PREVALENCE OF HEPATITIS B, C VIRUSES AND HUMAN IMMUNODEFICIENCY VIRUS IN PATIENTS WITH HAEMATOLOGICAL MALIGNANCIES IN LAGOS

Abstract

BACKGOUND: Patients with haematological malignancies are immuno depressed as a result of the disease process and chemotherapeutic interventions. The immunodepression may lead to reawakening of latent viral infections. Co-morbid conditions like viral infections will increase both the severity of morbidity and mortality. Information on reawakening of infections is vital for planning a comprehensive management of patients. OBJECTIVES: (i) to determine the prevalence of hepatitis B, C and HIV in patients with haematological malignancies. (ii) To determine any relationship between liver function tests and the viral status of the patient during treatment. SUBJECTS AND METHODS: Patients diagnosed by clinical and laboratory parameters to have haematological malignancies were recruited into the study. Convenience sampling method was used. Informed consent was obtained before a questionnaire was administered by interviewing patient. Questionnaire on risk that may predispose to acquisition of HBV, HCV and HIV infections was administered. Voluntary blood donors were recruited into the study as controls. Blood sample was collected from each subject into sterile universal bottle as well as EDTA bottle; serum was separated from each sample within 1 hour of collection and kept frozen at -20oC in aliquots. Each subject’s serum was screened before commencement of chemotherapy for: (i) Hepatitis B surface Antigen (HBsAg),(ii) Hepatitis B core antibody (HBcAb) (iii)Hepatitis B envelope Antigen (HBeAg) (iv)Hepatitis C virus antibodies and (v)HIV antibodies. All the tests were by third generation ELISA. Each subject’s serum was also assayed for liver enzymes: - ALT, AST, alkaline phosphatase, bilirubin, total protein and albumin levels, using the standard provided by the manufacturers before and after chemotherapy. RESULTS: A total of 88 subjects were recruited into the study. These were
made up of 42 patients with different types of haematological malignancies and
46 healthy blood donor controls. The male: female ratio for patients with
haematological malignancies was 1:1.5. The peak age was 56 years with a range
of 50-59years. Chronic lymphocytic leukemia (CLL) is the commonest (13 of 42)
haematological malignancy in the study followed by Non Hodgkin’s Lymphoma
(NHL) (9 of 42).
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Prevalence of HBsAg for the patient group (14.3%) is not significantly different
from 21.3% for the blood donor controls P>0.05. Only 2 patients were HBeAg
positive and both of them had NHL, none (0%) of the control was HBeAg positive.
HBcAb is prevalent in both the control and patient population. Twenty five
(54.3%) of 46 controls and 20(50%) of 40 patients tested for HBcAb were positive
respectively (P= 0.68). HIV prevalence rate among patients was 4.8% (2 of 42).
There is a mild elevation of AST post chemotherapy. The mean values of urea
and other measured tests of liver functions pre and post chemotherapy were not
significantly different. Two(10%) of the 20 subjects who had history of blood
transfusion were HIV infected while none of the 68 with no history of blood
transfusion were HIV infected.( 2=2.31, P=0.22).
CONCLUSIONS: There is a biochemical evidence of hepatic injury defined as
ALT>50 IU/L in patients with haematological malignancies on cytotoxic
chemotherapy.There is no biochemical evidence of reactivation(AST>200
IU/L) after a two point measurement of hepatic markers.