its prevalence is not associated with blood transfusions, age, tattoos or gender. It has a non-significant association with increasing age and sexual activity. HBV infection has been markedly reduced due to vaccination introduced in 2005 in Zambia. The prevalence of HCV is 0.7% and could not be subjected to much statistical manipulation.

Conclusion: HBV prevalence amongst the SCD is 2.2%. Its prevalence was not associated with increase in number of blood transfusions. There was a non-significant association between HBV prevalence and increase in age as well as sexual activity. The prevalence of HCV is 0.7%.