| Abstract|| |
The prevalence of anti-HCV antibodies among hemodialysis patients in the Eastern region of Saudi Arabia was 42.8%. This is comparable to the observations from the Central region of the country. Repeated blood transfusions of non-screened HCV blood seems to be the major factor responsible for this high prevalence. Clinical liver disease was infrequent in the early phase of the infection.
Keywords: Hepatitis C virus, Hemodialysis, Saudi Arabia.
|How to cite this article:|
Al-Muhanna FA. Hepatitis C Virus Infection Among Hemodialysis Patients in the Eastern Region of Saudi Arabia. Saudi J Kidney Dis Transpl 1995;6:125-7
|How to cite this URL:|
Al-Muhanna FA. Hepatitis C Virus Infection Among Hemodialysis Patients in the Eastern Region of Saudi Arabia. Saudi J Kidney Dis Transpl [serial online] 1995 [cited 2020 Apr 5];6:125-7. Available from: http://www.sjkdt.org/text.asp?1995/6/2/125/40851
| Introduction|| |
Hepatitis C virus (HCV) infection is emerging as an important cause of chronic liver disease  . The magnitude of the disease is being better defined after the introduction of new laboratory techniques for detection of anti-HCV antibodies ,, . The prevalence of the disease in the general population has varied from 0.5% to 1.5% in international studies ,, . Patients on maintenance hemodialysis (HD) constitute a vulnerable group for acquiring this infection.
The frequency of anti-HCV iii HD patients has however, varied significantly in different parts of the world ,,,, . We evaluated the prevalence of HCV infection in the HD population of the Eastern region of Saudi Arabia and studied the clinical and laboratory characteristics of the affected patients.
| Materials and Methods|| |
A retrospective study was undertaken to assess the problem of HCV infection in the dialysis population of the Eastern region of Saudi Arabia. Diagnosis of HCV infection was made by testing sera for anti-HCV by second generation ELISA. Reactive samples were retested in duplicate and were considered positive if both determinations were positive. Positive serum samples were then analyzed by second generation tests to confirm antibody specificity. A request was sent to Saudi Centre for Organ Transplantation (SCOT), Riyadh to get relevant information about the anti-HCV positive HD patients being treated in major dialysis units of the Eastern region of Saudi Arabia. The dialysis units featuring in this study were: Dammam Central Hospital (DCH), Dammam, King Fahd Military Medical Complex (KFMMC), Dhahran, Al-Jubail General Hospital (JGH) and King Fahd Hospital of the University (KFHU), Al-Khobar. The study patients were evaluated with reference to age, sex, blood transfusion status, presence of markers for hepatitis B virus (HBV) and liver function tests.
| Results|| |
A total of 162 patients were studied, of whom 70 patients (43.2%) were positive for anti-HCV. The prevalence rates in the individual hospitals studied are given in [Table - 1].
There were 43 females and 27 males in the anti-HCV positive group. The age distribution of anti-HCV positive patients is given in [Table - 2]. The maximum prevalence was in the age-group 31-50 years.
The relationship of blood transfusion to HCV status was evaluated. Out of 70 patients having anti-HCV antibodies, 67 (95.7%) had received repeated blood transfusions during the period they were on HD (3 months-10 years). Liver enzymes were elevated in 13 patients (18.6%), 11 of whom were asymptomatic. The association between HCV and HBV infection was looked into. Only one of the four dialysis units, DCH, featuring in this study has a set-up for dialyzing HBsAg positive patients and hence this association could be assessed in that unit only. Eight out of 102 (7.8%) HD patients in DCH were HBsAg positive. There was however, only one case who was positive for both HBsAg and anti-HCV.
The relationship between nationality of the patients and HCV status could not be assessed since most dialysis units cater predominantly to Saudi patients. In our study, there were 149 Saudis and 13 non-Saudis on HD. Among the Saudis 63 (42.3%) had antiHCV antibodies while six (46%) Non-Saudis were positive for anti-HCV.
| Discussion|| |
The overall prevalence of anti-HCV in our dialysis patients was 43.2%. This is consistent with the findings of two previous studies from Saudi Arabia (Riyadh area) in which prevalence rates were 53.7% and 34.8%  . Though the prevalence rates of anti-HCV in dialysis units in different parts of the world have been high ,,,,,,,, there are wide variations ranging from 10.1% in West Germany  to 53.7% in Saudi Arabia  . The variations are likely to be due to multiple factors including care in identifying cases, transfusion practices of the unit and control of cross-infection in the dialysis units.
Transfusion of non-HCV screened blood has been the greatest culprit in the past. Ninety-seven percent of our patients had received multiple blood transfusions for correction of anemia and might have contracted infection from their non-screened blood donors.
However, the use of blood transfusions has reduced considerably with the advent of erythropoietin for the treatment of anemia. A long-term study of HD patients regarding HCV has documented that out of 45 patients who were negative prior to initiation of HD and seroconverted during the course of HD, 29 had received blood transfusions prior to seroconversion  . The rate of new infections decreased significantly in this French unit after 1988 when routine testing of blood for HCV was enforced in France. High risk of HCV infection via blood transfusion has also been reported by Tamura, et al  . They further observed that the percentage of positivity increased with amount of blood transfused.
Cross-infection in dialysis units has been seen in the transmission of HBV infection. A similar mechanism may be possible in case of HCV infection. Contamination from dialysis machines and other equipments used in dialysis units are likely to be other risk factors for HCV.
In conclusion, the prevalence of HCV among HD patients in the Eastern region of Saudi Arabia is high. Blood transfusions and cross-infection during dialysis seem to be major factors in the transmission of this infection. Clinical liver disease is infrequent, at least in early phases of HCV infection.
| Acknowledgment|| |
The author is thankful to Saudi Center for Organ Transplantation for providing the relevant.
| References|| |
|1.||Alivanis P, Derveniotis V, Dioudis C, et al. Hepatitis C virus antibodies in aemodialysed and in renal transplant patients: correlation with chronic liver disease. Transplant Proc 1991;23:2662-3. [PUBMED] |
|2.||Kuo G, Choo QL, Alter JH, et al. An assay for circulating antibodies to a major etiologic virus of human non-A, non-B hepatitis. Science 1989;244:362-4. |
|3.||Skidmore S. Recombinant immunoblot assay for hepatitis C antibody (letter). Lancet 1990;335:1346. [PUBMED] [FULLTEXT]|
|4.||Aach RD, Stevens CE, Hollinger FB, et al. Hepatitis C virus infection in posttransfusion hepatitis. An analysis with firstand secondgeneration assays. N Engl J Med 1991;325:1325-9. |
|5.||Stevens CE, Taylor PE, Pindyk J, et al. Epidemiology of hepatitis C virus. A preliminary study in volunteer blood donors. JAMA 1990;263:49-53. |
|6.||Esteban JI, Esteban R, Viladomiu L, et al. Hepatitis C virus antibodies among risk groups in Spain. Lancet 1989;2:294-7. [PUBMED] |
|7.||Gaeta GB, Giusti G. Epidemiology of chronic viral hepatitis in the Mediterranean area: present status and trends. Infection 1990;18:21-5. [PUBMED] |
|8.||Fakunle YM, Al-Mofarreh M, ElKaramany WM, et al. Prevalence of antibodies to hepatitis C virus in hemodialysis' patients in Riyadh. Ann Saudi Med 1991;ll:504-6. |
|9.||Jeffers LJ, Perez GO, de Medina MD, et al Hepatitis C infection in two urban hemodialysis units. Kidney Int 1990;38:320-2. |
|10.||Zeldis JB, Depner TA, Kuramoto IK, Gish RG, Holland PV. The prevalence of hepatitis C virus antibodies among emodialysis patients. Ann Intern Med 1990;112:958-60. [PUBMED] |
|11.||Schlipkoter U, Roggendorf M, Ernst G, et al. Hepatitis C virus antibodies in haemodialysis patients. Lancet 1990;335:1409-10. |
|12.||Yamaguchi K, Nishimura Y, Fukoka N, et al. Hepatitis C virus antibodies in haemodialysis patients. Lancet 1990;335:1409-10. |
|13.||Saeed AA, Fairclough D, Al-Admawi AM, et al. Hepatitis C virus in Saudi Arabia: a preliminary survey. Saudi Med J 1990;ll:331-2. |
|14.||Gilli P, Morettim, Soffritti S, Menini C. Anti-HCV positive patients in dialysis units? Lancet 1990;336:243-4. |
|15.||Simon N, Courouce AM, Lemarrec N, Trepo C, Ducamp S. A twelve year natural history of hepatitis C virus infeotion in hemodialyzed patients. Kidney Int 1994;46:504-ll. |
|16.||Tamura I, Kobayashi Y, Koda T, et al. Hepatitis C virus antibodies in haemodialysis patients (Letter). Lancet 1990;335:1409-10. |
Fahad A Al-Muhanna
Assistant Professor of Internal Medicine and Consultant Nephrologist, King Fahd Hospital of the University, P.O. Box 40085, Al-Khobar 31952
[Table - 1], [Table - 2]