People with β-thalassaemia who depend on repeated blood transfusions continue to face a substantial burden of hepatitis C infection, according to a new systematic review and meta-analysis published in Scientific Reports.
The analysis found that 22% of patients tested positive for antibodies against hepatitis C virus, while 13% had detectable HCV RNA indicating active infection. Hepatitis B surface antigen positivity was lower at 4%.
Hepatitis C remained the larger burden
Researchers searched PubMed and Scopus on 30 October 2025 for English-language observational studies published during the preceding 10 years. From 260 records, 37 studies met the eligibility criteria.
For hepatitis B, 25 studies involving 10,130 patients produced a pooled hepatitis B surface antigen prevalence of 4%, with a 95% confidence interval of 3% to 5%.
The hepatitis C burden was considerably higher. Across 34 studies and 10,527 patients, the pooled prevalence of anti-HCV antibodies was 22%, with a 95% confidence interval of 17% to 27%. Anti-HCV antibodies indicate previous exposure to the virus but do not by themselves establish that an infection remains active.
Sixteen studies involving 3,867 patients also reported HCV RNA results. The pooled prevalence of detectable HCV RNA was 13%, with a 95% confidence interval of 8% to 22%. Detectable viral RNA provides evidence of active HCV infection.
Results varied substantially between studies
The pooled percentages should not be interpreted as uniform rates across countries. Statistical heterogeneity was high for every major outcome. The I² statistic was 84.5% for hepatitis B surface antigen, 96.3% for anti-HCV antibodies and 97.2% for HCV RNA.
Country and geographical region were significant sources of variation in the hepatitis C analyses. Pooled estimates were higher in South Asian and North African regions and lower in the Middle East. Sensitivity analyses nevertheless supported the overall robustness of the principal outcomes.
How the evidence was assessed
The researchers assessed reporting quality using the STROBE framework and evaluated risk of bias with the Joanna Briggs Institute Critical Appraisal Checklist. Of the 37 included studies, 35 were classified as having a moderate risk of bias and two as having a low risk.
Heterogeneity was assessed using Cochran’s Q and I² statistics, while funnel plots and Egger’s regression were used to investigate publication bias. This approach allowed the researchers to combine evidence across multiple populations while also examining how strongly the underlying studies differed.
Why repeated transfusions matter
β-thalassaemia is an inherited blood disorder in which patients can require regular transfusions. Those transfusions are essential treatment, but repeated exposure to donated blood has historically increased the opportunity for blood-borne infections to be transmitted when screening and other safeguards are insufficient.
The findings therefore reinforce the importance of rigorous donor screening, hepatitis B vaccination, routine HCV surveillance and confirmatory HCV RNA testing when a patient tests positive for anti-HCV antibodies.
Important limitations
The meta-analysis does not show that 22% of all people with β-thalassaemia currently have active hepatitis C. Anti-HCV positivity reflects exposure, whereas the pooled estimate for active infection based on HCV RNA was 13%.
The very high heterogeneity also limits the usefulness of treating the pooled estimates as universal prevalence figures. Infection rates can differ because of geography, transfusion practices, donor screening, vaccination coverage, patient characteristics and the diagnostic methods used in individual studies.
In addition, nearly all included studies were judged to have a moderate risk of bias. The review was restricted to English-language research from the preceding decade and therefore may not capture all relevant evidence.
What the findings mean
The results suggest that hepatitis C remains a clinically important concern among transfusion-dependent β-thalassaemia populations despite improvements in blood safety. The distinction between antibody positivity and active infection is particularly important for clinical interpretation.
For health systems, the findings support continued investment in safe blood supplies and systematic viral surveillance. For patients who repeatedly receive transfusions, reliable screening and appropriate confirmatory testing can help identify infections that require further assessment and treatment.
Source Information
Study: Prevalence of hepatitis B and C infection markers in patients with β-thalassaemia: a systematic review and meta-analysis
Authors: Nirmani Yasara, Sajith Thilakarathne, Nisakya Madiwila, Shiromi Perera, Anuja Premawardhena and Sachith Mettananda
Journal: Scientific Reports
Published: 25 September 2026
DOI: 10.1038/s41598-026-72411-3
Study type: Systematic review and meta-analysis of 37 observational studies
Funding: The authors reported receiving no financial support.
