The Correlation between Different Risk Factors of Hepatitis C and Different Genotypes
Mozhgan Mokhtari1, Hanieh Basirkazeruni2, Mojtaba Rostami3
1 Department of Pathology, Faculty of Medicine, Isfahan University of Medical Sciences, Isfahan, Iran
2 Department of Pathology, Isfahan Research Center, Isfahan University of Medical Sciences, Isfahan, Iran
3 Department of Infectious Disease, Isfahan Research Center, Isfahan University of Medical Sciences, Isfahan, Iran
|Date of Web Publication||17-Apr-2017|
Department of pathology, Isfahan University of Medical Sciences, Isfahan
Source of Support: None, Conflict of Interest: None
Background: Hepatitis C infection is one of the health problems in the world. Several known risk factors are responsible in transmission of this infection. We are going to study the prevalence of these risk factors for different genotypes of hepatitis C and if possible, specify probable relations between each risk factor and transmission of each genotype. Materials and Methods: This is a cross-sectional study done on 270 people who had positive anti-hepatitis C virus (HCV) antibody and HCV RNA. Demographic specificity and possible risk factors were collected using a questionnaire, and statistical analysis was done by SPSS software (version 20). Chi-square test used to estimate the prevalence and relation between each qualitative risk factor and HCV genotype transmitted. Analysis of variance was used for studying the prevalence and relation between quantitative risk factors and HCV genotypes. Results: The sample size was 270 persons. Of these, 217 (80.4%) were men and 185 (68.5%) were infected with genotype Type III. Most people were in age range of 31–40 years old 92 (34%). Single people were 126 (46.7%) and 169 (62.6%) were high school and university graduated. Tattooing as a risk factor had a meaningful relation with hepatitis C genotype (P < 0.001). Conclusions: According to the findings, most people in central provinces of Iran with hepatitis C are carrying genotype III, with most prevalent risk factors such as intravenous drug use and unsafe sexual activity. Besides, tattooing had a significant association with hepatitis C genotype, so that in these groups of people, genotype I was more frequent isolated virus.
Keywords: Genotype, hepatitis C, risk factor
|How to cite this article:|
Mokhtari M, Basirkazeruni H, Rostami M. The Correlation between Different Risk Factors of Hepatitis C and Different Genotypes. Adv Biomed Res 2017;6:45
|How to cite this URL:|
Mokhtari M, Basirkazeruni H, Rostami M. The Correlation between Different Risk Factors of Hepatitis C and Different Genotypes. Adv Biomed Res [serial online] 2017 [cited 2017 Apr 26];6:45. Available from: http://www.advbiores.net/text.asp?2017/6/1/45/204588
| Introduction|| |
Hepatitis C infection is one of the significant health problems in the world because of its high tendency of converting to chronic liver disease, hepatic failure, and hepatocellular carcinoma. Known risk factors for transmission of hepatitis C are blood transfusion, intravenous (IV) drug use, unsafe sex, unsterile medical procedures, and needle stick. Also, tattooing, phlebotomy and acupuncture may have role, as potential ways, in transmission of hepatitis C. The most prevalent hepatitis C virus (HCV) genotype in the world is Type I and the others are in the next levels., The prevalence of HCV genotypes are different in several parts of the world, and some of the risk factors are responsible in transmission of especial HCV genotype. So, determining different risk factors and significance of each in relation to different genotypes of hepatitis C can be a way for prevention and treatment of hepatitis C. Most of the studies and medical literature up to now, have been focused on total prevalence of each risk factors, but their association with HCV genotype is ignored. The studies about HCV genotype and risk factors are limited in Iran, so, we are going to conduct this study on the prevalence of these risk factors one by one for different genotypes of hepatitis C. Could be determine, if there is an especial risk factor for each genotype of HCV to transmit or not? This study can be an effort to clarify the role of different risk factors considering genotypes, to prevent, treat and reduce the prevalence of HCV.
| Materials and Methods|| |
This is a cross-sectional study done between February 2013 and July 2013 in referral laboratory. This study doesn't have a special direction. The target group, are the samples in hepatology and infectious referral laboratory, which are from the central part of Iran including Isfahan, Kohgiluyeh and buyerahmad, Chahar Mahal and Bakhtiari, some parts of Fars, Arak and Lorestan. These samples were tested by polymerase chain reaction (PCR) and result of antibody (Ab) assay were registered in the patients' files. The inclusion criteria were the people who had positive anti-HCV Ab and confirmed by HCV RNA and genotyping. Patients with positive anti-HCV Ab but negative HCV RNA were excluded from the study. The sample size was 270 patients calculated by formula with accuracy rate of 0.06 and confidence interval of 95%. This research is confirmed by moral committee of Isfahan University of Medical Sciences. We chose randomly all anti-HCV Ab and HCV RNA positive patients from central parts of Iran who were referred to referral laboratory by specialists for PCR and genotyping. Demographic informations like age, sex, education level, marital status and HCV risk factors like IV drug use, blood transfusion, being incarcerated with IV drug users (IVDUs), unsafe sexual activity, history of unsanitary dental manipulation, surgery, accident and blood transfusion, suturing and other medical procedures with unsterile instruments, needle stick, tattooing, acupuncture and phlebotomy were extracted and registered by the researcher in files of laboratory for each patient. Kiagen kit for extraction of viral RNA and genotype detection used. Synthesis of C-DNA was done by Italian Sacace kit on extracted RNA (with Moloney Murine Leukemia Virus enzyme for 30 min in 37°C). The HCV genotype is extracted with sacace kit, which is PCR-based. This extraction was done on the 342 5' untranslated region part of HCV genome. Finally, different viral genotype makes different PCR product which are as below:
- HCV genotype Ia → 338 bp
- HCV genotype Ib → 395 bp
- HCV genotype II → 286 bp
- HCV genotype IIIa → 227 bp.
Different PCR products were electrophoreses on agarose 4% made by etedium bromide gel in the tris borate EDTA 0.5 × buffer and is detected with ultraviolet technology.
Statistical analysis was done by SPSS software (version 20) (statistical package for social science) (IBM, Armonk, NY, United states of America). Chi-square test was used to estimate the prevalence and relation between each qualitative risk factors and HCV genotype transmitted. Analysis of variance (ANOVA) was used for studying the prevalence and relation between quantitative risk factors (such as episodes of blood transfusion) and HCV genotypes.
| Results|| |
The sample size was 270 persons. Of these, 217 (80.4%) were males, and the rest were females. The youngest patient in this study was 14 and the eldest was 67 years old. The average age for each genotype was as following:
- Genotype I → 36.1 ± 10.3 years old
- Genotype II → 33.7 ± 9.5 years old
- Genotype III → 34.9 ± 10.3 years old.
A total of 62 (23%) persons were infected with genotype Type I, 23 (8.5%) genotype Type II and 185 (68.5%) genotype Type III [Table 1]. We checked education level and marital status that can be seen in [Table 2]. Totally, 9 persons didn't mention their marital status, which were named as missed samples. The frequency of each risk factors for different genotypes can be seen in [Table 3], and the frequency of quantitative risk factor (episodes of blood transfusion) is seen in [Table 4]. 12 (19.4%) people with genotype 1,3 (13%) people with genotype 2 and 31 (16.8%) people with genotype 3 knew that they were affected with hepatitis C [Table 5].
| Discussion|| |
We studied HCV genotypes considering association of different risk factors. The most prevalent HCV genotype in this study was genotype Type III. In recent studies done in Iran, the most prevalent genotype, was Type III , and studies in other countries including, Saudi Arabia revealed genotype IV as the most prevalent,,, genotype Type II in Chinese and Brazilian prisoners,, Type II in Greek IVDUs  and Type I in other Countries.,,
One-way ANOVA did not find a meaningful relation between the average age with different genotypes (P = 0.58), in other studies, the age of 40 and older, explained as one of the risk factors.
Also, the average age for female prisoners in the province of Isfahan was 34.54 ± 11.2 years old.
Of 270 HCV positive patients, most patients (80.45%) were male which was compatible with recent researches of hepatitis C that males were dominant ,,,,, except for a Yemanian study which majority were female.,
We can say that the most patients in this study were high school and university graduated. In other countries, the prevalence of HCV was more in those people with education level under diploma and university degrees. The most patients in one study in Isfahan had elementary school degrees  and in yemen, most patients had the lowest education level. We studied the prevalence of the HCV risk factors one by one for different genotypes of HCV and their relations. The most frequent risk factors between them were unsafe sexual activity and IVDU but no meaningful relation to HCV genotypes found (P < 0.05) in other studies done on the prevalence of HCV risk factors, the most prevalent were, IVDU, multiple sexual partner, being in prison some time in their lifetime, and blood transfusion especially in hematologic diseases such as hemophilia but there wasn't any study to investigate the relation of the risk factors with different HCV genotype in these patients.,,, Tatooing as a risk factor had a meaningful relation with hepatitis C genotype (P < 0.001) but in other studies, this relation has not been studied and tattooing is mentioned just as a risk factor.
Totally, 46 patients knew how they had been sick with hepatitis C, but we could not find a similar result in other studies. Hepatitis C is a worldwide problem and 85% of cases have affinity to become chronic hepatitis, cirrhosis and finally hepatocellular carcinoma, so, defining the prevalence of hepatitis C risk factors and genotypes, and their relations help us to prevent HCV transmission and treat it.
| Conclusion|| |
The most prevalent genotype in central parts of Iran is genotype Type III, which is relevant with other studies. Most patients were male with high school diploma and higher education level, most of them were single (46.7%) that was matched with recent studies in Iran. The most prevalent risk factors were IVDU and high-risk sexual activity. Tatooing had a meaningful relation with hepatitis C genotype and in these patients, genotype I was the most prevalent.
This study is limited to central part of Iran (Isfahan), so we suggest more studies in other parts of Iran for studying the prevalence of HCV risk factors and genotypes and their relations, so we can draw a protocol to prevent and treat HCV.
Financial support and sponsorship
Conflicts of interest
Isfahan University of Medical Sciences.
| References|| |
Lango DL, Fauci AS, Kasper DL, Hauser SL, Jameson JL, Loscalzo J. Harrison's Principles of Internal Medicine. 18th
ed., Vol. 304. New York: McGraw Hill; 2012. p. 2545-9.
Goldman L, Sachafer AI. Goldman's Cecil Medicine. 24th
ed., Vol. 150. Philadelphia: Elsevier Saunders; 2012. p. 966-73.
Vossughinia H, Goshayeshi L, Bayegi HR, Sima H, Kazemi A, Erfani S, et al
. Prevalence of hepatitis C virus genotypes in Mashhad, Northeast Iran. Iran J Public Health 2012;41:56-61.
Zarkesh-Esfahani SH, Kardi MT, Edalati M. Hepatitis C virus genotype frequency in Isfahan province of Iran: A descriptive cross-sectional study. Virol J 2010;7:69.
Abdel-Moneim AS, Bamaga MS, Shehab GM, Abu-Elsaad AA, Farahat FM. HCV infection among Saudi population: High prevalence of genotype 4 and increased viral clearance rate. PLoS One 2012;7:e29781.
Njouom R, Caron M, Besson G, Ndong-Atome GR, Makuwa M, Pouillot R, et al.
Phylogeography, risk factors and genetic history of hepatitis C virus in Gabon, central Africa. PLoS One 2012;7:e42002.
Halawani M, Bakir TM. Determination of hepatitis C virus genotypes in pruritus patients in saudi arabia. Genet Test Mol Biomarkers 2012;16:46-9.
Santos BF, de Santana NO, Franca AV. Prevalence, genotypes and factors associated with HCV infection among prisoners in Northeastern Brazil. World J Gastroenterol 2011;17:3027-34.
Tian D, Li L, Liu Y, Li H, Xu X, Li J. Different HCV genotype distributions of HIV-infected individuals in Henan and Guangxi, China. PLoS One 2012;7:e50343.
Gigi E, Sinakos E, Sykja A, Androulakis G, Tanis C, Stayridou V, et al.
Epidemiology, clinical data, and treatment of viral hepatitis in a large cohort of intravenous drug users. J Addict Med 2013;7:52-7.
Burguete-García AI, Conde-González CJ, Jiménez-Méndez R, Juárez-Díaz Y, Meda-Monzón E, Torres-Poveda K, et al
. Hepatitis C seroprevalence and correlation between viral load and viral genotype among primary care clients in Mexico. Salud Publica Mex 2011;53:S7-12.
Romero-Figueroa S, Ceballos-Salgado E, Santillán-Arreygue L, Miranda-García M, Rubio-Lezama M, Garduño-García JJ. Risk factors associated with hepatitis C virus infection in an urban population of the State of Mexico. Arch Virol 2012;157:329-32.
Rodrigues Neto J, Cubas MR, Kusma SZ, Olandoski M. Prevalence of hepatitis C in adult users of the public health service of São José dos Pinhais – Paraná. Rev Bras Epidemiol 2012;15:627-38.
Nokhodian Z, Yazdani MR, Yaran M, Shoaei P, Mirian M, Ataei B, et al.
Prevalence and risk factors of HIV, syphilis, hepatitis B and C among female prisoners in Isfahan, Iran. Hepat Mon 2012;12:442-7.
Osmond DH, Padian NS, Sheppard HW, Glass S, Shiboski SC, Reingold A. Risk factors for hepatitis C virus seropositivity in heterosexual couples. JAMA 1993;269:361-5.
Kinner SA, Jenkinson R, Gouillou M, Milloy MJ. High-risk drug-use practices among a large sample of Australian prisoners. Drug Alcohol Depend 2012;126:156-60.
Carmo RA, Campos LN, Melo AP, Guimarães MD. Hepatitis C among patients with mental illness in Brazil: An analysis of associated factors. Gen Hosp Psychiatry 2013;35:129-33.
Gacche RN, Al-Mohani SK. Seroprevalence and risk factors for hepatitis C virus infection among general population in central region of Yemen. Hepat Res Treat 2012;2012:689726.
Lee MH, Yang HI, Jen CL, Lu SN, Yeh SH, Liu CJ, et al.
Community and personal risk factors for hepatitis C virus infection: A survey of 23,820 residents in Taiwan in 1991-2. Gut 2011;60:688-94.
Memon AR, Shafique K, Memon A, Draz AU, Rauf MU, Afsar S. Hepatitis B and C prevalence among the high risk groups of Pakistani population. A cross sectional study. Arch Public Health 2012;70:9.
Kandeel AM, Talaat M, Afifi SA, El-Sayed NM, Abdel Fadeel MA, Hajjeh RA, et al.
Case control study to identify risk factors for acute hepatitis C virus infection in Egypt. BMC Infect Dis 2012;12:294.
Havens JR, Lofwall MR, Frost SD, Oser CB, Leukefeld CG, Crosby RA. Individual and network factors associated with prevalent hepatitis C infection among rural Appalachian injection drug users. Am J Public Health 2013;103:e44-52.
Yazdani MR, Kassaian N, Ataei B, Nokhodian Z, Adibi P. Hepatitis C virus infection in patients with hemophilia in Isfahan, Iran. Int J Prev Med 2012;3:S89-93.
Carney K, Dhalla S, Aytaman A, Tenner CT, Francois F. Association of tattooing and hepatitis C virus infection: A multicenter case-control study. Hepatology 2013;57:2117-23.
[Table 1], [Table 2], [Table 3], [Table 4], [Table 5]