In the present study, the prevalence of HB and HC among participants of the PERSIAN Guilan Cohort Study (PGCS) were 0.24% and 0.11%, respectively. Moreover, rural participants were significantly more HB positive, while male individuals were significantly more HC positive. HB positive patients had significantly lower platelet count, RDWCV, cholesterol, LDL, and LDL: HDL ratio and HC positive patients had significantly higher MCH, MCHC, AST, ALT, and HDL, and significant lower LDL and LDL: HDL ratio compared to related negative individuals.
The prevalence of HB and HC is very different worldwide, related to geographical region and demographic factors. In 2015, it has been reported that HB seroprevalence was 8.83% (0.48 - 22.38) in African region, 0.81% (0.20 - 13.55) in Americas region, 3.01% (0.67 - 14.77) in Eastern Mediterranean region, 2.06% (0.01 - 10.32) in European region, 1.90% (0.82 - 6.42) in South East Asian region, and 5.26% (0.37 - 22.70) in Western Pacific region (26). Also, there is much diversity in HB prevalence between different states/provinces of each country. Since 2006 when the national vaccination program for Iranian people born after 1993 was started and continued, an obvious decrease in the HB prevalence was seen (27). Therefore, Iran is classified as a low to intermediate prevalence areas (21). Although our detected HB infection rate is lower than the reported pooled prevalence of HB in Iran among the general population (2.2%) in 2016 (22). It is approximately similar to our previous report about volunteer blood donors (0.45 - 0.48%) (28) and to reported rates from Karaj (0.4%) (29), Kermanshah (0.7%) (30) and Kurdistan (0.8%) (31). Also, our reported HB infection rate is lower than those reported from Birjand (1.6%) (32), Tehran, Golestan, and Hormozgan (2.6% (33)), and Nahavand (2.3%) (34). In addition, some population sub-groups are more likely susceptible to have HB. For instance, in Guilan province, 71.3% of hemophiliacs (35), and 0.38 - 3.8 % of hemodialysis patients (36-38) were HB positive. We found that men are more HB positive than women (16 vs. 9 cases), which is similar to previous reports from Iran about a higher prevalence of HB infection in men (22, 39). Furthermore, the prevalence of HB and HC in Tulemat is higher than in other geographical areas of Someh’ E Sara. It might be related to the high number of drug abusers in this area compared to other areas. Based on the subgroup analysis, the prevalence of drug abuser among rural HB positive patients is higher compared to urban HB positive patients.
The pooled HC prevalence of 0.3%, 6.2%, and 32.1% was reported for general, intermediate- and high-risk Iranian populations, respectively (40). Again, diversities between different cities/provinces and subgroups are seen. It has been reported that all healthy adults of Isfahan and Mashhad, blood donors of Tehran, Ardabil, and Ahvaz, infertile male of Tehran, and male blood donors of Tabriz were HC negative (40). Our detected HC prevalence (0.1%) is lower than the pooled prevalence of HC among the general population of Iran (0.3%) (40) and is differed from the previous report from Rasht (0.03%) and Guilan (0.32%) (28). Also, our detected HC prevalence is lower than other reported prevalence from the Northern provinces of Iran. The prevalence of HC was 0.48% in Babol and 0.18% to 1.00% in Golestan. However, Zamani et al. reported a similar HC prevalence (0.08%) in the general population of Mazandaran province. Higher male HC positivity, as seen in our study, was also reported previously from Kerman, Zahedan, and Kavar. However, in opposite to our study, Ghadir et al. reported that females were more HC positive compared to males in the general population of Golestan (40, 41). The finding of one woman who her daughter also was HC positive and both had the same HC genotype highlighted the precise role of interfamilial HC transmission and confirmed the significant role of close relatives, which was reported previously (42).
Although we detected no significant associations between in most of demographic variables and prevalence of HB and HC, it seems that different demographic features of the population in different regions are the most important reasons for these differences in HB and HC prevalence. Based on Baig's study, the male to female ratio of HB increased during the reproductive years. There may be an influence of estrogen in the protection of hepatocytes against the development of chronic liver disease (43). In Zeng et al. study, married people had the highest prevalence of HBsAg (44). On the other hand. Ataei et al. demonstrated no statistical difference observed in terms of marital status in Isfahan province, but males (OR= 3.79) had a higher prevalence of HB than women (45).
Regarding biochemical analysis, we found some significant differences. A decrease in LDL level and subsequently LDL: HDL ratio in HB and HC positive patients is interesting. These are in line with those reported recently as significant hypolipidemia in patients with HB (46) and HC (47). Lower platelet count in HB positive, as we found in this study, also reported previously (48). It can be said that both HB and HC influenced the liver tissue, and the changes in biochemical and hematological parameters can be related to these changes in the hepatic functions.