{"id":59825,"date":"2024-09-30T10:18:46","date_gmt":"2024-09-30T10:18:46","guid":{"rendered":"https:\/\/biomedpharmajournal.org\/?p=59825"},"modified":"2024-10-09T18:49:18","modified_gmt":"2024-10-09T18:49:18","slug":"prevalence-of-human-pegivirus-infection-during-high-risk-pregnancy-and-its-vertical-transmission-to-the-newborn","status":"publish","type":"post","link":"https:\/\/biomedpharmajournal.org\/staging\/vol17no3\/prevalence-of-human-pegivirus-infection-during-high-risk-pregnancy-and-its-vertical-transmission-to-the-newborn\/","title":{"rendered":"Prevalence of Human Pegivirus Infection during High Risk Pregnancy and its Vertical Transmission to the Newborn"},"content":{"rendered":"\n

Introduction <\/strong><\/p>\n\n\n\n

Viral infections during pregnancy may lead to adverse pregnancy\noutcomes, including pregnancy loss, premature labor, congenital anomalies,\nmaternal and fetal mortality1<\/sup>.<\/p>\n\n\n\n

One of the main causes of acute and chronic liver diseases are hepatitis\nviruses A-E, but these viruses do not explain all cases of viral associated\nliver disease. Many evidence refer to the presence of another infectious agent\nfor example 0.4 percent of post \u2013 transfusion hepatitis is unexplained and\nclassified as non- A, non B, non- C hepatitis 2<\/sup>.<\/p>\n\n\n\n

Human pegivirus (HPgV-1), which was known as hepatitis G virus (HGV) or\nGB virus C (GBV-C) is a single \u2013 stranded positive RNA virus belonging to the\ngenus Pegivirus of Flaviviridae family 3<\/sup>. <\/p>\n\n\n\n

Concurrent\ninfection with HPgV-I and HCV is common, the prevalence of HPgV-1 in patients\nwith HCV infection undergoing liver transplant is 24% pre-transplantation and\n28% post- transplantation 4<\/sup>.<\/p>\n\n\n\n

It is documented that HPgV-1 can be transmitted parentally and sexual\ncontact may be another important route of transmission. Vertical transmission\nfrom infected mother to her newborn has been reported. HPgV-1 can cause acute and\npersistent infection in human. Persistent viremia has been documented in the\nabsence of transaminase elevation 5<\/sup>. HPgV-1 has been reported to be\ninvolved in the etiology of fulminant hepatic disease and others found no\nHPgV-1 in patient with fulminant liver disease 6<\/sup>. <\/p>\n\n\n\n

The role of HPgV-1 is little\nunderstood. The aim of\nour study was to assess the prevalence of HPgV-1 in pregnant female with\ndocumented HCV and those with history of previous blood transfusion. Also, to\nevaluate the possibility of maternal transmission to newborns and the effect of\nHPgV-1 on liver functions. <\/p>\n\n\n\n

Patients and Methods <\/strong><\/p>\n\n\n\n

Our study was done on 60 term pregnant females attending El Galaa Teaching Hospital and Medical Research Centre of Excellency, NRC. They were classified to: Group I 30 term high risk pregnant females which subdivided as: <\/p>\n\n\n\n

Group I (a): Comprised 18 term pregnant females with documented HCV infection. <\/p>\n\n\n\n

Group I (b): Comprised 12 term pregnant females with history of previous blood transfusion. <\/p>\n\n\n\n

Group II: 30 normal pregnant females with neither history of liver disease nor blood transfusion as a control group. <\/p>\n\n\n\n

Ethical Approval <\/strong><\/p>\n\n\n\n

The current study was carried out\nin accordance with the principles and regulations of the Helsinki’s\ndeclaration. Informed consent was taken from all patients before enrollment\nwith explanation of the type of the study. Approval from the Ethical Committee\nof General Organization of Teaching Hospital and Institutes was obtained. <\/p>\n\n\n\n

Venous blood were collected from each female of both groups for detection of HPgV-1 infection using RT-PCR technique. Serum was separated and stored at -70\u00b0C till the end of the study. Pregnant females proved to have HPgV-1 infection were subjected to complete medical, obstetric and ultrasonography examination before delivery. <\/p>\n\n\n\n

Newborns of HPgV-1 infected mothers were subjected within 24 hours of\ndelivery to thorough medical examination including birth weight and 3 CC blood\nwere collected to detect HPgV-1 by PCR technique and serum transaminases to\nassess liver functions. <\/p>\n\n\n\n

HPgV-1 detection<\/strong><\/p>\n\n\n\n

The total RNA was extracted from 100uL of serum according to the manufactures recommendations and subjected to reverse transcriptase PCR. We used 2 oligonucleotide primers from HPgV-1 5 UTR region. (Tetro cDNA Synthesis Kit (Make: Meridian Bioscience, Cat. No: BIO-65043).<\/p>\n\n\n\n

The sequences of the oligonucleotides were (Oligo ACIS) AGG GTT(GC) G\n(AT) (AT) GGT (GC) GTAA ATCC and (Oligo 7AS) CAA GAG (AC) G (AG) CAT TGA AG\n(AF) GCGA. The PCR mixture was formed of MgCl2<\/sub> (25mM), 10 x PCR\nbuffer, dNTPs (100mM), Primers (10 Pmol\/U1) and Taq Polymerase. The cycling\ncondition was: 94\u00b0C for one min, 55\u00b0C for one min and 72\u00b0C for one min., to be repeated\nfor 45 cycles. The product was visualized on 1% agarose gel electrophoresis\nstained with ethidium bromide. The positive cases were shown as a band at 210 bp\n(figure 1).<\/p>\n\n\n\n

Ethical Approval <\/strong><\/p>\n\n\n\n

The current study was carried out in accordance with the principles and\nregulations of the Helsinki’s declaration. Informed consent was taken from all\npatients before enrollment with explanation of the type of the study. Approval\nfrom the Ethical Committee of General Organization of Teaching Hospital and Institutes\nwas obtained. <\/p>\n\n\n\n

Results <\/strong><\/p>\n\n\n\n

Eight pregnant females found to have HPgV-1 infection. Five of them pregnant females\nwith HCV infection, two pregnant females with previous history of blood\ntransfusion and one in control group. <\/p>\n\n\n\n

The newborns delivered to HPgV-1 infected females (8 newborns) were\ntested for the presence of HPgV-1 infection within 24 hr. of delivery. HPgV-1\nwas detected in 3 newborns out of 5 delivered to mothers with both HCV and\nHPgV-1 infection (Group 1a) and in one newborn delivered to the infected mother\nof the control group (Group II) (Table 1). <\/p>\n\n\n\n

Serum transaminases were done for the 8 newborns of HPgV-1 infected\nmothers and were found to be within normal rang for both HPgV-1 Positive\nnewborns (4 newborns) and negative newborns (4 newborns).<\/p>\n\n\n\n

Table 1: HPgV-1 positive frequency among pregnant female and their newborns. <\/strong><\/p>\n\n\n\n\n\n\n\n\n\n\n
\n

Group<\/strong><\/p>\n<\/td>\n

\n

No. of HPgV-1 +ve females<\/strong><\/p>\n<\/td>\n

\n

%<\/strong><\/p>\n<\/td>\n

\n

No. of HPgV-1 +ve newborns<\/strong><\/p>\n<\/td>\n<\/tr>\n

\n

I-High risk group (n=30)<\/p>\n<\/td>\n

\n

 <\/strong><\/p>\n<\/td>\n

\n

 <\/strong><\/p>\n<\/td>\n

\n

 <\/strong><\/p>\n<\/td>\n<\/tr>\n

\n

I (a) HCV infected mothers (n=18)<\/p>\n<\/td>\n

\n

5<\/p>\n<\/td>\n

\n

27.7%<\/p>\n<\/td>\n

\n

3<\/p>\n<\/td>\n<\/tr>\n

\n

I (b) Females with previous blood transfusion (n= 12)<\/p>\n<\/td>\n

\n

2<\/p>\n<\/td>\n

\n

16.6%<\/p>\n<\/td>\n

\n

–<\/p>\n<\/td>\n<\/tr>\n

\n

II control group (n=30)<\/p>\n<\/td>\n

\n

1<\/p>\n<\/td>\n

\n

3.3%<\/p>\n<\/td>\n

\n

1<\/p>\n<\/td>\n<\/tr>\n

\n

Total <\/strong><\/p>\n<\/td>\n

\n

8<\/strong><\/p>\n<\/td>\n

\n

 <\/strong><\/p>\n<\/td>\n

\n

4<\/strong><\/p>\n<\/td>\n<\/tr>\n<\/tbody>\n<\/table>\n

 <\/p>\n\n\n\n
\"\"<\/td>\nFigure 1:<\/strong> An agarose gel electrophoresis of HPgV-1, Lanes 1 and 7 showing 50- bp DNA size ladder marker. <\/strong>

<\/p>\n

Click here to view Figure<\/a><\/p>\n<\/td>\n<\/tr>\n<\/tbody>\n<\/table>\n\n\n

Discussion <\/strong><\/p>\n\n\n\n

The known major hepatotropic viruses (A-E) are not associated with 10% to 20% of cases of community acquired hepatitis and transfusion associated hepatitis. The detection of HPgV-1 which is about 25% identical to the HCV from patients with hepatitis, has implicated it as a cause of non A-E hepatitis 7<\/sup>. <\/p>\n\n\n\n

In our study 5 pregnant females out of 18 (27.7%) were found to have dual infection of HPgV-1 and HCV. The risk of HPgV-1 infection seems to be increased in people who are also infected with HCV 8<\/sup>. Similar results were reported by Lucas who detected HPgV among 16(25%) of 63 women and 5 (8%) of 63 newborns, corresponding to vertical transmission rate of 31% 9<\/sup>.<\/p>\n\n\n\n

This work revealed that two pregnant females out of 12 (16.6%) with\nprevious history of blood transfusion were positive to HPgV-1. <\/p>\n\n\n\n

Aniel and colleagues reported that the prevalence of HPgV infection was\n12.42% in recipients of blood products and multiple blood transfusion 10<\/sup>.\nHPgV is less infectious than HCV in blood products which can be explained as\nHPgV is inactivated by manufacturing process or due to the presence of\nneutralizing antibodies 11<\/sup>.<\/p>\n\n\n\n

The difference in frequency between HPgV-1 and HCV infection was\nexplained as the exposed individuals are more able to clear infection with\nHPgV-1 due to the structural difference between the envelope glycoproteins of\nHCV and HPgV, which gives shielding effect preventing antibody binding to the\nunder lying protein of HCV and by immune escape phenomenon which may prevent\nneutralizing antibodies. This can explain that HPgV infection is a transient\ninfection as compared to HCV 12,13<\/sup>. <\/p>\n\n\n\n

The prevalence of HPgV-1 infection in the normal control females in our\nwork was 3.3%, which is similar to Jarvis who reported 3.2% prevalence in the\ngeneral population in Edinburgh14<\/sup>. They also have noticed the\nparadox of the high rate of HGV infection in the general population with no\nhistory of past parenteral exposure several times that of HCV which may be\nattributed to different modes of transmission between both viruses 15<\/sup>.\n<\/p>\n\n\n\n

Vertical transmission of HPgV could be associated with high rate of\npersistent infection. This may be the explanation of HPgV positively in the\ngeneral population which constitutes the main reservoir of infection in\ncommunities. This is documented in HBV vertical transmission which is\nassociated with persistent infection in around 90% of cases compared with 2-10%\nin adult infection 16<\/sup>. <\/p>\n\n\n\n

Vertical HPgV-1 transmission was documented in 4 newborns out of 8\ninfected mothers, however, this infection did not affect liver functions of the\nnewborns. This mother to baby transmission was also reported by Lucas and\ncolleagues in 2017 9<\/sup>. <\/p>\n\n\n\n

Conclusion and Recommendations<\/strong><\/p>\n\n\n\n

HPgV infection is relatively common especially in patients with HCV\ninfection and its does not seem to contribute to clinical or biochemical liver\ndisease. However, follow up of individuals especially newborns identified as\nHPgV PCR positive is essential to detect the persistence of infection and its\nimpact on liver functions. <\/p>\n\n\n\n

Acknowledgments<\/strong><\/p>\n\n\n\n

All appreciations to all participants <\/p>\n\n\n\n

Conflicts of Interest<\/strong><\/p>\n\n\n\n

There is no conflict of interest.<\/p>\n\n\n\n

Funding Sources<\/strong><\/p>\n\n\n\n

There are no funding Sources<\/p>\n\n\n\n

References<\/strong><\/p>\n\n\n\n

  1. Yu W, Hu X, Cae B, Shi D. Viral Infections During pregnancy. The Big Challenge Threatening Maternal and Fetal health. Maternal \u2013 Fetal Medicine. 2022; 4 (1): 72-86.
    CrossRef<\/a><\/li>
  2. Norah A; Miriam T; Ka Wang, and Gonzague J. Viral hepatitis and pregnancy. Nature Reviews Gastroenterology and Hepatology. 2021; 18: 117-130.
    CrossRef <\/a><\/li>
  3. Yaqi Y, Zhenzhou W, Jian H, Xiang U Y, Chiyu Z. Review of Human Pegivirus: Prevalence, transmission, pathogenesis and clinical implication. Virulence 2022; 13(1): 324-341.
     CrossRef <\/a><\/li>
  4. Berenguer M, Terrult NA, Piatak M. Hepatitis G. Virus infection in patients with hepatitis C virus infection undergoing Liver transplantation. Gastroenterology. 1996; III: 1569-75.
     CrossRef <\/a><\/li>
  5. Chan MY and Smith MA. Infections in Pregnancy. Comprehensive Toxicology. 2018; 232-249.
     CrossRef <\/a><\/li>
  6.  Mortada HF, Naglaa M, Engy A, Mona A, Mohamed F. Perinatal Transmission of Hepatitis C Virus: an update, Arch Med Sci. 2020; 16 (6): 1360-1369.
     CrossRef <\/a><\/li>
  7. Kayesh MEH, Kohara M, Tsukiyama K. Epidemiology and Risk factors for acute Viral Hepatitis in Bangladesh: An over view. Microorganisms.  2022; 15; 10 (11): 2266.
    CrossRef <\/a><\/li>
  8. DaMota LD, Nishiya AS, Finger \u2013 Jardim F, Barral MF, Silva CM, Nader MM et al., prevalence of human pegivirus infection in Patients carrying HIV- I C or non C in Southern Brazil. J. Med Virol. 2016; 88 (12): 2016-2114.
    CrossRef <\/a><\/li>
  9. Lucas M, Ruben C;, Maria F;, Carla V;, Vanusa P, Ana MB. Prevalence and Vertical transmission of human pegivirus among pregnant women infected with HIV. Int J Gynaecol Obstet. 2017; 138 (1): 113-118.
    CrossRef <\/a><\/li>
  10. de Sarom A, Clayton P, Rafael R, Pedro V, Patricia D, Leticia L. et al. Human Pegivirus (HPgV, GBV-C) RNA in Volunteer blood donors from a public hemotherapy service in Northern Brazil. Virol J. 2020; 14; 17 (1) 153.
    CrossRef <\/a><\/li>
  11. Michelle S, Ingrid C, Karen R, Ja- Young K, Paula A, Gil M. Viral infections during pregnancy Am J Reprod. Immunol 2015; 73 (3): 199-213.
     CrossRef <\/a><\/li>
  12. Jack T. Human pegivirus Type 1: A common Human Virus that is Beneficial in Immune \u2013 Mediated Disease. Front Immunol. 2022; 30: 13-88.
    CrossRef <\/a><\/li>
  13. Victor N and Justin C. Viral Hepatitis in Pregnancy. Eur J Obstet. Gynecol Reprod BioL. 2021; 256: 287-296.
    CrossRef <\/a><\/li>
  14. Jarvis L M, Davidson F, Hanley JP. Infection with hepatitis G Virus among recipients of plasma products. Lancet, 1996; 348: 1352-55.
    CrossRef <\/a><\/li>
  15. Vasiliy I, Tatiana I, ljudmila U. Hepatitis G Virus. World J. Gastroenterol. 2008; 14 (30): 4725-4734.
    CrossRef <\/a><\/li>
  16. Yao H and Hui Y. Prevention Strategies of mother to child transmission of hepatitis B Virus infection. Pediatr Investig. 2020;4 (2): 133-137.
     CrossRef <\/a><\/li><\/ol>\n","protected":false},"excerpt":{"rendered":"

    Introduction Viral infections during pregnancy may lead to adverse pregnancy […]<\/p>\n","protected":false},"author":15,"featured_media":0,"comment_status":"closed","ping_status":"closed","sticky":false,"template":"","format":"standard","meta":{"footnotes":""},"categories":[117],"tags":[],"class_list":["post-59825","post","type-post","status-publish","format-standard","hentry","category-vol17no3"],"_links":{"self":[{"href":"https:\/\/biomedpharmajournal.org\/staging\/wp-json\/wp\/v2\/posts\/59825","targetHints":{"allow":["GET"]}}],"collection":[{"href":"https:\/\/biomedpharmajournal.org\/staging\/wp-json\/wp\/v2\/posts"}],"about":[{"href":"https:\/\/biomedpharmajournal.org\/staging\/wp-json\/wp\/v2\/types\/post"}],"author":[{"embeddable":true,"href":"https:\/\/biomedpharmajournal.org\/staging\/wp-json\/wp\/v2\/users\/15"}],"replies":[{"embeddable":true,"href":"https:\/\/biomedpharmajournal.org\/staging\/wp-json\/wp\/v2\/comments?post=59825"}],"version-history":[{"count":5,"href":"https:\/\/biomedpharmajournal.org\/staging\/wp-json\/wp\/v2\/posts\/59825\/revisions"}],"predecessor-version":[{"id":61750,"href":"https:\/\/biomedpharmajournal.org\/staging\/wp-json\/wp\/v2\/posts\/59825\/revisions\/61750"}],"wp:attachment":[{"href":"https:\/\/biomedpharmajournal.org\/staging\/wp-json\/wp\/v2\/media?parent=59825"}],"wp:term":[{"taxonomy":"category","embeddable":true,"href":"https:\/\/biomedpharmajournal.org\/staging\/wp-json\/wp\/v2\/categories?post=59825"},{"taxonomy":"post_tag","embeddable":true,"href":"https:\/\/biomedpharmajournal.org\/staging\/wp-json\/wp\/v2\/tags?post=59825"}],"curies":[{"name":"wp","href":"https:\/\/api.w.org\/{rel}","templated":true}]}}