Frequency of Hepatitis B, C, and Human Immunodeficiency Virus (HIV) among Children with Transfusion-Dependent Thalassemia at the National Institute of Child Health, Karachi, Pakistan
Keywords:
Children, hepatitis B, hepatitis C, human immunodeficiency virus, thalassemiaAbstract
OBJECTIVE: To evaluate the current screening and transfusion practices for blood-borne infections and the frequency of hepatitis B virus (HBV), hepatitis C virus (HCV), and human immunodeficiency virus (HIV) among children with transfusion-dependent thalassemia (TDT).
METHODOLOGY: This cross-sectional study was conducted at the Pediatric Outpatient Department of the National Institute of Child Health, Karachi, Pakistan, from February to July 2025. A total of 230 children aged ?1 year with TDT major were analyzed. We recorded demographics, disease duration, transfusion history, therapy type, HBV vaccination status, and presenting complaints. Data were entered and analyzed using IBM SPSS Statistics version 26.0.
RESULTS: Of a total of 230 patients, 127 (55.2%) were male, and the mean age was 8.6±4.1 years. HCV infection was detected in 29 (12.6%), and HBV in 6 (2.6%) children, while no HIV case was identified. HCV-positive children were relatively older (10.9±3.8 vs. 8.3±3.0 years, p<0.001), had longer disease duration (8.2±3.3 vs. 6.3±3.6 years, p=0.008), higher monthly transfusions (2.9±0.7 vs. 2.6±0.6, p=0.015), less HBV vaccination (58.6% vs. 77.1%, p=0.032), had fatigue (72.4% vs. 50.7%, p=0.029), lower hemoglobin (7.2±0.9 vs. 7.7±1.0 g/dl, p=0.012), and higher ferritin (3204.5±910.4 vs. 2584.1±762.8 ng/ml, p=0.001). HBV-infected children were less likely to be vaccinated (16.7% vs 76.3%, p=0.001).
CONCLUSION: This study highlighted a significant burden of HCV and, to a lesser extent, HBV infection among transfusion-dependent beta-thalassemia children, with strong associations with older age, longer disease duration, higher transfusion frequency, and incomplete vaccination.
References
1. Jalil T, Yousafzai YM, Rashid I, Ahmed S, Ali A, Fatima S et al. Mutational analysis of beta thalassaemia by multiplex arms-PCR in Khyber Pakhtunkhwa, Pakistan. J Ayub Med Coll Abbottabad. 2019; 31(1): 98-103.
2. Bajwa H, Basit H. Thalassemia. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2025 Jan. Available from: https://www.ncbi.nlm.nih.gov/books/NBK545151/
3. De Sanctis V, Kattamis C, Canatan D, Soliman AT, Elsedfy H, Karimi M et al. Thalassemia Distribution in the Old World: an Ancient Disease Seen from a Historical Standpoint. Mediterr J Hematol Infect Dis. 2017; 9(1): e2017018. doi: 10.4084/MJHID.2017.018.
4. Origa R. ?-Thalassemia. Genet Med. 2017; 19(6): 609-619. doi: 10.1038/gim.2016.173.
5. Ehsan H, Wahab A, Anwer F, Iftikhar R, Yousaf MN. Prevalence of Transfusion Transmissible Infections in Beta-Thalassemia Major Patients in Pakistan: A Systematic Review. Cureus. 2020; 12(8): e10070. doi: 10.7759/cureus.10070.
6. Thalassemia Federation of Pakistan. What is Thalassemia [Internet]. Thalassemia Federation of Pakistan. 2021. Available from: http://tfp.org.pk/what-is-thalasseamia/.
7. Shah FT, Sayani F, Trompeter S, Drasar E, Piga A. Challenges of blood transfusions in ?-thalassemia. Blood Rev. 2019; 37: 100588. doi: 10.1016/j.blre.2019.100588.
8. Menitove JE. What is it all about? Transfusion. 2017; 57(Suppl 2): 1585-1587. doi: 10.1111/trf.14177.
9. Bhuyan GS, Noor AUZ, Sultana R, Noor FA, Sultana N, Sarker SK et al. Frequency of Hepatitis B, C and HIV Infections among Transfusion-Dependent Beta Thalassemia Patients in Dhaka. Infect Dis Rep. 2021; 13(1): 89-95. doi: 10.3390/idr13010011.
10. Saeed M, Hussain S, Rasheed F, Ahmad M, Arif M, Hamid Rahmani MT. Silent killers: Transfusion Transmissible Infections (TTI) among asymptomatic population of Pakistan. J Pak Med Assoc. 2017; 67(3): 369-374.
11. Ahmed S, Ayub M, Naeem M, Nazir FH, Hussain A, Ghilzai D et al. Thalassemia Patients from Baluchistan in Pakistan Are Infected with Multiple Hepatitis B or C Virus Strains. Am J Trop Med Hyg. 2021; 104(4): 1569-1576. doi: 10.4269/ajtmh.20-0740.
12. Khalil S, Khan HS, Akhtar P. Status of Hepatitis B and C in Beta Thalassemia Major Patients. J Islamabad Med Dent Coll. 2016; 5(2): 71-73.
13. Wohab MA, Choudhury NAB, Ara MN. Frequency of Hepatitis B, C and HIV Infections among Transfusion-Dependent Beta Thalassemia Patients in Bangladesh Shishu Hospital and Institute. Arch Pediatr Neonatol. 2025; 8(1): 1-5. doi: 10.22259/2638-5155.0801001.
14. Kousar T, Qureshi R, Lohan BG, Das C, Hotwani S. Frequency of Hepatitis C Virus and Hepatitis B Virus among Children undergoing multiple Blood Transfusions. Pak J Med Health Sci. 2021; 15(10): 3384-3386. doi: 10.53350/pjmhs2115103384.
15. Agrawal S, Sulaniya PK, Garg K, Choudhary R, Sulaniya C. Seroprevalence of hepatitis-C infection in multi-transfused thalassemic children: study from a West Indian tertiary care center. Int J Contemp Pediatr. 2017; 4(5): 1871–1874. doi: 10.18203/2349-3291.ijcp20173802.
16. Mukherjee K, Bhattacharjee D, Chakraborti G. Prevalence of hepatitis B and hepatitis C virus infection in repeatedly transfused thalassemics in a tertiary care hospital in eastern India. Int J Res Med Sci. 2017; 5(10): 4558–4562. doi: 10.18203/2320-6012.ijrms20174596.
17. Ocak S, Kaya H, Cetin M, Gali E, Ozturk M. Seroprevalence of hepatitis B and hepatitis C in patients with thalassemia and sickle cell anemia in a long-term follow-up. Arch Med Res. 2006; 37(7): 895-8. doi: 10.1016/j.arcmed.2006.04.007.
18. Mahmoud RA, El-Mazary AA, Khodeary A. Seroprevalence of Hepatitis C, Hepatitis B, Cytomegalovirus, and Human Immunodeficiency Viruses in Multitransfused Thalassemic Children in Upper Egypt. Adv Hematol. 2016; 2016: 9032627. doi: 10.1155/2016/9032627.
19. Rujeerapaiboon N, Tantiworawit A, Piriyakhuntorn P, Rattanathammethee T, Hantrakool S, Chai-Adisaksopha C et al. Correlation Between Serum Ferritin and Viral Hepatitis in Thalassemia Patients. Hemoglobin. 2021; 45(3): 175-179. doi: 10.1080/03630269.2021.1926277.
20. Di Marco V, Capra M, Gagliardotto F, Borsellino Z, Cabibi D, Barbaria F et al. Liver disease in chelated transfusion-dependent thalassemics: the role of iron overload and chronic hepatitis C. Haematologica. 2008; 93(8): 1243-6. doi: 10.3324/haematol.12554.
21. Naz R, Ullah F, Muhammad T, Khan O, Shah F, Rehman AU et al. Incidence of Hepatitis B Due to Multiple Transfusions in Patients of ?-Thalassemia Major: Incidence of Hepatitis B in Patients of ?-Thalassemia Major”, Pak J Health Sci. 2023; 4(02): 86–90. doi: 10.54393/pjhs.v4i02.558.
22. Prasad GJ, Hapani PT, Harsha G. Prevalence of human immunodeficiency virus and hepatitis B among multi-transfused thalassemia children. J App Hematol. 2015; 6(2): 70-73. doi: 10.4103/1658-5127.160204.
23. Altaf W, Hussain M. Frequency of Hepatitis B Virus and Hepatitis C Virus Infection in Beta Thalassemia Major Children in Tertiary Care Hospital. Indus J Bioscience Res. 2025; 3(1): 444-448. doi: 10.70749/ijbr.v3i1.490.
24. Valizadeh N, Noroozi M, Hejazi S, Nateghi S, Hashemi A. Seroprevalence of Hepatitis B, Hepatitis C and Human Immunodeficiency Viruses among Thalassemia Patients in West North of Iran. Iran J Pediatr Hematol Oncol. 2015; 5(3): 145-148.
25. Hussein MH, Abid IN, Jabber AS, Al-Badry BJ. Prevalence of hepatitis B infections in local and incoming populations of the public health laboratory reviewers in Al- Nasiriyah city - Iraq. Iraq Med J. 2019; 3(1): 27-30.
26. Kiani AR, Anwar M, Waheed U, Asad MJ, Abbasi S, Abbas ZH. Epidemiology of Transfusion Transmitted Infection among Patients with ?-Thalassaemia Major in Pakistan. J Blood Transfus. 2016; 2016: 8135649. doi: 10.1155/2016/8135649.
Downloads
Published
How to Cite
Issue
Section
License
Copyright (c) 2026 Journal of Liaquat University of Medical & Health Sciences
This work is licensed under a Creative Commons Attribution-NonCommercial-ShareAlike 4.0 International License.
Submission of a manuscript to the journal implies that all authors have read and agreed to the content of the undertaking form or the Terms and Conditions.
When an article is accepted for publication, the author(s) retain the copyright and are required to grant the publisher the right of first publication and other non-exclusive publishing rights to JLUMHS.
Articles published in the Journal of Liaquat University of Medical & health sciences are open access articles under a Creative Commons Attribution-Noncommercial - Share Alike 4.0 License. This license permits use, distribution and reproduction in any medium; provided the original work is properly cited and initial publication in this journal. This is in accordance with the BOAI definition of open access. In addition to that users are allowed to remix, tweak and build upon the work non-commercially as long as appropriate credit is given and the new creations are licensed under the identical terms. Or, in certain cases it can be stated that all articles and content there in are published under creative commons license unless stated otherwise.
