Journal of Clinical and Diagnostic Research, ISSN - 0973 - 709X

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Thanking you
With sincere regards
Dr. Rajendra Kumar Ghritlaharey, M.S., M. Ch., FAIS
Associate Professor,
Department of Paediatric Surgery, Gandhi Medical College & Associated
Kamla Nehru & Hamidia Hospitals Bhopal, Madhya Pradesh 462 001 (India)
On May 11,2011

Dr. Shankar P.R.

"On looking back through my Gmail archives after being requested by the journal to write a short editorial about my experiences of publishing with the Journal of Clinical and Diagnostic Research (JCDR), I came across an e-mail from Dr. Hemant Jain, Editor, in March 2007, which introduced the new electronic journal. The main features of the journal which were outlined in the e-mail were extensive author support, cash rewards, the peer review process, and other salient features of the journal.
Over a span of over four years, we (I and my colleagues) have published around 25 articles in the journal. In this editorial, I plan to briefly discuss my experiences of publishing with JCDR and the strengths of the journal and to finally address the areas for improvement.
My experiences of publishing with JCDR: Overall, my experiences of publishing withJCDR have been positive. The best point about the journal is that it responds to queries from the author. This may seem to be simple and not too much to ask for, but unfortunately, many journals in the subcontinent and from many developing countries do not respond or they respond with a long delay to the queries from the authors 1. The reasons could be many, including lack of optimal secretarial and other support. Another problem with many journals is the slowness of the review process. Editorial processing and peer review can take anywhere between a year to two years with some journals. Also, some journals do not keep the contributors informed about the progress of the review process. Due to the long review process, the articles can lose their relevance and topicality. A major benefit with JCDR is the timeliness and promptness of its response. In Dr Jain's e-mail which was sent to me in 2007, before the introduction of the Pre-publishing system, he had stated that he had received my submission and that he would get back to me within seven days and he did!
Most of the manuscripts are published within 3 to 4 months of their submission if they are found to be suitable after the review process. JCDR is published bimonthly and the accepted articles were usually published in the next issue. Recently, due to the increased volume of the submissions, the review process has become slower and it ?? Section can take from 4 to 6 months for the articles to be reviewed. The journal has an extensive author support system and it has recently introduced a paid expedited review process. The journal also mentions the average time for processing the manuscript under different submission systems - regular submission and expedited review.
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Overall, the publishing process with JCDR has been smooth, quick and relatively hassle free and I can recommend other authors to consider the journal as an outlet for their work."

Dr. P. Ravi Shankar
KIST Medical College, P.O. Box 14142, Kathmandu, Nepal.
On April 2011

Dear team JCDR, I would like to thank you for the very professional and polite service provided by everyone at JCDR. While i have been in the field of writing and editing for sometime, this has been my first attempt in publishing a scientific paper.Thank you for hand-holding me through the process.

Dr. Anuradha
On Jan 2020

Important Notice

Original article / research
Year : 2011 | Month : August | Volume : 5 | Issue : 4 | Page : 766 - 768

Hepatitis B or Hepatitis C: The Bigger Threat in Multiple Infected HIV Positive Blood Donors

Neha Agarwal, Usha Dubey, Asha Agarwal, Riddhi Jaiswal

Corresponding Author. Jr. Resident, Deptt. of Pathology, GSVM Medical College, Kanpur, India. Professor, Deptt. of Pathology, GSVM Medical College, Kanpur, India. MD Pathology, GSVM Medical College, Kanpur, India.

Correspondence Address :
Dr. Neha Agrawal
Junior Resident
Department of Pathology,
GSVM Medical College, Kanpur-208 002
Uttar Pradesh, India.


Aim: To study the prevalence of hepatobiliary co-infections – Hepatitis B (HBV) and Hepatitis C (HCV) in Human Immunodeficiency Virus (HIV) positive voluntary and replacement blood donors in the blood bank of a tertiary health care centre.

Methods: 2,48,387 donors were screened for HIV, HBV and HCV co-infections from 1999 to 2010 by using commercially available ELISA kits.

Results: The results were as follows: • The total number of donors who were studied from 1999 to 2010 – 2,48,387 • HIV positive cases – 273 (0.11%)The HCV co-infection was detected in 30/273 (10.99%) HIV positive donors, while the HBV co-infection was found in 6/273 (2.19%) donors. 5/273 (1.83%) HIV positive donors tested positive for both HBV and HCV.

Conclusion: The implication of HCV and/or HBV co-infection in apparently healthy HIV positive blood donors is of utmost importance as they mostly lie within the reproductive age group of 21-40 years. The knowledge of the co-infection in such cases is vital due to the increased risk of the sexual and perinatal transmission of the hepatitis virus along with increased hepatotoxicity with antiretroviral therapy and rapid progression to cirrhosis and hepatocellular carcinoma.


Co-infection, HIV, HBV, HCV, blood donors, voluntary

The transfusion of blood and blood products is a life saving measure but at the same time, the transfusion of infected blood or one of its components carries a significant risk of the transmission of many blood transmitted diseases like HIV, HBV, HCV etc. which do not have any specific treatment and are potentially life threatening.

The diagnosis of the HIV infection depends upon the demonstration of the antibodies to HIV or the direct detection of HIV or its components. The antibodies to HIV generally appear in the circulation 2 to 12 weeks following infection with the virus.

A diagnosis of the HBV infection can be made by the detection of HBsAg in the serum even before the elevation of serum aminotransferases or the appearance of clinical symptoms.

A specific serological diagnosis of Hepatitis C can be made by demonstrating the presence of anti HCV antibodies in the serum. However, the assays of HCV RNA are the most sensitive tests for HCV infection. The HCV RNA can be detected before the acute elevation of aminotransferases and before the appearance of anti HCV antibodies in patients with acute Hepatitis C. Hepatobiliary diseases are a major cause of morbidity and mortality in HIV infection-predominantly being a reflection of the problems which are encountered in the setting of Hepatitis B or Hepatitis C.

We studied the prevalence of HIV, HBV and HCV in both replacement and voluntary blood donors, along with the prevalence of HBV and HCV co-infection in multiple infected HIV positive donors from the year 1999 to 2010, in the blood bank of a tertiary health care centre.

Material and Methods

The present study was conducted at the blood bank of a tertiary health care centre from January 1999 to December 2010.

By using a standard protocol for donor selection, 2,48,387 donors were screened for HIV, HBV and HCV viral markers. The detection of these viral markers was done by employing commercially available kits which were developed by J Mitra and Co.

The detection of antibodies to HIV 1 and/or HIV-2 was done by Microlisa – HIV based on Indirect ELISA. The absorbance was read at 450 nm. The cutoff value was determined by adding the mean negative control (NCx¯ ) and mean positive control (PCx¯ ) and by dividing the sum by 6.

Cut off value NCx PCx = + 6

HBsAg detection was done by the Hepalisa technique which was based on the “Direct Sandwich” principle. The cut off value was determined by NCx¯ + 0.1.

Similarly, for the detection of anti HCV antibodies, HCV Microlisa technique was employed. The cutoff value was determined by 0.1 x PCx¯ + 0.1.

All the test specimens with an absorbance value which was greater than or equal to the cutoff value were considered to be reactive.

OBSERVATION This study involves tests which were done on 2,48,387 donors from 1999 to 2010. The results were as follows :

Total number of HIV positive donors in 1999-2010 = 273Number of donors who tested positive for both HIV and HCV = 30 Number of donors who tested positive for HIV and HBsAg = 06 Number of donors who tested positive for HIV, HCV and HBsAg = 05


Though recognised as an emerging disease only in the 1980s, AIDS by now has been established throughout India. During the year 2005, the number of HIV positive cases rose to 5.2 million (1). The situation looks more dreadful when we broaden our outlook globally. The south-east Asian region saw the number of HIV/AIDs positive patients rising to 7.2 million in December, 2006 (1).

The diseases of the hepatobiliary system pose a major problem in patients with HIV infection. Among the HIV infected patients, 2-4 million are estimated to have chronic HBV infection, while 4-5 million are estimated to be co-infected with HCV (2). Literature on the prevalence of HIV co-infection with HBV and or HCV in India is sparse (3) .

There is an associated increase in liver related mortality in patients with HIV and active HBV infection as compared to the rates in patients with either infection alone. A reduced survival rate with a higher rate of hepatic decompensation and chronic viral liver disease among the co-infected patients has been reported (4) .

The presentation of HCV can vary from a carrier state with a normal liver biopsy to an abnormal liver histology in HCV RNA positive patients with normal serum aminotransferases. In Hepatitis C, cirrhosis can develop in as many as 20% of the patients within 10- 20 years of having the acute form of the illness (5) .

Patients who are co-infected with HIV have an increased risk of HCV disease progression to cirrhosis and hepatocellular carcinoma. In a study which was conducted by Valdez H et al, it was concluded that an inadequate Iymphocyte response to the HCV antigens in HCV infection was potentiated by HIV, resulting in a failure to control HCV propagation (6). Patients with HIV/HCV co-infection have higher serum HCV viral loads than patients with HCV mono infection (7). HCV has been detected in the semen of co-infected men and in the genital tracts of co-infected women (8),(9). Among the co-infected women, the risk of the perinatal transmission of HCV is approximately 17% or four to five times greater than the risk among women who are infected with the HCV mono-infection (10), (11).

In the present study, we found that though the total number of 4272 (1.72%) HBV positive cases were more than either HIV positive (273) (0.11%) or HCV positive patients -994 (0.40%) alone. Out of the 273 HIV positive donors, 30 tested positive for both HCV and HIV (10.99%), 6 tested positive for HBV and HIV (2.19%) and 5 tested positive for all the viral markers (1.83%). Thus, we conclude that HCV is more commonly associated with HIV, which is in concordance with the study which was conducted by Ahsan et al (12). They tested 200 serum samples from HIV positive patients who were admitted to the hospital. Out of the 200 HIV positive sera which were tested, 7 (3.5%) were HBs Ag positive and 16(8%) were anti HCV positive.

Saravanan et al screened five hundred HIV infected patients for hepatitis B virus and hepatitis C virus in 2007 (3). HBV co-infection was detected in 9% of the patients, while HCV co-infection was detected in 2.2% of the patients. The low incidence of the HCV infection could be due to the low incidence of intravenous drug use and infrequent transfusion in this study group (3).

However, Mehta et al studied 28,995 blood samples from blood donors in Rajasthan (13). 81 (0.27%) of the samples tested positive for HCV, while only 1 (1.2%) donor tested positive for both HCV and HIV.

Amongst the studies which were conducted abroad, the prevalence of HCV/ HIV co-infection in 6154 blood donors at the National Blood Transfusion Centre at the Kenyatta National Hospital was found to be very low at 0.02 by Karuru et al (14).

Since the present study involved healthy asymptomatic donors who were within the reproductive age group of 21 - 40 years, the HIV positive partners of the individuals with HCV infection should be counselled about the risk of sexual and perinatal transmission of the virus. Also, there exists an important association between HIV and hepatitis C virus, such as hepatotoxicity with the antiretroviral therapy and the more rapid progression to cirrhosis and hepatocellular carcinoma. As such, more concern towards the surveillance and prevention of this relatively more prevalent pattern of co-infection in HIV positive cases is needed in this region.


Part K Epidemiology of communicable disease. Park’s Text book of Preventive and Social Medicine 19th ed, Jabalpur Banarsidas Bhanot Publishers,2007: 286-287.
Alter MJ Epidemiology of viral hepatitis and HIV co-infection. J Hepatol 2006;44 : S6-S9, pub med.
Sarvan S, Velu VK, Kumarasamy N, Nanda Kumar S, Murugavel KG, Balakrishnan P et al Co-infection of hepatitis B and hepatitis C virus in HIV-infected patients in South India. World J Gastroenterol 2007; 13 (37) : 5015-5020.
Ockenga J, Tillman HL, Trautween C, StooL M, Manns MP, Schmidt RE. Hepatitis B and C in HIV infected patients – Prevalence and prognostic value. J Hepatol 1997; 27 (1) : 8-24.
Dienstag JL, Isselbacher KJ . Acute viral hepatitis In : Kasper DL, Fauci AS, Longo DL, Braunwald. E, Hauser SL, Jamseson JL (eds) Harrison’s Principles of Internal Medicine. McGraw-Hill Companies, Inc, United States of America 2005: pp 1835.
Valdez H, Anthony D, Farukhi F. et al Immunological responses to Hepatitis C and hepaitis C antigens in hepatitis Virus (HCV) infected and human immunodeficiency virus (HIV) - HCV co-infected patients. Program and abstracts of the XIII International AIDS Conference, Durban, South Africa. Abstract We Or A526; 2000;489.
Sulkowski MS, Mast EE, Seeff LB et al Hepatitis C virus infection as an opportunistic disease in persons who are infected with the human immunodeficiency virus. Clin Infect Dis 2000; 30 (SuppI1) S77-84.
Briat A, Dulious E, Galimand J. et al Hepatitis C Virus in the semen of men who are co-infected with HIV-1 : prevalence and origin. AIDS 2005; 19 (16) : 1827-35.
Pasquier C, Bujan L, Daudin M et al. Intermittent detection of hepatitis C Virus (HCV in semen from men with human immunodeficiency virus type 1 (HIV-1) and HCV. J Med Virol 2005 69 (3) : 344-9.
Thomas DL, Villano SA, Riester KA et al Perinatal transmission of Hepatitis C virus from human immunodeficiency virus type- infected mothers. J Infect Dis 1998; 177 (6) : 1480-8.
Roberts EA, Yeung L. Maternalinfant transmission of hepatitis C virus infection. Hepatology 2002; 36 (5 suppl 1) : S106-13.
Ahsan SM, Mehta PR HIV, HBV and HCV co-infection study. Bombay Hospital J 2005; 47 (02).
Mehta NM, Purohit A, Haag A, Mathur A, Joshi KC, Joshi R et al (2002) The co-infection rate of HIV and Hepatitis C Virus (HCV) among blood donors in Rajasthan. India. Int. Conf. AIDS Jul 7-12 abstract no. TuPeA4401.
Karuru JW, Lale GN, Joshi M, Azzala O Prevalence of HCV and HIV/ HCV co-infection among voluntary blood donors and VCT clients. East African Medical J 2005; 82 (4) : 166-69.

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