Hepatitis E Virus Infection Among Iranian Patients with Beta-Thalassemia

HEV Infection in Beta-Thalassemia Patients

Thalassemia is an inherited hematological disorder characterized by a decrease in the synthesis of or absence of one or more globin chains. Hepatitis E virus (HEV) is a major cause of acute viral hepatitis, constituting a major global health burden and emerging as a critical public health concern. HEV infection is mainly transmitted via the fecal-oral route; however, parenteral transmission through blood components has been reported in both developing and developed countries. Although HEV infection is typically self-limiting, immunocompromised individuals, patients with chronic liver disease, and thalassemic patients are at a heightened risk of contracting the infection and may develop chronic hepatitis and life-threatening complications that require treatment. The reported prevalence rates of HEV in thalassemia patients vary significantly by country. Age, gender, residential area, and the cumulative amount of blood transfusions received have been identified as associated risk factors for HEV infection. In order to enhance blood safety and ensure the protection of vulnerable patient populations, such as thalassemia patients, several countries have introduced universal or targeted HEV screening policies in blood donations. Other preventive measures include vigilant monitoring of thalassemic patients and screening for anti-HEV antibodies. The aim of this review is to explore the prevalence, risk factors, clinical impact and management of HEV infection in patients with thalassemia.

Prevalence and risk factors of hepatitis E virus infection among patients with β-thalassemia major in South of Iran

This study was performed to determine the prevalence and risk factors of hepatitis E virus (HEV) infection among thalassemia patients. All β-thalassemia major patients on regular blood transfusion attending the blood transfusion centers located in southern Iran were invited to participate in this study. ELISA was used to detect anti-HEV IgM and anti-HEV IgG antibodies. The molecular detection of HEV infection was performed by nested RT-PCR assay, targeting the ORF2 region of HEV genome, and sequencing. In this study, 16.67% of thalassemia patients were positive for anti-HEV IgG compared to 12.1% of the controls. Thalassemia patients were negative for anti-HEV IgM and HEV viremia. Patients with blood transfusion every two weeks had significantly higher anti-HEV IgG seroprevalence compared to the patients with blood transfusions at longer intervals (OR: 12.50; 95% CI: 1.76-88.74; P = .012). Anti-HEV IgG seroprevalence was not statistically associated with age, gender distribution, ethnicity, place of residency, education level, and serum levels of liver enzymes. This study reports a high seroprevalence of HEV among thalassemia patients, while frequency of blood transfusion was significantly associated with anti-HEV IgG seropositivity. This suggests that frequent blood transfusion may be a risk factor for exposure to HEV infection among thalassemia patients.