Division of Rheumatology, Department of Internal Medicine and
1 Clinical Microbiology, Ege University School of Medicine, Bornova, zmir, Turkey
Correspondence to:
K. Aksu, 80 Sokak No: 27/3, 35040 Bornova, zmir, Turkey.
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Abstract |
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Methods. In addition to 124 patients [male:female (M/F): 73/51], all fulfilling the diagnostic criteria of the International Study Group for BD (1991), 14 patients with systemic necrotizing vasculitis (M/F: 7/7), 47 patients with ankylosing spondylitis (M/F: 36/11) and 51 healthy controls (M/F: 22/29) were also included in this study. Serological markers of four different types of hepatitis (anti-HAV IgM, total anti-HAV, HBsAg, anti-HBs, total anti-HBc, anti-HBc IgM, anti-HCV and anti-HEV) were studied in all cases.
Results. There was no difference between the groups with respect to HAV, HCV and HEV serologies. Anti-HBs positivity was observed less frequently in BD compared with healthy controls and systemic vasculitis (P<0.05).
Conclusion. Serological evidence of previous HAV, HCV and HEV infections was not significantly different between Behçet's patients and other groups. However, previous HBV infection was found in a significantly lower number of BD patients as compared with healthy controls and systemic vasculitic patients.
KEY WORDS: Behçet's disease, Hepatitis A virus (HAV), Hepatitis B virus (HBV), Hepatitis C virus (HCV), Hepatitis E virus (HEV), Prevalence
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Introduction |
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In this study, we aimed to determine the prevalence of hepatitis A (HAV), B, C and E (HEV) viruses in BD.
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Materials and methods |
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Sera were tested for total anti-HAV, anti-HAV IgM (AXSYM System, Abbott Diagnostics, USA), HbsAg, anti-HBc IgM and total anti-Hbc, anti-HBs (Organon Teknika, The Netherlands), anti-HCV (UBI, III generation, United Biomedical Inc., USA) and anti-HEV (Abbott Diagnostics, USA) antibodies. Sera were also tested for HCV antibodies by third-generation line immunoassay (LiaTek, HCV III, Organon Teknika, The Netherlands) when results of the enzyme immunoassay were positive. HCV RNA was tested by reverse transcription-polymerase chain reaction (RT-PCR) (Cobas Amplicor, Roche Diagnostic Systems, USA) in antibody-positive patients.
The data were evaluated under SPSSWIN by MannWhitney U, Wilcoxon, Fisher's exact test and Pearson analyses using a two-sided P value of <0.05 as the level of significance.
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Results |
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In the AS group, 95% (45/47) anti-HAV, 2% (1/47) anti-HEV, 23% (11/47) anti-HBc and anti-HBs positivity were found. Only one patient in this group was an HbsAg carrier, while no HCV positivity was detected.
In the healthy control group, the rate of previous HAV infection was 93% and HBV infection was 47%. Anti-HEV positivity was detected in 8% of the subjects. There were 4% HBsAg carriers and none with anti-HCV positivity. The rate of previous HBV infection was significantly lower with respect to the control group, BD (P=0.0428) and AS groups (P=0.0211). No significant difference was found between the BD patients and the other study groups regarding HAV, HCV and HEV prevalences.
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Discussion |
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On the other hand, we could find no study in the literature regarding the relationship of BD with HAV, HBV and HEV. HBV infection has been well known to contribute to the aetiopathogenesis of SV. Anti-HBs positivity, as evidence of previous HBV infection, was significantly higher in our SV group than the BD group. Since the mean age in the SV group was higher than in the other three groups, these patients may have been exposed to HBV more frequently, which might explain their higher anti-HBs positivity rate.
Several epidemiological studies performed in different parts of Turkey have reported anti-HBs prevalence to range between 20.6 and 56.3%, and the rate of the HBsAg carrier state to range between 3.9 and 12.5% [5]. Unfortunately, there was no study performed to search for the prevalence of anti-HBs positivity in zmir and the central Aegean of Turkey, where the patient population of our study was living. Being a unique SV, BD may also be expected to have a significantly higher frequency of HBsAg positivity, compared with normal controls. However, this was not the case in our study. Since ethnic differences are considerably higher in different parts of Turkey, this might have affected our results. Remembering the anti-HBs positivity rates in different regions of Turkey, the anti-HBs positivity rate of our healthy controls (47%), which is actually higher than that of our Behçet's group, is not unacceptably high.
The reason why anti-HBs positivity in BD and AS was lower than in healthy controls can be speculated on in two ways. Thirty-two out of 85 patients with anti-Hbs-negative BD had been receiving azathioprine treatment (2 mg/kg/day), as well as moderate doses of prednisolone (0.250.5 mg/kg/day). There were even some patients receiving pulse cyclophosphamide treatment. Since immunosuppressive treatment interferes with humoral immunity, this might well contribute to the reduction in titres of antibodies against HBsAg in patients with BD.
One of the mechanisms of transmission of HBV infection is sexual. Eighty-six per cent (n=106) of our patients with BD had recurrent genital ulceration. Genital ulceration might well prevent these patients from having frequent sexual intercourse.
HAV and HEV are both transmitted by the faecaloral route. HEV can cause fulminant hepatitis in the course of pregnancy, but none of the patients were pregnant during the study. In Turkey, seroprevalences of HAV and HEV in adults were reported to be 90 and 6%, respectively [6]. Similar rates have also been found in our study. Regarding positive HAV and HEV serology, there was no significant difference between BD and all the other groups, including healthy controls.
In conclusion, seroprevalences of HAV, HCV and HEV infections were not significantly different between Behçet's patients and other groups including healthy controls. While there was no significant difference between Behçet's patients and other groups with respect to HBsAg positivity, anti-HBs positivity in Behçet's patients was significantly lower than in the SV group. We may conclude that, despite the well-known role of hepatitis viruses in SV, BD does not seem to be related to these viruses.
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References |
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