Frequency of viral infections in adolescent and adult in-patient Ethiopians with acute leukemia at presentation to a tertiary care teaching hospital: a cross-sectional study

Abstract

Background Leukemic patients are prone to infectious agents such as viruses due to dysregulated immune system resulting from infiltration of the bone marrow by malignant cells, chronic stimulation, reactivation of some viruses and viral pathogenicity as well as rarely from acquisition of a new infections leading to severe complications. However, the prevalence of these infections has not been systematically documented in resource-limited settings such as Ethiopia. Objective To determine the prevalence of HBV, HCV, and HIV among adult and adolescent in-patients with acute leukemia before the administration of chemotherapy, at the Tikur Anbessa Specialized Hospital (TASH) in Addis Ababa, Ethiopia. Methods A cross sectional study was conducted on 176 adult and adolescent inpatient Ethiopians, who were diagnosed with acute leukemia from April 2019 to June 2021. Socio-demographic characteristics and relevant clinical data were collected. Peripheral blood samples were collected and tested for HBV, HIV, and HCV using Enzyme-Linked Immunosorbent Assay (ELISA) and real-time PCR. Chi-square tests were used to assess associations between variables. Results Of the 176 patients, 109(62%) were males. The median age was 25[IQR,18–35] yr, with a range from 13 to 76 year. The prevalence of HBV (positivity for HBsAg plus HBV DNA), HCV and HIV was 21.6%, 1.7%, and 1.7%, respectively. HBsAg was positive in 19 cases (10.8%). Among 157 HBsAg negative patients, 52(33.1%) were positive for Anti-HBcAg; of these seropositive cases, 47.5% were positive for HBV DNA. Most DNA positive, HBsAg negative cases (79.0%) had DNA concentrations below 200 IU/ml indicating true occult HBV infection (OBI). Of the 176 cases, 122 had a history of blood transfusions, but no statistically significant association was found between HBV infection and blood product transfusion history (P = 0.963). Conclusions The prevalence of HBV, HIV and HCV in patients with acute leukemia was similar to the national prevalence level of these infections. Given the HBsAg positivity and the high prevalence of occult hepatitis B infection in our study, these patients may be at increased risk for chemotherapy related hepatitis flares. Hence, clinicians caring these patients are strongly advised to screen their patients for HBV and also for HIV and HCV infections routinely.

Seroprevalence of SARS-CoV-2 and Hepatitis B Virus Coinfections among Ethiopians with Acute Leukemia

“…Plasma samples were screened using an HBsAg enzyme immunoassay (HBsAg ELISA-Beijing Wantai Biological Pharmacy Enterprise Co., Ltd., Beijing, China), and negative samples were tested for both IgM and IgG using anti-HBcAg ELISA kits (Monolisa Anti-HBc PLUS, Bio-Rad, Marnes-la-Coquette, France). The plasma samples that tested positive for anti-HBcAg were further analyzed using PCR for HBV DNA [21].…”

“…Briefly, 200 µL of each plasma sample was subjected to DNA extraction, amplification, and detection at the molecular biology laboratory of ALERT hospital using a commercially available real-time PCR platform (Abbott Molecular Inc., 1300 East Touhy Avenue, Des Plaines, IL 60018 USA) with an Abbott m2000rt instrument, with a lower detection limit of <1.18 log IU/mL genome equivalent to 15 IU/mL, to determine occult hepatitis B infection (OBI). Microbiologically detectable HBV infection was defined as either HBsAg positive or HBsAg negative but HBV DNA positive [21].…”

“…Ltd., New Delhi, India) was used to screen for HIV to detect HIV-1 and/or HIV-2 and HIV-1 p24 antigen. Rapid tests using the Ethiopian national algorithm were again performed on positive samples: SD HIV 1/2 3.0, Standard Diagnostics, Inc. (Kyonggi-do, South Korea); ABON, Abon Biopharm Co., Ltd., (Hangzhou, China); and CHEMBIO, Chembio Diagnostic Systems, Inc. (Medford, NY, USA) [21].…”

“…Anti-HCV ELISA, Beijing Wantai Biological Pharmacy Enterprise Co., Ltd., Beijing, China, was used to screen for HCV. Positive samples were then examined using the Wondfo one-step fast antibody test for HCV, Guangzhou Wondfo Biotech Co., Ltd., Guangzhou, China [21].…”

“…We also tested plasma samples from leukemia patients for other viruses: HBV, hepatitis C virus (HCV), and human immunodeficiency virus (HIV) [21]. Out of a total of 110 cases, the prevalence of HBV infection was 22.7% (25/110).…”