High prevalence of hepatitis C in patients with thalassemia and patients with liver diseases in Myanmar (Burma)

Prevalence of HBV and HCV infection in beta-thalassemia major patients of Tabriz city, Iran

People with beta-thalassemia major are more likely to acquire blood-borne viral infections due to the need for frequent blood transfusions. Of these viruses, hepatitis B virus (HBV) and hepatitis C virus (HCV) are of particular importance. In this study, the prevalence of HBV, HCV and their risk factors in beta-thalassemia major patients in East Azerbaijan province was investigated. The study was descriptive cross-sectional, and 116 beta-thalassemia major patients who received blood in Shahid Ghazi hospital and Children's hospital in Tabriz city were studied. Data were collected by a questionnaire, and blood samples of patients in terms of serum markers HCV-Ab, HBsAg and HBs-Ab were analyzed by ELISA, and positive HCV-Ab results were confirmed by Real Time-PCR. Then using SPSS software version 22 and with the help of t-tests including Anova T-test, Man-Whitney U test, Independent sample t-test, chi-square and Fisher exact test, Statistical studies were performed. Of the 116 patients studied, no HBsAg positive cases were found. Four patients (3.4%) were positive for HCV-Ab, of which two patients (1.7%) became HCV-RNA positive after Real Time-PCR. There was a significant relationship between HCV-Ab positive and HCV-RNA positive (P = 0.000), blood transfusion intervals (P = 0.043), number of injected blood units (P = 0.001) and duration of blood transfusion (P = 0.006). The prevalence of HCV was lower in patients who started receiving blood after a blood donor screening program. HCV is less prevalent in thalassemia patients in East Azerbaijan province than in some studies in the country and various global statistics. After 1996, the prevalence of HCV in the thalassemia patient population has decreased significantly, and it seems that HCV infections since 1996 have been associated with various factors such as people's jobs, position, behaviour in society, etc.

Comparison of HIV-, HBV-, HCV- and co-infection prevalence between Chinese and Burmese intravenous drug users of the China-Myanmar border region

Background

Co-infection with HIV and HCV and/or HBV is highly prevalent in intravenous drug users (IDUs). Because of the proximity to the “Golden Triangle”, HIV prevalence among the IDUs is very high in the China-Myanmar border region. However, there are few studies about co-infection with HIV and HCV and/or HBV, especially in the region that belongs to Myanmar.

Methods

721 IDUs, including 403 Chinese and 318 Burmese, were investigated for their HIV, hepatitis B virus (HBV), and hepatitis C virus (HCV) serological status. Statistical analysis was performed to evaluate the differences of the epidemic situation between the Chinese IDUs and the Burmese IDUs.

Results

Among the Chinese IDUs and the Burmese IDUs, HCV infection was the most prevalent (69.0% vs 48.1%, P<0.001), followed by HBV (51.6% vs 43.1%, P<0.05) and HIV (33.7% vs 27.0%, P>0.05). Besides, there were more HIV-HBV co-infected IDUs (20.1% vs 11.3%, P<0.005), and HIV-HCV co-infected IDUs (31.8% vs 23.9%, P<0.05) in China than in Myanmar, as well as HIV-HBV-HCV triple infection (19.1% vs 10.4%, P<0.005).

Conclusion

Co-infection with HIV and HCV and/or HBV is highly prevalent among the IDUs in the China-Myanmar border region. The HIV epidemic appears to be in a downward trend, compared with previous reports. However, all infections were more prevalent among the Chinese IDUs than among the Burmese.

Possible correlation between iron deposition and enhanced proliferating activity in hepatitis C virus-positive hepatocellular carcinoma in Myanmar (Burma)

BACKGROUND

The aim of this study was to survey the effect of deposited iron on the cell kinetics of hepatitis C virus (HCV)-positive hepatocellular carcinoma (HCC) in Myanmar (Burmese) patients.

METHODS

Formalin-fixed and paraffin-embedded liver tissues from 34 Myanmar patients with HCC were used. To detect iron deposition, Prussian blue staining was performed. Cell proliferation and apoptosis were assessed by Ki-67 staining and by the terminal deoxynucleotidyl transferase (TdT)-mediated dUTP-biotin nick end labeling (TUNEL) assay, respectively. HCV RNA was detected by in situ hybridization, and HCV protein, Fas and Fas ligand (FasL) were localized by immunohistochemistry. To identify the subtype of lymphocytes, CD8 was used as a surface marker.

RESULTS

Iron deposition was found in 43% of the HCC cases, and was heavier in moderately differentiated HCC than in well-differentiated HCC. The Ki-67 labeling index (LI) in cancer cells was higher in Prussian blue-positive-HCC than in -negative HCC (3.8 +/- 2.2 vs 1.5 +/- 1.7, mean +/- SD; P=0.0067), whereas there was no significant difference between these groups in TUNEL LI. HCV protein was localized in cancer cells, and was found in 89% of the patients. In addition, Fas was expressed in HCC cells, and FasL was localized in HCC cells as well as in infiltrating CD8+ T lymphocytes. The frequency of apoptosis of HCC cells was correlated significantly with the population density of infiltrating CD8+ T lymphocytes.

CONCLUSIONS

Our results indicated that, in Myanmar patients with HCC, iron deposition might accelerate hepatocarcinogenesis, by promoting cancer cell proliferation, without affecting the Fas/FasL apoptotic system.