PREVALENCE OF HEPATITIS G VIRUS AMONG PATIENTS WITH CHRONIC LIVER DISEASE AND HEALTHY INDIVIDUALS, SANA'A CITY-YEMEN

Objective: Hepatitis G virus (HGV) is a newly discovered and enveloped RNA positive-stranded flavivirus-like particle, which has not yet been proven to have major negative effects on liver. Therefore, it is important to estimate the prevalence and risk factors of hepatitis G virus infection in Yemeni viral hepatitis patients and general population to design standard prevention and treatment plans. Methods: Screening HGV antibodies among 60 chronic HBV and 144 chronic HCV patients comparing with its prevalence in 218 healthy controls were carried out. Serum samples were collected and tested for human HGV IgG by commercially available ELISA technique. Demographic data such as gender, age, and risk factors of contracting HGV virus were recorded in predesigned questionnaire. Results: The crude prevalence rate of HGV was 2.8%, female specific rate was 0% and male specific rate was 3.5%. The prevalence of HGV among HBV patients was 0%; HCV was 1.4% while in healthy individuals it was 4.6%. When age groups considered, the prevalence of HGV among age groups 20-29 years and 30-39 years was 3.5%, while in older age groups the rate of HGV was 0%. There was a trend towards increased levels of HGV infection with the second and third decades of life (3.5%). There was no significant association between HGV infection and risk factors of hepatitis viruses. Conclusion: It can be concluded from this study that HGV virus is circulating in the risk groups and in the community in general Yemen, and there is a possibility that this virus may at some time become epidemic if preventive measures are not applied. The risk of community among healthy people more than in risk groups as HBV and HCV patients. Additionally HGV increases with young male adults.


INTRODUCTION
From 1995 to 1996, two independent laboratories in the USA isolated a new enveloped RNA virus similar to flavi viruses. The first laboratory named it GB virus C/GBV-C and the second as hepatitis G virus (HGV) 1 . HGV is a virus in the flaviviridae family and known to be infectious for human, but it has not been established to cause human disease with certainly 2 . However, there is a suspicious link between HGV infection and acute or fulminant hepatitis, chronic hepatitis and hepatic fibrosis 3, 4 . High prevalence is observed among subjects with risk of parenteral exposure including those with exposure to blood and blood products 5 . Approximately, 2% of healthy United States blood donors had viremia with HGV and up to 13% of blood donors had antibodies against E2 protein, indicating a possible prior infection 6 . Sexual contact and vertical transmission could be another route of HGV transmission 6 . Furthermore, HCV and HBV infected patients have evidence of higher rate of HGV infection 7,8 . However, none of the studies indicated that HGV infection can cause any liver enzyme elevation or hepatic failure certainly, but co-infection with other hepatitis viremia can increase morbidity and mortality rates 9 . HGV prevalence rate among healthy and the role of this agent in acute and chronic liver disease in Yemen is absent or at least poorly understood, so this study was carried out as one of the first study to detected the prevalence rate of HGV /GBV-C among HBV and HCV infected patients comparing with healthy controls, and risk factors of transmission ISSN: 2456-8058 2 CODEN (USA): UJPRA3 HGV/GBV-C and the co-infection with HBV and HCV in Yemen.

Statistical Analysis
To relate possible risk factors for HGV infection, the data were examined in a case-control study format. For HGV, persons with evidence of previous or current infection with HGV (antibodies-positive) were matched up with those who were HGV antibodies negative.

Ethical Consideration
Ethical clearance for the study was taken from the Faculty of Medicine and Health Sciences Research Review Committee. Informed Consent was taken from the volunteers before the collecting specimens.

RESULTS
The crude prevalence rate of HGV was 2.8%, female specific rate was 0% and male specific rate was 3.5%.  (Table 3). Associated Odds ratio of HGV: There were significant risk factors of HGV with males in which the rate was 3.5%, while in female the rate was 0% (p<0.001). In respect of age groups, there were no significant risk factors of HGV (Table 2). In respect of risk factors, there were no significant risk factors of HGV with usual risk factors of hepatitis G virus (Table  4).

DISCUSSION
The     individuals were enrolled and selected randomly, the calculated prevalence data for hepatitis G in them are reliable. However, in general, all results published showed that hepatitis G infection was uncommon in healthy individuals, and this was also confirmed by current study. The specific female prevalence of HGV was 0% among both patients and healthy control females, while male prevalence was 3.5 %. Current study result was different to the sex distribution of HGV /GBV-C infection in western countries where equal distribution is the feature in all reports 22, 23 . In addition; the present study showed that there was trend toward increased levels of HGV /GBV-C infection with the second, and the third decades of life where the rates were 3.5% , with OR=1.4, and 7.1% with OR=2.95 respectively. This similar to findings in prospective study of 2796 hemodialysis patients seen in Germany 24 which reported that higher prevalence of HGV /GBV-C were in the 3 rd decades of life among hemodialysis patients. The increasing of prevalence rate with increasing age in current study could indicate an accumulation risk of infection over time. There was no significant association between HGV /GBV-C infection and history of all parenteral transmission routes (Table 4), and this opposite to the findings by Fogeda et al., 25 and Basaras et al., 26 that prior factors were risk factors for HGV /GBV-C in Spain and Germany.

CONCLUSION
It can be concluded from this study that HGV virus is circulating in the risk groups and in the community in Sana'a city, and there is a possibility that this virus may at some time become epidemic if preventive measures are not applied. The risk of exposure to HGV increases with advancing age, and no significant risks of contracting HGV through parenteral transmission.