Seroprevalence of transfusion transmissible viral infections (HIV, HBV and HCV) among voluntary blood donors at University of Gondar Comprehensive Specialized Hospital, Gondar; Northwest Ethiopia

Human immunodeficiency virus (HIV), hepatitis B virus (HBV) and hepatitis C virus (HCV) are the greatest threats to blood safety because of their prolonged presence in the blood as a carrier or latent state. They are the leading cause of death, chronic and life-threatening abnormality. Blood transfusion accounts for 5–10% of HIV infections in sub-Saharan Africa [1]. The frequency of HIV infection among blood donors varies significantly between different countries of the world. There is a strong association between infection with the human immunodeficiency virus and hepatitis C virus infection [2]. HIV infection occurs worldwide and is endemic in central Africa. Transmission occurs through sexual contact, exposure to contaminated blood or blood products, and perennially. Human immunodeficiency virus is one member of the human retrovirus and is associated with progressive immune deficiency accompanied by a wide range of opportunistic infections [3].

Hepatitis B virus (HBV) is generally recognized as highly infectious and associated with long term occurrence of disease and death due to complications like cirrhosis, portal hypertension, and Hepato-cellular carcinoma. Approximately greater than 2 billion people have been infected by HBV and 350 million individual people have chronic infection [1, 4]. The common high-risk groups for HBV infections are parenteral drug abusers, institutionalized persons, health care personnel, multiply transfused patients, organ transplant patients, hemodialysis patients, highly promiscuous persons, sexual transmission and newborn infants born to mothers with hepatitis B virus [5]. The virus is highly infectious and relatively easy to be transmitted from one infected person to another by blood to blood contact, during birth, unprotected sex, and by sharing needles and has a relatively increase the prevalence in the tropics [6].

Hepatitis C virus (HCV) was identified in 1989 as the major agent of post-transfusion hepatitis previously designated under the name of “non-A, non-B hepatitis [7]. It is a blood-borne pathogen transmitted most efficiently by percutaneous membrane exposure to contagious blood. It is estimated that 60% of hepatitis C cases are related to injection drug use (IDU) [8]. HCV infection is highly recognized as a major healthcare problem throughout the world and around 130 to 170 million people are chronic carriers of this virus in the world, with an average seroprevalence estimated at 2.2%. This rate varies from country to country: it is very low in Europe, higher in Southeast Asia and Africa [7]. HCV causes 85% persistent infection, of this 70% of them develops chronic hepatitis, resulting in cirrhosis of the liver within 20 years and hepatocellular carcinoma (HCC) in a further 10 years [9]. Hepatitis C virus is associated with the seropositivity of the human immunodeficiency virus infection [2]. There are some reports which indicate the burden of transfusion-transmissible viral infections in Ethiopia. However, there are several localities including the current study area in which prevalence and trends yet not determined. Therefore, this study was aimed to determine the seroprevalence of HIV, Hepatitis B and C virus among blood donors at the University of Gondar Comprehensive Specialized Hospital., Gondar, Ethiopia.

One of the main recommendations of the WHO to achieve a safe and sufficient blood supply is the collection of blood from voluntary regular non-remunerated donors who have a lower risk of TTIs compared to family replacement and commercial donors. In this study, the overall prevalence of HIV among blood donors in the last three years at University of Gondar compressive specialized Hospital blood bank, 2.5% is lower than previous studies conducted Ethiopia, 3.8 and 11.79% [16, 25], in Cameroon, 2.9 and 4.1% [12, 23], in Dares salaam, 3.8% [13], in Mozambique, 8.5% [24], in Nigeria, 2.8, 6.2 and 3.1% [17, 26, 27]. However, the overall prevalence of HIV in this study, 2.5% was higher as compared to the prevalence of HIV in Ethiopia, 1.4, 0.25 and 0.1% [18, 37, 39], in Netherland, 0.06% [10], in Nepal, 0.12% [11], in the University Clinics of Kinshasa of Democratic Republic of the Congo, 2.2% [2], in Saudi Arabia, 0% [14], in Istanbul, Turkey, 0.008% [28], in Kathmandu, Nepal, 0.007% [29], in Pakistan, 0.007, 0.25, 0.017 and 0.09% [30, 35, 38, 40], in Delhi, 0.56% [31], in Kashan, Iran, 0% [32], in southeastern Anatolia, 0.0004% [33], in India, 0.27 and 0.39% [34, 42], in Koudougou, 2.21% [36], in Lahore, 0.05% [41]. This variation of seroprevalence of TTIs from other studies might be due to due to difference in the characteristics of the study population, geographical distribution and diagnostic techniques.

The prevalence of HBV in this study among University of Gondar Hospital blood bank blood donors, 4.1% in line with the previous study in Pakistan, 4.0% [30]. The prevalence of HBV among blood donors in the present study, 4.1% was higher when compared with studies on blood donors in Netherlands, 0.215% [10], and in Nepal, 0.46 and 0.007% [11, 29], in Saudi Arabia, 1.5% [14], in Istanbul, Turkey, 1.76% [28], in Delhi, 2.23% [31], in Kashan, Iran, 0.5% [32], in southeastern Anatolia, 3.17% [33], in India, 1.38 and 1.41% [34, 42], in Pakistan, 2.51, 2.35 and 1.9% [35, 38, 40], in Ethiopia, 1.2% [37], in Lahore, 1.7% [41], and lower than a study in Ethiopia, 25 and 10.9% [25, 39], in Cameroon, 10.3 and 10.1% [12, 23], in Dares salaam, 8.8% [13], in Mozambique, 10.6% [24], in Nigeria, 10 and 18.6% [26, 27], in Koudougou, 14.96% [36]. The reasons for the relatively lower or higher rate of seroprevalence of HBV in this study as compared to other studies might be the improvement in diagnostic technology might make current screening reagents to be more specific and reliable; the economic status of the country and the geographical differences in prevalence.

The seroprevalence of HBV detected in the age groups of 20–29, 1.9% (113/5983) and 30–39 years, 0.9% (54/5983) was higher than other age groups. The risk of HBV infection among age groups 20–29 was 1.5 times higher compared with other age groups. This study was similar to the previous reports in Kathmandu, Nepal [11], Amhara and Tigray regional states, Ethiopia [15]. HBV seroprevalence was highest in these age groups might be due to the different risk behaviors in these age groups. HBV infection by gender distribution showed that the prevalence of HBV among males, 3.64% was higher than the females, 0.43%. A higher seroprevalence rate among male donors than the female blood donors might be due to risk behaviors of males, such as outside socialization, multiple sex relationships and may also be due to fewer females donating blood; hence fewer females are screened compared to males.

The prevalence of HCV in this study was 1.6% in blood donors. This study showed a similar prevalence rate with the study in Amhara and Tigray regional states, Ethiopia, 1.7% [15], in Dares salaam, 1.5% [13], in Abidjan Cote d'Ivoire, 1.5% [22], in Antananarivo, Madagascar, 1.6% [19] and in Nigeria, 1.5% [26]. However, this study showed higher prevalence than a study in Ethiopia, 0.7, 0.32 and 0.4% [16, 37, 39], in Netherland, 0.488% [10], Nepal, 0.64 and 0.48% [11, 29], in the University Clinics of Kinshasa of Democratic Republic of the Congo, 1.3% [9], Saudi Arabia, 0.4% [14], Istanbul, Turkey, 0.07% [28], in Delhi, 0.66% [31], in Kashan, Iran, 0.5% [32], in southeastern Anatolia, 0.64% [33], in India, 0.54 and 0.84% [34, 42]. But this HCV prevalence in this study lower than a study in Ethiopia, 13.3% [25], Cameroon, 4.8% [23], in Pakistan, 3.3, 5.14, 3.26, 2.61% [30, 35, 38, 40], in Nigeria, 6% [27], in Koudougou, 8.69% [36] and in Lahore, 7.69% [41]. This difference in prevalence of HCV from other studies might be due to the difference in characteristics of the study population, geographical distribution and diagnostic techniques.

The seroprevalence of HCV was detected in the age groups of 20–29, and 30–39 years was 0.7% (42/5983) & 0.55% (33/5983), respectively which is higher as compared to other age groups. The difference is statistically significant (p = 0.003). Which shows, the risk of HCV in the age group 20–29 increased by 93% compared with other age groups. This finding in line with other studies [20, 21]. The risk of HCV infection in young age increment might be due to a higher habit of alcohol drinking, having multiple sexual partners and intravenous drug users among young age groups.

HCV infection by gender distribution showed that male had a 1.5% prevalence which shows higher than their female counterparts, 0.15%. This finding similar to the finding of seroprevalence HCV among blood donors in Gondar [16] and in Madagascar [19]. High prevalence of HIV, HBV, and HCV co-infection was detected among blood donors and five cases showed the presence of three markers (HIV, HBV, and HCV). The HIV–HBV co-infection rate was 50%, the HIV–HCV co-infection rate was 24%, the HBV–HCV co-infection rate was 26% and HIV–HBV- HCV co-infection rate was 8.6%. It might be due to a similar mode of transmission, namely through sexual activity, blood and blood products, sharing of needles to inject drugs and co-infection with the impairment of the immune system.

The trends in transfusion-transmitted infections (TTIs) in blood donors tend to decrease in this study, HIV, HBV, and HCV went from 3.3, 5.2, and 1.4% in September 2014 – August 2015, 2.6, 5.2, and 2.3% in September 2015 – August 2016 and 1.7, 4.0 and 1.3% in September 2016 – September 2017 respectively, compared with those in the previous studies [13, 22]. But the seroprevalence of HCV was not constantly decreased in this study. The lower prevalence and decreasing trend TTIs in this study might be due to the increment of awareness on the prevention measures, the disease, and modes of prevention.

A large percentage of the blood donors harbor transfusion-transmissible infections, 8.2% with at least one screened pathogen and 0.96% with multiple infections. The prevalence of TTI infection high for all blood donors especially for age groups such as 20–29 and 30–39 years. Therefore, strict selection of blood donors with the emphasis on getting voluntary donors and highly sensitive and specific tests for screening of donors’ blood for HIV, HBV, and HCV using standard methods are highly recommended to ensure the safety of blood for the recipient. The prevalence of HIV-HBV, HIV-HCV, and HBV-HCV co-infection need to be studied on a larger scale for a better understanding of the impact on clinical condition and treatment response.