The table 3 shows the details of gender and age wise distribution of HBsAg Positive, HIV and HCV reactive patients.  In the present study seropositivity was more in males followed by females. Considering the age group, a higher seroprevalence was observed in 41-50 year and 51-60 years followed by 31-40 years and 61-70 years among HBsAg positive patients.  A higher seroprevalence was observed in 31-40 years followed by 41-50 years in anti HIV 1&2 reactive patients.  A higher seroprevalence was observed in 51-60 years followed by 41-50 years and 61-70 years among  HCV reactive patients.

Table 3: Gender and age wise distribution of HBsAg positive, HIV and HCV reactive patients from 2007 to 2014 (8 years).

The table 4 shows the details of the department wise distribution of the HBsAg positive, HIV & HCV reactive patients. Some of the important points from the table 4 are i) Majority of the HBsAg positive Inpatients belonged to the following departments: Cardiology, neurosurgery, orthopedics, oncology, gastroenterology and nephrology and internal medicine, ii) Majority of the HBsAg positive out patients belonged to the following departments: Cardiology, gastroenterology, internal medicine,  surgical gastroenterology,  orthopedics, nephrology and health checkup, iii) Majority of the HIV reactive inpatients belonged to the following departments: Cardiology, neurosurgery, orthopedics, neurology, internal medicine and pulmonology, iv) Majority of the HIV reactive out patients belonged to the following departments: Internal medicine, cardiology, casualty, pulmonology, orthopedics and nephrology, v) Majority of the HCV reactive inpatients belonged to the following departments: Cardiology, nephrology, orthopedics, neurosurgery, gastroenterology and cardiothoracic unit, vi) Majority of the HCV reactive out patients belonged to the following departments: Gastroenterology, nephrology, cardiology, surgical gastroenterology, infertility clinic, crthopedics and neurosurgery.

Table 4: Department wise distribution of HBsAg positive, HIV and HCV reactive patients from 2007 to 2014 (8 years).

Discussion

The study was carried out to document the seroprevalence of HBsAg, anti HIV 1&2 & anti HCV in patients attending to KIMS hospital, Secunderabad, Telangana, 1,00,590 patients were screened 1,805 (1.79 %) were positive for HBsAg. 92,819 patients screened 501 (0.53%) were reactive for HIV 1&2 antibodies. 61,072 screened 744 (1.21%) were reactive for HCV infection.

In the screening method, when HBsAg was found to be positive, it was confirmed by one more method of testing with enzyme linked immuno fluorescence assay (ELFA). A sample which was tested positive in two different screening methods was reported as positive for HBsAg. The ELFA is qualitative test 100% sensitivity, 100% specificity.

In this study, HBsAg seroprevalence was 1.79 %. In a previous study, Lodha et al. (2001) in their review article on hepatitis B epidemiology have suggested the true prevalence rate in India as 1-2% [13]. The prevalence of HBsAg in different regions of our country varies widely, and the highest prevalence has been reported from the aborigine population of Andaman as well as from Arunachal Pradesh [21]. The prevalence of hepatitis B varies from country to country and depends upon a complex mix of behavioral, environmental, and host factors. Sood et al. has noted 0.87% prevalence in a study of HBsAg prevalence in hospital based population [14]. Our data confirms the endemicity of HBV infection in Telangana region; and shows that this is a problem that poses a risk to health care workers.

The seroprevalence of HBsAg among males and females was 1.8% (1,384/72,869) and 1.5% (421/27,721) respectively. Most of the studies have reported higher prevalence among males which was also found in our study. Sood et al. has reported the prevalence of 1.04% and 0.58% respectively for males and females. Dutta et al. has reported prevalence of 35.3% in males and 19.3% in females [22]. Singh et al. has noticed prevalence to be 0.65% and 0.25% respectively in males and female subjects [23]. No plausible explanation has been given for the higher prevalence in males in the general population but it is hypothesized that females probably clear the HBV more efficiently in comparison to males [24]. In the present study seropositivity was higher in 41-50 year and 51-60 years followed by 31-40 years and 61-70 years. Similar findings were found by Sood et al. [14].

In the screening method, when anti HIV 1&2 was found to be reactive, it was confirmed by two more methods of testing with enzyme linked immuno fluorescence assay and immunochromatography (ICT) rapid visual test (HIV TRI-DOT) in a step wise order. A sample which was tested reactive in three different methods was reported as reactive for anti-HIV 1&2.

The WHO & UNAIDS recommends three criteria for choosing an HIV testing strategy: i) Objective of the test (transfusion/ transplant , safety, surveillance, diagnosis of HIV infection), ii) Sensitivity and specificity, iii) HIV prevalence in the population being tested.

Strategy III requiring 3 test for use in diagnosis in population with an HIV prevalence ≤10% among asymptomatic. The selection of testing technologies and the order in which they are used are important for obtaining valid results. First, the test should contain different antigen. Second the sensitivity of the first test should be as high as possible. The first test is the screening test, so it is necessary to use a highly sensitive test to detect all positives. Because a few false positives will occur, the second test (confirmatory test) needs to be highly specific to ensure that all truly negative test results are identified as negative.

Based on ELFA technology, VIDAS DUO Ultra was used. It is a screening test for the combined detection of anti HIV 1 (group M&O) and anti HIV 2 total immunoglobulins and HIV 1 p24 antigen. It is qualitative test 100% sensitivity, 100% specificity. The immunochromatography is a qualitative test and visual read results and differentiates between HIV1 & HIV 2 with 100% sensitivity and 100% specificity.

In this study, the antibodies to HIV prevalence were 0.53 %. The seroprevalence of antibodies to HIV in tertiary care hospital in Jaipur was reported to be 0.35% [14]. The seroprevalence of HIV antibodies among 183,912 persons screened in a teaching tertiary care hospital in Haryana was reported to be 0.64% [15].

 In the present study, seropositivity was more in males 0.59%) (382/63,720) compared to females 0.40% (119/29,099) and age wise highest prevalence was observed in 31-40 years followed by 41-50 years which was comparable with Sood et al. [14]. In a study on HIV seroprevalence in a hospital-based population in Secunderabad (Andhra Pradesh), 4.3% males and 2% females tested positive for HIV and the highest seroprevalence was reported in males and females of age group 21–30 years [26].

In the screening method, when anti HCV was found to be reactive, it was confirmed by one more method of testing with chemiluminescent microparticle immunoassay (CMIA)/ enzyme linked immuno fluorescence assay. A sample which was tested reactive in two different methods was reported as reactive for anti-HCV.

In this study, the HCV prevalence of 1.21% was observed. This seroprevalence is lower than the 1.7% seroprevalence reported in an earlier study from Jaipur (Rajasthan) in 2007 [16]. In India, the seroprevalence of HCV varies among hospital-based populations with 1.57% reported from Cuttack (Orissa) [17], 4.8% from Pondicherry [18], and 2.46% from Jodhpur (Rajasthan) [19].

Geographical variation in the seroprevalence of HCV has also been documented [20]. The seroprevalence of HCV among males and females was 1.29% (512/39,441) and 1.07% (232/21,631) respectively. In the present study seropositivity was higher in 51-60 years followed by 41-50 years and 61-70 years. Similar observations were made by Sood et al [14]. However, Ramarokoto et al., in their study on the seroprevalence of hepatitis C in urban areas of Madagascar reported that the prevalence did not differ significantly according to the gender but it increased with age [25].

 Conclusion

Our study gives us the observed rates of the blood borne transmissible viruses among the patients attending to a tertiary care hospital and the importance of screening the viral markers. This study serves a basis of knowledge for the possibility of viral transmission to the community as well as health care workers (HCW). This emphasizes all that HCWs should adhere to universal precautions, including the appropriate use of hand washing, protective barriers, and care in the use and disposal of needles and other sharp instruments and should also comply with current guidelines for disinfection and sterilization of reusable devices used in invasive procedures. 

 Acknowledgements

We would like to acknowledge KIMS hospital for giving us the opportunity to carry out the study.

 Conflict of Interest

The authors declare no conflict of interest.