Saudi Journal of Gastroenterology
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Year : 2000  |  Volume : 6  |  Issue : 2  |  Page : 79-83
Hepatitis G virus (HGV) infection in Saudi dialysis patients and healthy controls

1 Department of Medicine, King Khalid University Hospital, Riyadh, Saudi Arabia
2 Department of Family & Community Medicine, King Khalid University Hospital, Riyadh, Saudi Arabia
3 Department of Microbiology, King Khalid University Hospital, Riyadh, Saudi Arabia

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Date of Submission29-Nov-1999
Date of Acceptance02-Feb-2000


Background: Viral hepatitis is a global health problem with a high mortality rate. End stage renal disease (ESRD) patients have a high prevalence of Hepatitis B and C virus infection. Present study was done to identify the prevalence and course of a new isolate Hepatitis G virus (HGV) infection in Saudi dialysis patients. Methods: The pattern of viral hepatitis infection (HBV. HCV and HGV) was investigated in 109 Saudi patients with ESRD and 100 healthy Saudi blood donors. Donated blood was tested for markers of Hepatitis B, C and G viruses. Liver functions were measured and blood picture and liver biopsies were also performed at regular intervals. Results: Out of the 109 ESRD patients 68 (62.4%) were positive for at least one viral marker: 59 (54.1%) were positive for HCV, six (5.5%) were positive for HGV and three (2.8%) were positive for HBsAg. Four of the six HGV positive patients were also co-infected with HCV. Eight (8%) of the blood donors were positive for at least one viral marker. Elevated ALT levels (>4 times normal) were recorded in four out of the six HGV-positive patients including three co-infected with HCV. Conclusions: Our results are in agreement with similar studies from different countries and also raise the question about the causal relationship between HGV and liver disease among dialysis patients.

Keywords: Hepatitis G Virus, Hepatitis C Virus, Hepatitis B Virus, Dialysis

How to cite this article:
Mitwalli AH, Al Wakeel JS, Alam AA, Nauman T, Al Rashed RS, Ramia S. Hepatitis G virus (HGV) infection in Saudi dialysis patients and healthy controls. Saudi J Gastroenterol 2000;6:79-83

How to cite this URL:
Mitwalli AH, Al Wakeel JS, Alam AA, Nauman T, Al Rashed RS, Ramia S. Hepatitis G virus (HGV) infection in Saudi dialysis patients and healthy controls. Saudi J Gastroenterol [serial online] 2000 [cited 2022 Jun 25];6:79-83. Available from:

Viral hepatitis is a global health problem. Millions of individuals are infected with Hepatitis C (HCV) and hepatitis B (HBV), with an estimated mortality of over a million annually[1]. Patients with ESRD are at increased risk of viral hepatitis due to frequent blood transfusions and quite often due to breakdown of universal precautions in dialysis units. Despite the availability of diagnostic tests for detection of hepatitis C virus[2], there are still up to 5% of the patients whose posttransfusion hepatitis can not be attributed to hepatitis A, B, C, D or E viruses[3],[4]. Also some 4-20% of hepatitis cases in Europe and United States are associated with non-A through E hepatitis[5],[6] . Among the candidates for non-A through E viral hepatitis, the GB hepatitis agent was the one most extensively studied[7],[8]. The abbreviation GB stands for the initials of a surgeon who suffered acute sporadic hepatitis and whose serum on the third day of jaundice induced hepatitis in tamarins[9]. Recently two groups of researchers described independently the isolation of a new virus from the serum of patients with hepatitis. This virus is provisionally named hepatitis GBV-C[10],[11] or hepatitis G virus (HGV)[12]. Nucleotide sequences of the NS3 regions of HGV and GBV-C are 85% identical and the amino acid sequences are 100% identical, suggesting that HGV and HGV-C are independent isolates of the same virus and may belong to a distinct group of hepatitis viruses [10],[12] within the Flaviviridae family. The nomenclature of this virus has not been decided yet, but for the purpose of this article it will be referred to as HGV. In the Kingdom of Saudi Arabia 7% and 1-2% of adults are chronic carriers of HBV and HCV respectively[13],[14]. Among ESRD patients undergoing dialysis the seroprevalence of HBV infection was reported as high as 14% in 1994[15] while HCV infection was reported to be between 40-70%[16],[17] The aim of this study was to identify the prevalence of HGV and the pattern of HBV and HCV infection Saudi dialyzed-ESRD patients.

   Patients and Methods Top

Patients and controls:

This study took place between January and December of 1997, at the King Khalid University Hospital and Security Forces Hospital, Riyadh, Saudi Arabia and included 109 Saudi patients on dialysis. Both hospitals are well equipped and provide comprehensive care for ESRD patients. The control group included 100 healthy Saudi volunteers who visited the hospitals for blood donation and were chosen at random. These donors had no history of liver disease. Informed consent was also obtained from patients and controls and approval was obtained from the ethical committees at both hospitals.

Laboratory Methods:

Donated blood was tested for markers of Hepatitis B, C and G viruses. Biochemical markers of liver function including aspartate, alanine, transaminases and gamma glutamyl transpeptidases, bilirubin, alkaline phosphatase, and albumin were also measured. Commercially available kits using enzyme-linked immunosorbent assay (ELISA) were used for detecting HBsAg (Abbott Laboratories, North Chicago, Ill.) and anti-HCV (4B1 HCV EIA 4.0) (United Biomedical Inc. Beijing, China). The assay employs an immunosorbent that consists of synthetic peptides corresponding to highly antigenic segments of core, NS3, NS4 and NS5 regions of HCV, bound to wells of the microplate. Anti-HCV ­positive samples were additionally tested by a supplemented assay (Liatek HCV III, Organon Teknika N. V. Vedijk, Turnout, Belgium). The reverse transcriptase-polymerase chain reaction (RT­PCR) assay was used for detecting HCV-RNA. For HGV- RNA (Sorin Diagnostics S.r.1, HGV5'UTR; code:PSHGV5) was used, identification: sequence S 1-›3 1 (oligo ACIS: AGG GTT [GC] G ARTICLESARTICLES GGT [GC] GTAA ATCC and oligo 7AS: CAA GAG [AC] G [AG] CAT TCA AG [AG] GCGA). The one step PCR eliminated the possibility of carry­over contamination during the transfer for amplification. The PCR products were detected by DNA enzyme immunoassay (DEIA) and the absorbance measured with a photometer. The run (2.8%) was taken as valid when the ratio of DEIA positive control absorbance value to the DEIA negative control mean absorbance was > 10 (CP DEIA/CN DEIA > 10). Hybridization was recorded to have taken place whenever the test absorbance value was greater than the mean negative control value by at least 0.150 absorbance units, the results were recorded based on that. Data are presented as mean and range or standard deviation. The proportions of ESRD subjects with positive viral markers were detennined and compared with the respective proportions in the control group. The test of proportions (z statistics) was used for determining clinical significance and a probability value below 0.05 were considered significant.

   Results Top

Among the 109 ESRD patients investigated, 58 (53%) were males, and 51 (47%) were females. Seventy-eight (71.6%) were undergoing maintenance hernodialysis for 4.9 + 2.1 years, while 31 (28.4%) had peritoneal dialysis for 3.2 + 1.2 years (Table 1). All the blood donors were males (mean: age 38 years: ± 3.5 years). Out of 109 ESRD patients 68 (62.4%) were positive for at least one marker. Fifty­nine (54.1%) were positive for HCV, six (5.5%) for HGV and three (2.8%) for HBsAg (Table 2). Four of the six HGV positive patients were also co-infected with HCV. Eight (8%) of controls were positive for at least one viral marker: five (5%) for HBsAg, two (1.8%) for HCV and one (1%) for HGV (Table 2). Relevant information on HGV and HCV positive patients is shown in Table 3. Five of the HGV positive cases were <40 years of age, three had history of frequent blood transfusions and one was on peritoneal dialysis (Table 3). Elevated ALT levels (> 4 times normal) were recorded in four of six HGV positive patients including three co-infected with HCV. ALT levels were normal in all control subjects.

   Discussion Top

Our result of 1% infection rate for HGV in healthy blood donors was similar to earlier report of 2.5% by Shobokshi et al from Saudi Arabia [18] and that reported from many European countries [19],[20] , Japan [21] , Taiwan [22] and the United State [23] . The frequency of HGV infection in our dialysed patients was relatively lower than those reported in hemodialysis patients from other countries[24],[25],[26],[27] which ranged from 3.1-57.5%. The lowest (3.1%) was reported from Japan (26) and the highest (57.5%) was from France[27]. Both Japanese and French investigators found a positive association between the rate of HGV infection and the duration of dialysis and number of blood transfusions. The majority of our patients however, were younger than those in the two previously cited studies (< 40 years) and with a relatively shorter duration of dialysis (2.9 - 5.5 years). The finding that 4 out of the 6 HGV positive patients were also HCV-co- infected is in agreement with similar studies from other countries[23],[28],[29] suggesting some common mode of transmission of the two viruses Studies have shown that in HCV-positive patients co-infected with HGV, HGV had no apparent influence on the clinical course or clinical outcome of the disease. Moreover, ALT levels in those patients parallel those of disease activity related to HCV-RNA rather than those of HGV-RNA[30]. Furthermore, in patients with chronic HCV infection co-infected with HGV and underwent interferon therapy[31],[32], HGV did not influence the response to therapy and the rate of response to the therapy did not differ between patients with and without infection. Similarly the role of HGV in chronic or fulminant non A-E hepatitis is still controversial[33],[34],[35], It is worth mentioning that hundreds of thousands of units of blood contaminated with HGV were and are still given in transfusions every year but cases of fulminant hepatitis have not been reported [36]. The benignity of HGV infection has also been confirmed in dialysis patients where long persistence-up to 16 years-failed to show any evidence of liver disease[26]. It seems from this study and those of others that the causative relationship between HGV and liver disease still awaits a clearer answer. It is perhaps more accurate at this stage that HGV be still considered as an orphan flavivirus still looking for a human disease[36],[27]. Regarding HBV infection in our patients only 2.8% were HBsAg-positive compared to 5% in the blood donor group. Our results show that there has been a great reduction in HBsAg in dialysis patients during the past decade where HBsAg was reported to be as high as 14%[15]. This reduction has been mainly due to the introduction of the latest technologies for screening donated blood for HBsAg in addition to other important factors including strict infection control strategies, screening of patients and staff for HBsAg and vaccination of susceptible individuals, isolated rooms and machines for seropositive patients and prohibition of dialyzer reuse in such patients[37]. No doubt that the inclusion of HBV vaccine in the Expanded Program of Immunization (EPI) in 1990 by Saudi Ministry of Health will further reduce the rate of HBV infection in the Saudi population. In contrast to HBV infection the rate of HCV infection among our ESRD patients is still over 50% and is similar to earlier reports from the Kingdom of Saudi Arabia[16],[17]. It must be mentioned however, that most of our patients have been on dialysis before 1995, when effective screening programs for anti-HCV were been implemented at our institutions. Although some investigators suggest that HCV infection in dialysis unit could be nosocomial[38],[39] we believe that our continued effective screening of transferred blood in addition to strict infection control measures will lead to a drastic decline in the incidence of HCV among dialysis patients in the future. It is worth mentioning at this stage that since the major number of HGV infected patients are also HCV-coinfected, a control of HCV infection will undoubtedly lead to further reduction in the incidence of HGV infection.

   References Top

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Correspondence Address:
Ahmed Hassan Mitwalli
Department of Medicine (38), King Khalid University Hospital, P.O. Box 2925, Riyadh 11461
Saudi Arabia
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Source of Support: None, Conflict of Interest: None

PMID: 19864716

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