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ABO/Rh Blood Groups and Risk of HIV Infection and Hepatitis B Among Blood Donors of Abidjan, Côte D’ivoire

ABO/Rh Blood Groups and Risk of HIV Infection and Hepatitis B Among Blood Donors of Abidjan, Côte... European Journal of Microbiology and Immunology 5 (2015) 3, pp. 205–209 Original article DOI: 10.1556/1886.2015.00029 ABO/Rh BLOOD GROUPS AND RISK OF HIV INFECTION AND HEPATITIS B AMONG BLOOD DONORS OF ABIDJAN, CÔTE D’IVOIRE 1, 2,3 4 5 Liliane Kouabla Siransy , Zizendorf Yves Nanga , Flore Sandrine Zaba , Nyasenu Yawo Tufa , Sery Romuald Dasse Immunology–Allergology Department, UFR Medical Sciences, Felix Houphouet Boigny University, Abidjan, Côte d’Ivoire Faculty of Pharmaceutical and Biological Sciences, Felix Houphouet Boigny University, Abidjan, Côte d’Ivoire National Public Health Laboratory, Abidjan, Côte d’Ivoire Bacteriology–Virology Department, Central Laboratory of the University Hospital of Yopougon, Côte d’Ivoire Laboratory of Microbiology – CNR/HIV, University Hospital Sylvanus Olympio, Togo Received: August 22, 2015; Accepted: August 24, 2015 Hepatitis B and HIV infection are two viral infections that represent real global public health problems. In order to improve their management, some hypotheses suggest that genetic predispositions like ABO and Rh blood groups would inf luence the occurrence of these diseases. The aim of the present study was to examine the association between ABO and Rhesus blood groups and the susceptibility to HIV infection and hepatitis B. We conducted a cross-sectional and analytical study in a population of voluntary blood donors in the Blood Transfusion Center of Abidjan. All blood donors who donated blood between January and June 2014 were tested for HBs antigen and anti-HIV anti- bodies (ELISA tests) and were ABO typed. The total number of examined blood donors during this period was 45,538, of which 0.32% and 8.07% were respectively infected with HIV and hepatitis B virus. O-group donors were more infected than non-O donors. Our study is an outline concerning the search for a link between ABO and Rh blood groups and hepatitis B and HIV infection. Further studies should be conducted to confirm the interaction between these two infections and contribute to the search for new therapeutic approaches. Keywords: ABO blood group, Rh blood groups, HIV infection, hepatitis B, blood donors, Côte d’Ivoire Introduction d’Ivoire, with a prevalence of HBs antigen estimated at over 10% in the general population, is at a level of high AIDS pandemic has become in the space of 20 years a endemicity [4]. real development problem for almost all African countries Hepatitis B and HIV infection having the same modes because it affects the most active age group of the popu- of transmission, both infections are favored by various risk lation (15–49 years) [1]. With over 34 million deaths to factors. Indeed, some evidence suggests that genetic fac- date, HIV continues to be a major public health problem. tors like ABO and Rh blood groups would infl uence the In 2014, 1.2 million people died of HIV-related causes in occurrence of these viral infections. the world. Sub-Saharan Africa is the most affected region With the discovery of blood groups by Landsteiner and with almost 70% of new infections. The prevalence in subsequent great advancement in its study, many work- Côte d’Ivoire was 3.7% in the general population [2]. ers have tried to fi nd out a possible relationship between Moreover, despite the existence of an effective vac- the incidence of these blood groups and the incidence of cine, hepatitis B also remains a global public health prob- various diseases [5]. Thus, a strong association has been lem, with more than 350 million people with chronic described between peptic ulcer disease and blood group hepatitis and about 1 million deaths annually [3]. Côte O; between stomach cancer, pernicious anemia, diabetes * Corresponding author: Liliane Kouabla Siransy; Immunology–Allergology Department, UFR Medical Sciences, Felix Houphouet Boigny University, Abidjan, Côte d’Ivoire; Phone: (225) 01 05 07 34; E-mail: lilianesiransy@yahoo.fr ISSN 2062-8633 / $ 20.00 © 2015 The Author(s) 206 L. K. Siransy et al. mellitus and blood group A [6]; and between hepatocel- Study population lular carcinoma and blood group A [7]. A study in Nigeria in 2015 also proved the existence of a link between asthma All voluntary blood donors (old and new donors) un- and blood group A [8]. In the fi eld of dermatology and derwent clinical evaluation, which excluded individu- venereology, potential associations have also been shown als at risk for sexually transmitted diseases, drug use, between lichen planus and blood group A, pemphigus and anemia, infection, fever, or chronic diseases. Multitrans- seborrheic dermatitis and blood group B, and vitiligo and fused people, donors with an age outside acceptable lim- blood group AB [5]. its (18–65 years), with low weight (≤50 kg), lactating The association between hepatitis B or HIV infection women, and menstruating or pregnant women were also and ABO has also been the subject of some publications excluded. [9, 10]. Socio-demographic characteristics of selected blood However, no data on this association is available in donors were centralized in the database (PROGESA; Côte d’Ivoire. Considering the lack of studies addressing MAK; Computer Version 14; France) of the Blood Trans- this issue, the aim of the present study was to analyze the fusion Center. Blood donors were divided into new donors frequency of HIV infection and hepatitis B and the odds of and regular donors. New donors were voluntary blood do- being infected in a population of blood donors according nors who had accumulated less than two (2) blood dona- to donors’ ABO blood group antigen and antibody profi le. tions until the fi rst half of 2014. Regular donors were those Blood donors are ideal for this purpose, as all donors who had a number of donations higher or equal to two (2) are routinely subjected to ABO blood group antigen and during the same period. antibody typing and laboratory tests to detect these two infections [11]. Laboratory analysis Materials and methods Serology of blood donors This study was part of prospective investigations on ABO All collected blood donations were tested for HBs antigen and Rhesus blood groups at the Blood Transfusion Center and anti-HIV antibodies. in Abidjan (the economic capital of Côte d’Ivoire). This – HIV seropositivity was tested on blood donors sera, us- town is one of the largest and most populous cities of ing HIV Ab/Ag ELISA Kit (DIA.PRO, Italy), enzyme Côte d’Ivoire, between 500 miles and one million inhabit- immunoassay test for the detection of anti-HIV1, anti- ants. It was a cross-sectional and analytical study that was HIV2, anti-HIV1 group O antibodies, and P24 antigen conducted from January to June 2014. The study was ap- of HIV1; as per manufacturer’s manual; and Genie III proved by the local ethical committee. for HIV typing. Fig. 1. Distribution of blood donors infected with HIV and hepatitis B virus according to blood groups European Journal of Microbiology and Immunology ABO/Rh blood groups and risk of HIV infection and hepatitis B 207 – HBs antigen detection was performed by technical lection sites were predominantly schools and vocational enzyme immunoassay of “sandwich” type, using the training, followed by hospitals and health facilities. ELISA HBs Antigen Ultra Kit (DIA.PRO, Italy). The age group from 25 to 44 years was the most rep- resented, with a predominance of male donors (sex ratio: ABO and Rhesus blood grouping 4.79). The incidence of blood group A, B, AB, and O was found to be 22.51%, 23.53%, 4.40%, and 49.74%. The ABO and Rhesus blood grouping were performed simul- incidences of Rh-positive and Rh-negative blood groups taneously with reagents (anti-A, anti-B, anti-AB, and an- were found to be 97% and 3%. Hepatitis B was the infec- ti-D) from Diagast Laboratory. Red blood cell agglutina- tion most found among blood donors (8.07%). 0.32% of tion method was used for analysis of blood groups. Both donors were infected with HIV, with a predominance of Beth Vincent globular test and Simonin–Michon plasmatic HIV type 1 (73.76%). test were used. The highest frequencies of infected donors (hepatitis B and HIV infection) were observed in blood group O (Fig. 1). Statistical analysis In our study, ABO blood groups did not increase the risk of developing hepatitis B (Table 1). Also, there was no The data derived from this study were analyzed using Ex- statistical association between ABO blood groups and HIV cel software and Epi Info version 6.0. Odds ratios (OR) infection (Table 2). In addition, the Rh system had no ef- for and against hepatitis B and HIV infection based on fect on HIV infection and hepatitis B (Table 3). However, ABO and Rhesus blood groups and the respective 95% the highest frequencies of these infections were observed confi dence interval (CI) for blood groups were estimated. in Rh positive. Table 1. Infl uence of ABO blood groups on HBs serology HBs Ag + HBs Ag − OR IC (95%) P O 2,044 27,578 0.99 [0.13–1.05] 0.17 Others (A, B, AB) 2,075 27,630 A 947 12,299 1.04 [0.96–1.12] 1.13 Others (O, B, AB) 3,172 42,909 B 941 12,943 0.99 [0.92–1.07] 0.09 Others (O, A, AB) 3,178 43,206 AB 187 2,575 0.98 [0.84–1.14] 0.1 Others (O, A, B) 3,932 52,820 Table 2. Inf luence of ABO blood group on HIV status HIV + HIV − OR IC (95%) O 86 29,536 1.04 [0.77–1.41] 0.06 Others (A, B, AB) 83 29,622 A 36 13,206 0.96 [0.66–1.39] 0.06 Others (O, B, AB) 131 45,950 B 34 13,850 0.82 [0.56–1.19] 1.02 Others (O, A, AB) 135 45,308 AB 11 2,564 1.54 [0.83–2.84] 1.92 Others (O, A, B) 158 56,594 Table 3. Inf luence of Rh system on HBs serology Results HBs Ag + HBs Ag − The total number of voluntary blood donors was 45,538, Rh positive 7,217 80,984 of which 26,965 were new donors and 18,573 were regular Rh negative 490 6,025 donors. A total of 73,398 donations were recorded during Total 7,707 87,009 our study period, with 63% from regular donations. Col- European Journal of Microbiology and Immunology 208 L. K. Siransy et al. Discussion diagnosis of hepatitis B among blood donors, it would make sense to add other markers of infection for screening The Blood Transfusion Center is the structure in charge (for example, to detect occult infections). These results are of the transfusion activity in Côte d’Ivoire. Its main mis- lower than those of the regional blood transfusion center sion is to ensure the adequate supply of the whole coun- of Koudougou in Burkina Faso [17] that reveal rates of try in blood products while ensuring blood safety. Blood 2.21% and 14.96%, respectively, for HIV infection and trans fusion is only possible with blood donations. Indeed, hepatitis B. giving blood is an act of generosity and solidarity that is However, the low prevalence of HIV infection in our saving every year thousands of lives. study could be justifi ed by a rigorous selection to remove Donations recorded during our study period at the blood donors with infectious risk factors. Blood Transfusion Center of Abidjan were mainly from Furthermore, our study showed no correlation between regular donations. This loyalty of blood donors in the do- ABO blood groups and hepatitis B, and between ABO nation has multiple reasons: fi rstly, save lives and also en- blood groups and HIV infection. joy the benefi ts of regular blood donors. Our results are consistent with those of Emeribe and Volunteer blood donors in our series were relatively Ejezie [10], who found no signifi cant association between young. This result is superimposed on that obtained in a ABO blood group distribution and the presence of HBs study in Côte d’Ivoire in 2013 [12], where blood donors antigen (P greater than 0.05). Also, a study in Australia of the blood transfusion center of Abidjan were also dom- in 1971 [9] showed that, when the sample size was large inated by this age of the population (30–39 years). This enough, there was no difference in the distribution of ABO predominance of young people seems to be related to in- blood groups among HBs antigen carriers and noncarriers. creased awareness of the blood transfusion center on the However, the highest prevalence of hepatitis B and importance of blood donation in Côte d’Ivoire. HIV infection was found in group O blood donors, as Males were highly prevalent in our study with a sex confi rmed by the work of Emeribe and Ejezie [10], who ratio of 4.79. This result is corroborated by other studies. reported a higher prevalence of HBs antigen in donors of Thus, in a study in the blood transfusion center of Bouaké, group O (4.3%) against the 0% frequency for group AB in Côte d’Ivoire in 2001 [13], blood donors were mostly donors. Our results are also stackable with those of a study male (sex ratio: 2.75). In addition, a study in the blood conducted in Liverpool [18] during a circumscribed out- transfusion center in Abidjan in 2013 [12] reported a sex break of hepatitis B among patients and staff of a hemo- ratio of 2.19 in favor of men. This predominance of male dialysis unit, where a disproportionate excess of group O donors could be due to the different contraindications of was found. This suggests that host factors may be impor- blood donation among women: pregnant women, nursing tant in the genesis of the disease. or menstruating. Furthermore, in the study of Sayal in 1996 [5] about In our study, blood donors were mostly of blood group subjects of the armed forces, a relatively increased inci- O and Rh positive. Our results are superimposed with dence of HIV infection was observed in persons with blood those of a 2009 study on phenotypic and genotypic fre- group O and relatively lower incidence in blood group B. quencies of ABO and Rh systems in the Ivorian population Incidence of HIV infection was also low in Rh-negative [14]. The authors had reported frequencies of blood group subjects. These results suggest a possible relationship be- A: 22.6%, B: 22.12%, AB: 3.94%, O: 51.27%, Rh posi- tween the incidence of blood group and the natural defense tive: 93.30%, and Rh negative: 6.70%. mechanism against HIV infection. The level of natural In endemic high-prevalence countries such as Côte antibodies in humans may be different in different ABO d’Ivoire, certain viral infections including hepatitis B and blood groups. One would assume that those in group B HIV infection pose a serious threat in blood recipients. would have a higher degree of natural resistance against Thus, in order to ensure universal access to safe blood and HIV while those of group O have a lesser degree of this blood products, WHO recommends routine screening for natural resistance. transfusion-transmissible infections with quality assurance However, results contrary to ours were reported in oth- in all blood donations before their use. The prevalence of er studies. Thus, Zuckerman and McDonald [19] found an these infections in blood donations in high-income coun- excess of group A and a corresponding defi cit of group O tries is signifi cantly lower than in low- and middle-income in 378 cases of acute hepatitis during a probable outbreak countries [13]. Thus, in our study, the seroprevalence of of hepatitis B in the British Air Force. Moreover, a study HIV infection and hepatitis B was 0.32% and 8.07%, re- conducted in 2013 on Brazilians infected with HIV [11] re- spectively. This is confi rmed by the work of Assi et al. in vealed that the highest proportion of people infected with 2011 [15], who have reported a prevalence of 8% of HBs HIV has been observed in those of blood group B. The antigen in Abidjan. Hepatitis B was the infection most lowest proportion was observed in groups A and O. found. Ehoussou [16] found a slightly higher rate (12.5%) One explanation for the low prevalence of blood group in military blood donors. These rates refl ect the high en- O in these two studies is given by Dr. Heinrich Kremer. demicity of hepatitis B in the population of blood donors. According to him, patients belonging to blood group B, It confi rms that of the general population in Côte d’Ivoire. A, and AB would present the highest risk of developing a Since HBs antigen is the principal marker sought for the freely convertible protons defi ciency or systemic diseases. European Journal of Microbiology and Immunology ABO/Rh blood groups and risk of HIV infection and hepatitis B 209 They would be more willing to Th1–Th2 switches in favor K: ABO blood group and the risk of hepatocellular carci- noma: a case-control study in patients with chronic hepati- of Th2, compared to O blood group donors. The advantage tis B. PLoS One 7, (2012) would be a better antibody production and the drawback 8. Alo MN, Eze UA, Yaro SA, Jubril B, Nwanoke NN: Rela- would be a decreased cellular immunity. This would result tionship between ABO and Rhesus blood groups and sus- in greater susceptibility to transition to seropositivity [20]. ceptibility to asthma within Sokoto Metropolis, Nigeria. Int J Immunol 3, 37– 41 (2015) 9. Szmuness W, Prince AM, Cherubin CE: Serum hepatitis Conclusion antigen (SH) carrier state: relation to ABO blood groups. Br Med J 2, 198–199 (1971) Our study revealed no association between ABO and Rh 10. Emeribe AO, Ejezie GC: ABO blood groups distribution in blood groups and viral infections (hepatitis B and HIV relation to hepatitis B surface antigen and the presence of infection). However, the highest frequency of infected lipoidophil antibodies. East Afr Med J 69, 146 –1488 (1992) 11. Onsten TGH, Callegari-Jacques SM, Goldani LZ: The donors was observed in blood group O. It would be ad- higher frequency of blood group B in a Brazilian popula- visable to conduct further studies to confi rm the link be- tion with HIV infection. Open AIDS J 7, 47–50 (2013) tween these two parameters in Côte d’Ivoire, to identify 12. N’dri N, Thot’o AS, Okon AJ, Assi C, Allah-Kouadio E, the mechanisms by which ABO antigens may infl uence the Soro D, Diakité M, Koné A, Koné S, Lohouès-Kouacou occurrence of these two viral infections, and to contribute MJ, Camara BM: Prevalence of HBs Ag among blood do- to the search for new therapeutic approaches. Furthermore, nors in Transfusion Center, Abidjan (Ivory Coast). Open J the high frequency of hepatitis B observed in our study Gastroenterol 3, 165–169 (2013) could be lowered by raising awareness of vaccination 13. Kra O, N’dri N, Ehui E, Ouattara B, Bissagnene E: Préva- against hepatitis B among blood donors. lence de l’antigène HBs chez les donneurs de sang au centre régional de transfusion sanguine de Bouaké (Côte d’Ivoire) en 2001. Bull Soc Pathol Exot 100, 127–129 (2007) 14. Dembélé B, Inwoley K, Kouamé K, Siransy B, Diane M, Conflicts of interest Kpangni J: Les fréquences phénotypiques et génotypiques des systèmes ABO et Rhésus (d) dans la population ivoi- The authors declare that they have no confl icts of interest. rienne. Cah Santé Publique 8, 41– 49 (2009) 15. Assi C, Allah-Kouadio E, Ouattara A, Diakité M, Koné S, Lohoues-Kouacou MJ, Camara BM: Vaccination coverage References against the hepatitis B and prevalence of HBs Ag: a cross- sectional study involving 592 persons attending public 1. PNPEC: Care Guide for People Living with HIV, p. 93 screening in Abidjan. Clin Res Hepatol Gastroenterol 35, (2009) 506 –507 (2011) 2. World Health Organization, VIH/SIDA. Checklist No. 360 16. Ehoussou K, Tiembre I, Benie J, N’doutabe M, Dagnan S, (2015) Djeha D, Tagliante-Saracino J: Évaluation de la séropréva- 3. Aubry P: Hépatites virales en zones tropicales. Actualités lence de l’infection à VIH et à VHB chez les donneurs de 2012. Med Trop, 8 (2013) sang militaires à Abidjan. Med Afr Noire 44, 12 (1997) 4. Enel C, Desgrées LA, N’dri Yoman T, Danel C, Larma- 17. Sanou M: Séroprévalence des VIH, VHB, VHC et syphilis range J: Les hépatites virales B et C en Côte d’Ivoire: l’ur- chez les donneurs de sang au centre régional de transfusion gence d’une dynamisation de la lutte. J Afr Hepatol Gastro- sanguine de Koudougou au Burkina Faso en 2009. Transfus enterol 10, 1–5 (2015) Clin Biol 18, 338– 419 (2011) 5. Sayal SK, Das AL, Nema SK: Study of blood groups in 18. Lewkonia RM, Ronald F: ABO blood group distribution in HIV seropositive patients. Ind J Derm Ven Lepr 62, 295– serum hepatitis. Br Med J 3, 268–269 (1969) 297 (1996) 19. Zuckerman AJ, Mcdonald JC: ABO blood groups and acute 6. Roberts F: Blood groups and susceptibility to disease: a re- hepatitis. Br Med J 31, 537–538 (1963) view. Br J Prev Soc Med 11, 107–125 (1957) 20. Ehlers H: Interview du Docteur Heinrich Krener sur le 7. Qiang Li CY, Jin-Hong Y, Li Liu, Shuang-Shuang X, Wen- SIDA et le cancer. Raum & Zeit No. 114 (2001) Wen L, Xia Y, Wen-Bo F, Zhong-Tao G, Shi-Jun C, Naoya European Journal of Microbiology and Immunology http://www.deepdyve.com/assets/images/DeepDyve-Logo-lg.png European Journal of Microbiology & Immunology Pubmed Central

ABO/Rh Blood Groups and Risk of HIV Infection and Hepatitis B Among Blood Donors of Abidjan, Côte D’ivoire

European Journal of Microbiology & Immunology , Volume 5 (3) – Sep 18, 2015

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© 2015, The Author(s)
ISSN
2062-509X
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2062-8633
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10.1556/1886.2015.00029
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Abstract

European Journal of Microbiology and Immunology 5 (2015) 3, pp. 205–209 Original article DOI: 10.1556/1886.2015.00029 ABO/Rh BLOOD GROUPS AND RISK OF HIV INFECTION AND HEPATITIS B AMONG BLOOD DONORS OF ABIDJAN, CÔTE D’IVOIRE 1, 2,3 4 5 Liliane Kouabla Siransy , Zizendorf Yves Nanga , Flore Sandrine Zaba , Nyasenu Yawo Tufa , Sery Romuald Dasse Immunology–Allergology Department, UFR Medical Sciences, Felix Houphouet Boigny University, Abidjan, Côte d’Ivoire Faculty of Pharmaceutical and Biological Sciences, Felix Houphouet Boigny University, Abidjan, Côte d’Ivoire National Public Health Laboratory, Abidjan, Côte d’Ivoire Bacteriology–Virology Department, Central Laboratory of the University Hospital of Yopougon, Côte d’Ivoire Laboratory of Microbiology – CNR/HIV, University Hospital Sylvanus Olympio, Togo Received: August 22, 2015; Accepted: August 24, 2015 Hepatitis B and HIV infection are two viral infections that represent real global public health problems. In order to improve their management, some hypotheses suggest that genetic predispositions like ABO and Rh blood groups would inf luence the occurrence of these diseases. The aim of the present study was to examine the association between ABO and Rhesus blood groups and the susceptibility to HIV infection and hepatitis B. We conducted a cross-sectional and analytical study in a population of voluntary blood donors in the Blood Transfusion Center of Abidjan. All blood donors who donated blood between January and June 2014 were tested for HBs antigen and anti-HIV anti- bodies (ELISA tests) and were ABO typed. The total number of examined blood donors during this period was 45,538, of which 0.32% and 8.07% were respectively infected with HIV and hepatitis B virus. O-group donors were more infected than non-O donors. Our study is an outline concerning the search for a link between ABO and Rh blood groups and hepatitis B and HIV infection. Further studies should be conducted to confirm the interaction between these two infections and contribute to the search for new therapeutic approaches. Keywords: ABO blood group, Rh blood groups, HIV infection, hepatitis B, blood donors, Côte d’Ivoire Introduction d’Ivoire, with a prevalence of HBs antigen estimated at over 10% in the general population, is at a level of high AIDS pandemic has become in the space of 20 years a endemicity [4]. real development problem for almost all African countries Hepatitis B and HIV infection having the same modes because it affects the most active age group of the popu- of transmission, both infections are favored by various risk lation (15–49 years) [1]. With over 34 million deaths to factors. Indeed, some evidence suggests that genetic fac- date, HIV continues to be a major public health problem. tors like ABO and Rh blood groups would infl uence the In 2014, 1.2 million people died of HIV-related causes in occurrence of these viral infections. the world. Sub-Saharan Africa is the most affected region With the discovery of blood groups by Landsteiner and with almost 70% of new infections. The prevalence in subsequent great advancement in its study, many work- Côte d’Ivoire was 3.7% in the general population [2]. ers have tried to fi nd out a possible relationship between Moreover, despite the existence of an effective vac- the incidence of these blood groups and the incidence of cine, hepatitis B also remains a global public health prob- various diseases [5]. Thus, a strong association has been lem, with more than 350 million people with chronic described between peptic ulcer disease and blood group hepatitis and about 1 million deaths annually [3]. Côte O; between stomach cancer, pernicious anemia, diabetes * Corresponding author: Liliane Kouabla Siransy; Immunology–Allergology Department, UFR Medical Sciences, Felix Houphouet Boigny University, Abidjan, Côte d’Ivoire; Phone: (225) 01 05 07 34; E-mail: lilianesiransy@yahoo.fr ISSN 2062-8633 / $ 20.00 © 2015 The Author(s) 206 L. K. Siransy et al. mellitus and blood group A [6]; and between hepatocel- Study population lular carcinoma and blood group A [7]. A study in Nigeria in 2015 also proved the existence of a link between asthma All voluntary blood donors (old and new donors) un- and blood group A [8]. In the fi eld of dermatology and derwent clinical evaluation, which excluded individu- venereology, potential associations have also been shown als at risk for sexually transmitted diseases, drug use, between lichen planus and blood group A, pemphigus and anemia, infection, fever, or chronic diseases. Multitrans- seborrheic dermatitis and blood group B, and vitiligo and fused people, donors with an age outside acceptable lim- blood group AB [5]. its (18–65 years), with low weight (≤50 kg), lactating The association between hepatitis B or HIV infection women, and menstruating or pregnant women were also and ABO has also been the subject of some publications excluded. [9, 10]. Socio-demographic characteristics of selected blood However, no data on this association is available in donors were centralized in the database (PROGESA; Côte d’Ivoire. Considering the lack of studies addressing MAK; Computer Version 14; France) of the Blood Trans- this issue, the aim of the present study was to analyze the fusion Center. Blood donors were divided into new donors frequency of HIV infection and hepatitis B and the odds of and regular donors. New donors were voluntary blood do- being infected in a population of blood donors according nors who had accumulated less than two (2) blood dona- to donors’ ABO blood group antigen and antibody profi le. tions until the fi rst half of 2014. Regular donors were those Blood donors are ideal for this purpose, as all donors who had a number of donations higher or equal to two (2) are routinely subjected to ABO blood group antigen and during the same period. antibody typing and laboratory tests to detect these two infections [11]. Laboratory analysis Materials and methods Serology of blood donors This study was part of prospective investigations on ABO All collected blood donations were tested for HBs antigen and Rhesus blood groups at the Blood Transfusion Center and anti-HIV antibodies. in Abidjan (the economic capital of Côte d’Ivoire). This – HIV seropositivity was tested on blood donors sera, us- town is one of the largest and most populous cities of ing HIV Ab/Ag ELISA Kit (DIA.PRO, Italy), enzyme Côte d’Ivoire, between 500 miles and one million inhabit- immunoassay test for the detection of anti-HIV1, anti- ants. It was a cross-sectional and analytical study that was HIV2, anti-HIV1 group O antibodies, and P24 antigen conducted from January to June 2014. The study was ap- of HIV1; as per manufacturer’s manual; and Genie III proved by the local ethical committee. for HIV typing. Fig. 1. Distribution of blood donors infected with HIV and hepatitis B virus according to blood groups European Journal of Microbiology and Immunology ABO/Rh blood groups and risk of HIV infection and hepatitis B 207 – HBs antigen detection was performed by technical lection sites were predominantly schools and vocational enzyme immunoassay of “sandwich” type, using the training, followed by hospitals and health facilities. ELISA HBs Antigen Ultra Kit (DIA.PRO, Italy). The age group from 25 to 44 years was the most rep- resented, with a predominance of male donors (sex ratio: ABO and Rhesus blood grouping 4.79). The incidence of blood group A, B, AB, and O was found to be 22.51%, 23.53%, 4.40%, and 49.74%. The ABO and Rhesus blood grouping were performed simul- incidences of Rh-positive and Rh-negative blood groups taneously with reagents (anti-A, anti-B, anti-AB, and an- were found to be 97% and 3%. Hepatitis B was the infec- ti-D) from Diagast Laboratory. Red blood cell agglutina- tion most found among blood donors (8.07%). 0.32% of tion method was used for analysis of blood groups. Both donors were infected with HIV, with a predominance of Beth Vincent globular test and Simonin–Michon plasmatic HIV type 1 (73.76%). test were used. The highest frequencies of infected donors (hepatitis B and HIV infection) were observed in blood group O (Fig. 1). Statistical analysis In our study, ABO blood groups did not increase the risk of developing hepatitis B (Table 1). Also, there was no The data derived from this study were analyzed using Ex- statistical association between ABO blood groups and HIV cel software and Epi Info version 6.0. Odds ratios (OR) infection (Table 2). In addition, the Rh system had no ef- for and against hepatitis B and HIV infection based on fect on HIV infection and hepatitis B (Table 3). However, ABO and Rhesus blood groups and the respective 95% the highest frequencies of these infections were observed confi dence interval (CI) for blood groups were estimated. in Rh positive. Table 1. Infl uence of ABO blood groups on HBs serology HBs Ag + HBs Ag − OR IC (95%) P O 2,044 27,578 0.99 [0.13–1.05] 0.17 Others (A, B, AB) 2,075 27,630 A 947 12,299 1.04 [0.96–1.12] 1.13 Others (O, B, AB) 3,172 42,909 B 941 12,943 0.99 [0.92–1.07] 0.09 Others (O, A, AB) 3,178 43,206 AB 187 2,575 0.98 [0.84–1.14] 0.1 Others (O, A, B) 3,932 52,820 Table 2. Inf luence of ABO blood group on HIV status HIV + HIV − OR IC (95%) O 86 29,536 1.04 [0.77–1.41] 0.06 Others (A, B, AB) 83 29,622 A 36 13,206 0.96 [0.66–1.39] 0.06 Others (O, B, AB) 131 45,950 B 34 13,850 0.82 [0.56–1.19] 1.02 Others (O, A, AB) 135 45,308 AB 11 2,564 1.54 [0.83–2.84] 1.92 Others (O, A, B) 158 56,594 Table 3. Inf luence of Rh system on HBs serology Results HBs Ag + HBs Ag − The total number of voluntary blood donors was 45,538, Rh positive 7,217 80,984 of which 26,965 were new donors and 18,573 were regular Rh negative 490 6,025 donors. A total of 73,398 donations were recorded during Total 7,707 87,009 our study period, with 63% from regular donations. Col- European Journal of Microbiology and Immunology 208 L. K. Siransy et al. Discussion diagnosis of hepatitis B among blood donors, it would make sense to add other markers of infection for screening The Blood Transfusion Center is the structure in charge (for example, to detect occult infections). These results are of the transfusion activity in Côte d’Ivoire. Its main mis- lower than those of the regional blood transfusion center sion is to ensure the adequate supply of the whole coun- of Koudougou in Burkina Faso [17] that reveal rates of try in blood products while ensuring blood safety. Blood 2.21% and 14.96%, respectively, for HIV infection and trans fusion is only possible with blood donations. Indeed, hepatitis B. giving blood is an act of generosity and solidarity that is However, the low prevalence of HIV infection in our saving every year thousands of lives. study could be justifi ed by a rigorous selection to remove Donations recorded during our study period at the blood donors with infectious risk factors. Blood Transfusion Center of Abidjan were mainly from Furthermore, our study showed no correlation between regular donations. This loyalty of blood donors in the do- ABO blood groups and hepatitis B, and between ABO nation has multiple reasons: fi rstly, save lives and also en- blood groups and HIV infection. joy the benefi ts of regular blood donors. Our results are consistent with those of Emeribe and Volunteer blood donors in our series were relatively Ejezie [10], who found no signifi cant association between young. This result is superimposed on that obtained in a ABO blood group distribution and the presence of HBs study in Côte d’Ivoire in 2013 [12], where blood donors antigen (P greater than 0.05). Also, a study in Australia of the blood transfusion center of Abidjan were also dom- in 1971 [9] showed that, when the sample size was large inated by this age of the population (30–39 years). This enough, there was no difference in the distribution of ABO predominance of young people seems to be related to in- blood groups among HBs antigen carriers and noncarriers. creased awareness of the blood transfusion center on the However, the highest prevalence of hepatitis B and importance of blood donation in Côte d’Ivoire. HIV infection was found in group O blood donors, as Males were highly prevalent in our study with a sex confi rmed by the work of Emeribe and Ejezie [10], who ratio of 4.79. This result is corroborated by other studies. reported a higher prevalence of HBs antigen in donors of Thus, in a study in the blood transfusion center of Bouaké, group O (4.3%) against the 0% frequency for group AB in Côte d’Ivoire in 2001 [13], blood donors were mostly donors. Our results are also stackable with those of a study male (sex ratio: 2.75). In addition, a study in the blood conducted in Liverpool [18] during a circumscribed out- transfusion center in Abidjan in 2013 [12] reported a sex break of hepatitis B among patients and staff of a hemo- ratio of 2.19 in favor of men. This predominance of male dialysis unit, where a disproportionate excess of group O donors could be due to the different contraindications of was found. This suggests that host factors may be impor- blood donation among women: pregnant women, nursing tant in the genesis of the disease. or menstruating. Furthermore, in the study of Sayal in 1996 [5] about In our study, blood donors were mostly of blood group subjects of the armed forces, a relatively increased inci- O and Rh positive. Our results are superimposed with dence of HIV infection was observed in persons with blood those of a 2009 study on phenotypic and genotypic fre- group O and relatively lower incidence in blood group B. quencies of ABO and Rh systems in the Ivorian population Incidence of HIV infection was also low in Rh-negative [14]. The authors had reported frequencies of blood group subjects. These results suggest a possible relationship be- A: 22.6%, B: 22.12%, AB: 3.94%, O: 51.27%, Rh posi- tween the incidence of blood group and the natural defense tive: 93.30%, and Rh negative: 6.70%. mechanism against HIV infection. The level of natural In endemic high-prevalence countries such as Côte antibodies in humans may be different in different ABO d’Ivoire, certain viral infections including hepatitis B and blood groups. One would assume that those in group B HIV infection pose a serious threat in blood recipients. would have a higher degree of natural resistance against Thus, in order to ensure universal access to safe blood and HIV while those of group O have a lesser degree of this blood products, WHO recommends routine screening for natural resistance. transfusion-transmissible infections with quality assurance However, results contrary to ours were reported in oth- in all blood donations before their use. The prevalence of er studies. Thus, Zuckerman and McDonald [19] found an these infections in blood donations in high-income coun- excess of group A and a corresponding defi cit of group O tries is signifi cantly lower than in low- and middle-income in 378 cases of acute hepatitis during a probable outbreak countries [13]. Thus, in our study, the seroprevalence of of hepatitis B in the British Air Force. Moreover, a study HIV infection and hepatitis B was 0.32% and 8.07%, re- conducted in 2013 on Brazilians infected with HIV [11] re- spectively. This is confi rmed by the work of Assi et al. in vealed that the highest proportion of people infected with 2011 [15], who have reported a prevalence of 8% of HBs HIV has been observed in those of blood group B. The antigen in Abidjan. Hepatitis B was the infection most lowest proportion was observed in groups A and O. found. Ehoussou [16] found a slightly higher rate (12.5%) One explanation for the low prevalence of blood group in military blood donors. These rates refl ect the high en- O in these two studies is given by Dr. Heinrich Kremer. demicity of hepatitis B in the population of blood donors. According to him, patients belonging to blood group B, It confi rms that of the general population in Côte d’Ivoire. A, and AB would present the highest risk of developing a Since HBs antigen is the principal marker sought for the freely convertible protons defi ciency or systemic diseases. European Journal of Microbiology and Immunology ABO/Rh blood groups and risk of HIV infection and hepatitis B 209 They would be more willing to Th1–Th2 switches in favor K: ABO blood group and the risk of hepatocellular carci- noma: a case-control study in patients with chronic hepati- of Th2, compared to O blood group donors. The advantage tis B. PLoS One 7, (2012) would be a better antibody production and the drawback 8. Alo MN, Eze UA, Yaro SA, Jubril B, Nwanoke NN: Rela- would be a decreased cellular immunity. This would result tionship between ABO and Rhesus blood groups and sus- in greater susceptibility to transition to seropositivity [20]. ceptibility to asthma within Sokoto Metropolis, Nigeria. Int J Immunol 3, 37– 41 (2015) 9. Szmuness W, Prince AM, Cherubin CE: Serum hepatitis Conclusion antigen (SH) carrier state: relation to ABO blood groups. Br Med J 2, 198–199 (1971) Our study revealed no association between ABO and Rh 10. Emeribe AO, Ejezie GC: ABO blood groups distribution in blood groups and viral infections (hepatitis B and HIV relation to hepatitis B surface antigen and the presence of infection). However, the highest frequency of infected lipoidophil antibodies. East Afr Med J 69, 146 –1488 (1992) 11. Onsten TGH, Callegari-Jacques SM, Goldani LZ: The donors was observed in blood group O. It would be ad- higher frequency of blood group B in a Brazilian popula- visable to conduct further studies to confi rm the link be- tion with HIV infection. Open AIDS J 7, 47–50 (2013) tween these two parameters in Côte d’Ivoire, to identify 12. N’dri N, Thot’o AS, Okon AJ, Assi C, Allah-Kouadio E, the mechanisms by which ABO antigens may infl uence the Soro D, Diakité M, Koné A, Koné S, Lohouès-Kouacou occurrence of these two viral infections, and to contribute MJ, Camara BM: Prevalence of HBs Ag among blood do- to the search for new therapeutic approaches. Furthermore, nors in Transfusion Center, Abidjan (Ivory Coast). Open J the high frequency of hepatitis B observed in our study Gastroenterol 3, 165–169 (2013) could be lowered by raising awareness of vaccination 13. Kra O, N’dri N, Ehui E, Ouattara B, Bissagnene E: Préva- against hepatitis B among blood donors. lence de l’antigène HBs chez les donneurs de sang au centre régional de transfusion sanguine de Bouaké (Côte d’Ivoire) en 2001. Bull Soc Pathol Exot 100, 127–129 (2007) 14. 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Med Trop, 8 (2013) sang militaires à Abidjan. Med Afr Noire 44, 12 (1997) 4. Enel C, Desgrées LA, N’dri Yoman T, Danel C, Larma- 17. Sanou M: Séroprévalence des VIH, VHB, VHC et syphilis range J: Les hépatites virales B et C en Côte d’Ivoire: l’ur- chez les donneurs de sang au centre régional de transfusion gence d’une dynamisation de la lutte. J Afr Hepatol Gastro- sanguine de Koudougou au Burkina Faso en 2009. Transfus enterol 10, 1–5 (2015) Clin Biol 18, 338– 419 (2011) 5. Sayal SK, Das AL, Nema SK: Study of blood groups in 18. Lewkonia RM, Ronald F: ABO blood group distribution in HIV seropositive patients. Ind J Derm Ven Lepr 62, 295– serum hepatitis. Br Med J 3, 268–269 (1969) 297 (1996) 19. Zuckerman AJ, Mcdonald JC: ABO blood groups and acute 6. Roberts F: Blood groups and susceptibility to disease: a re- hepatitis. Br Med J 31, 537–538 (1963) view. Br J Prev Soc Med 11, 107–125 (1957) 20. Ehlers H: Interview du Docteur Heinrich Krener sur le 7. Qiang Li CY, Jin-Hong Y, Li Liu, Shuang-Shuang X, Wen- SIDA et le cancer. Raum & Zeit No. 114 (2001) Wen L, Xia Y, Wen-Bo F, Zhong-Tao G, Shi-Jun C, Naoya European Journal of Microbiology and Immunology

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Published: Sep 18, 2015

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