PREVALENCE AND GENOTYPIC DISTRIBUTION OF GB VIRUS C AND TT VIRUS AMONG HEMODIALYSIS PATIENTS IN YOGYAKARTA

HANGGORO TRI RINONCE, dr. Ahmad Ghozali, Sp.PA(K); dr. Totok Utoro, D.Med.Sc., Sp.PA(K)

2015 | Tesis | SP ILMU PATOLOGI ANATOMI

Latar Belakang: Pasien hemodialisis mempunyai risiko lebih tinggi terkena infeksi virus yang ditularkan melalui darah, antara lain virus GB tipe C (VGB-C) dan virus TT (virus torque teno; VTT). Namun, prevalensi dan distribusi genotipik kedua virus tersebut pada pasien hemodialisis di Indonesia belum jelas. Tujuan: Penelitian ini bertujuan untuk mengetahui prevalensi, distribusi genotipik, dan kemungkinan terjadinya infeksi nosokomial pada pasien hemodialisis di salah satu unit hemodialisis di Yogyakarta, Indonesia. Metode: RNA VGB-C dan DNA TTV dideteksi dengan PCR. Selanjutnya, dilakukan proses sekuensing langsung pada produk PCR yang positif. Genotipe ditentukan dengan analisis filogenetik berdasarkan 5'-untranslated region (UTR)/E1 untuk VGB-C dan ORF1 untuk TTV. Hasil: RNA VGB-C terdeteksi pada 92/161 pasien (57.1%) dengan nested reverse-transcription PCR. Analisis filogenetik 5'-UTR menggolongkan isolat-isolat VGB-C menjadi genotipe 6 (85%), 2 (8%), 4 (6%), and 3 (1%). DNA VTT terdeteksi pada semua pasien (100%) dengan nested dan semi-nested PCR yang mengamplifikasi 5'-UTR dan ORF1. Analisis filogenetik berdasarkan ORF1 menunjukkan bahwa genotipe 1 paling banyak ditemui (84%), diikuti oleh genotipe 2 (10%) dan 3 (6%). Peningkatan prevalensi VGB-C genotipe 6 pada pasien hemodialisis daripada populasi umum dan sekuen yang identik pada banyak isolat VGB-C memberikan bukti kuat adanya transmisi virus dari pasien ke pasien. Prevalensi VTT hampir sama dengan populasi umum dan hanya ada satu pasang isolat VTT identik. Hal tersebut menunjukkan bahwa infeksi nosokomial bukan penyebab utama tingginya prevalensi VTT. Kesimpulan: Infeksi VGB-C dan VTT GBV-C umum dijumpai pada hemodialisis pasien di Yogyakarta, Indonesia. Kemungkinan terjadi transmisi nosokomial pada infeksi VGB-C.

ABSTRACT Background: Hemodialysis patients are at increased risk of infection with blood-borne viruses, including GB virus C (GBV-C) and TT virus (torque teno virus; TTV). However, the prevalence and genotypic distribution of these viruses in Indonesian hemodialysis patients are unknown. Objective: This study investigated these issues and the possibility of nosocomial transmission among hemodialysis patients attending a hemodialysis unit in Yogyakarta, Indonesia. Methods: GBV-C RNA and TTV DNA were detected using PCR. The positive products were directly sequenced. The genotypes were determined by phylogenetic analysis based on 5'-untranslated region (UTR)/E1 for GBV-C and open reading frame-1 (ORF1) for TTV. Results: GBV-C RNA was detected in 92/161 patients (57.1%) by nested reverse-transcription PCR. Phylogenetic analysis of the 5'-UTR classified the GBV-C isolates into genotypes 6 (85%), 2 (8%), 4 (6%), and 3 (1%). TTV DNA was detected in all patients (100%) by nested and semi-nested PCR amplifying the 5â'-UTR and ORF1. Phylogenetic analysis based on the ORF1 revealed that genotype 1 was dominant (84%), followed by genotypes 2 (10%) and 3 (6%). The greater prevalence of GBV-C genotype 6 in hemodialysis patients compared with the general population and the identical sequences in many isolates provide strong evidence of patient-to-patient transmission. The prevalence of TTV in hemodialysis patients was similar to that of the general population and only one pair of TTV isolates was identical. These results indicate that nosocomial infection is not the main cause of the high prevalence of TTV. Conclusion: GBV-C and TTV infections are common in hemodialysis patients in Yogyakarta, Indonesia. Transmission is probably nosocomial in the case of GBV-C infection.

Kata Kunci : GB virus C, TT virus, hemodialysis, Yogyakarta