oa Molecular Diagnosis and Vaccines - TTV infection among hemodialysis patients in Egypt: relation to schistosomiasis and Hepatitis C virus co-infections
Patients on haemodialysis (HD) are a high-risk group for blood-borne infections. TTV is a new parenterally transmitted DNA virus and little is known about its pathogenic role and its endemic situation. It was our intent to determine the prevalence of TT virus in a population of Egyptian patients on HD, to evaluate its possible route (s) of transmission and its clinical impact especially relation with HCV infection and schistosomiasis as two endemic health problems of a great social and economic impact in Egypt. Seventytwo patients on maintenance HD and 24 healthy blood donors (control group) were tested for: TTV-DNA by heminested PCR using primers NG059, NG061 and NG063 from the ORF1 region. HBsAg, and anti-hepatitis C by ELISA-2. HCV-RNAby nested PCR with primers directed to the highly conserved 5' non-coding region. TTV-DNA was detected in 51.4% (37/72) of patients and in 25% (6/24) of the blood donors (p= 0.03). Eightyone percent (30/37) of TTV-DNA positive patients reported history of blood transfusion compared to 42.9% (10/35) of TTV-DNA negative patients (p= 0.001). Also, patients with TTV-viremia had significantly lower hemohglubin level than patients without TTV-viremia (p= 0.001). No significant difference was found between the two groups as regards age, gender, liver function tests, HCV infection, history of schistosomiasis, or duration of dialysis. TTV was present alone in 25%, of the patients, as a co-infection with HCV in 26.4%, while HCV infection was present alone in 31.9%. Mean ALT level in patients with HCV/TTV co-infection was significantly higher than that in patients with TTV alone (41 32 vs. 23 18, p= 0.04) but not in patients with HCV alone Mean hemoglobin level in patients with HCV/TTV co-infection was significantly lower than that in patients with HCV alone (8.8 vs. 10.1 gm/dl, p= 0.001) but not in patients with TTV alone. No significant differences were detected between patients with mixed TTV/HCV and either single TTV, or single HCV as regards age, history of schistosomiasis, blood transfusion, duration of HCV or duration of dialysis. In conclusions: TTV infection is common among Egyptian patients on HD; its high prevalence is significantly related to blood transfusion suggesting that it is very likely the route of TTV transmission in such patients; TTV infection in Egyptian HD patients is unrelated to either HCV infection of schistosomiasis; TTV alone, does not induce liver function abnormalities. Finally, the real clinical impact and epidemiological relevance are still unclear and in need for further studies.
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