title: Frequency of hepatitis C and D super infection in patients with hepatitis B related complex liver disorders.
abstract: OBJECTIVE
  To determine the frequency of super infection of hepatitis C and D in patients with hepatitis B related complex liver disorders and the distribution of HBV genotypes in these patients.
  
  
  METHODS
  Descriptive study.
  
  
  METHODS
  The Gastroenterology Unit of PMRC in JPMC, Karachi, from July 2006 to June 2007.
  
  
  METHODS
  All patients registered for HBV associated infections were selected. Blood was drawn from 180 patients who fulfilled the inclusion criteria. Those with an incomplete test profile were excluded. All clinical conditions were investigated through liver function tests, coagulation profile, and findings at abdominal ultrasonography, upper gastrointestinal endoscopy and liver biopsy. Liver cirrhosis and hepatocellular carcinoma (HCC) were diagnosed either on the basis of histology, or on a combination of radiological, endoscopic and laboratory data. Hepatitis B virus DNA was extracted from serum, and subjected to a nested PCR using the type specific primers for HBV genotype. Descriptive statistics were used for frequency and mean determination.
  
  
  RESULTS
  The 129 patients finally selected for statistical analysis included 108 (84%) males and 21 (16%) females. The age ranged from 6- 68 years (mean=31.5 +/-12.39 years). There were 70 (54.2%) patients of non-cirrhotic, chronic hepatitis (CLD), 38 (29.4%) carriers, 12 (9.3%) cirrhotics and 9 (6.9%) HCC patients. Among the 129 patients, 45 (34.9%) were positive for double infection with HDV. These included 35 CLD cases, 7 cirrhotic and 3 carriers, 4 (3.1%) patients were positive for double infection with HCV including one with CLD, 2 with cirrhosis and one with HCC. Triple infection with HBV/HDV/HCV was present in 4 (3.1%) patients who had CLD. Approximately 59% (n=76) patients were not coinfected, though 9 had developed HCC. The genotype distribution of HBV was observed as D in 98 (76%) patients, A in 24 (18.6%), and AD mix in 7 (5.4%). Genotypes B, C, E or F were not found. Accordingly, genotype D strains were the predominant strains among all categories.
  
  
  CONCLUSIONS
  The frequency of super infection of hepatitis C and D was found to be highest in HBV cirrhosis patients compared to patients having chronic liver disease (non-cirrhotics) and carriers. Genotype D of hepatitis B virus was found dominant in all hepatitis B related complex liver disorders.
authors.affiliation: Department of Biochemistry, Ziauddin Medical College, Ziauddin University, 4/B Shah-e-Ghalib, Block 6, Clifton, Karachi. baigsaeeda@yahoo.com
authors.forename: Saeeda
authors.initials: S
authors.lastname: Baig
authors.forename: Anwar Ali
authors.initials: AA
authors.lastname: Siddiqui
authors.forename: Waqar Uddin
authors.initials: WU
authors.lastname: Ahmed
authors.forename: Huma
authors.initials: H
authors.lastname: Qureshi
authors.forename: Ambreen
authors.initials: A
authors.lastname: Arif
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D006528:Carcinoma, Hepatocellular / Q000453:epidemiology; D002648:Child; D005260:Female; D006509:Hepatitis B / Q000150:complications; D006526:Hepatitis C / Q000453:epidemiology*; D003699:Hepatitis D / Q000453:epidemiology*; D006801:Humans; D008103:Liver Cirrhosis / Q000453:epidemiology; D008107:Liver Diseases / Q000453:epidemiology* / Q000821:virology; D008113:Liver Neoplasms / Q000453:epidemiology; D008297:Male; D008875:Middle Aged; D010154:Pakistan / Q000453:epidemiology; D015163:Superinfection / Q000453:epidemiology*; D055815:Young Adult