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Saudi Journal of Kidney Diseases and Transplantation
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ORIGINAL ARTICLE Table of Contents   
Year : 1995  |  Volume : 6  |  Issue : 2  |  Page : 128-131
The Prevalence of Hepatitis C Virus Antibodies Among Hemodialysis Patients in Jeddah Area, Saudi Arabia

1 Department of Medicine, National Guard King Khalid Hospital, Jeddah, Saudi Arabia
2 Department of Pathology, National Guard King Khalid Hospital, Jeddah, Saudi Arabia
3 Department of Medicine, King Fahd Hospital, Jeddah, Saudi Arabia
4 Department of Medicine, King Fahd Armed Forces Hospital, Jeddah, Saudi Arabia

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The prevalence of antibody to hepatitis C virus (HCV) in hemodialysis (HD) patients is high and variable. One hundred and thirty nine patients undergoing maintenance HD at three different renal units in Jeddah, Kingdom of Saudi Arabia, were studied for prevalence of anti-HCV antibody. The overall prevalence in the group examined was 52.5% (73/139). There was a significant correlation between prevalence of anti-HCV and duration of HD; 53/ 74 (71.6%) in patients on HD for > 3 years as against 20/65 (30.8%) for patients on HD for < 3 years (P< 0.05). We were unable to demonstrate a correlation of anti-HCV positivity with history of blood transfusions, previous exposure to hepatitis-B virus, sex, age, or ethnic group. The very high prevalence of anti-HCV found in patients on maintenance HD and the positive correlation between anti-HCV reactivity and duration on dialysis suggest that factors within the dialysis unit might contribute to the spread of the virus.

Keywords: Hepatitis C virus, Hemodialysis, Saudi Arabia.

How to cite this article:
Al Shohaib SS, Abdelaal MA, Zawawi TH, Abbas FM, Shaheen FA, Amoah E. The Prevalence of Hepatitis C Virus Antibodies Among Hemodialysis Patients in Jeddah Area, Saudi Arabia. Saudi J Kidney Dis Transpl 1995;6:128-31

How to cite this URL:
Al Shohaib SS, Abdelaal MA, Zawawi TH, Abbas FM, Shaheen FA, Amoah E. The Prevalence of Hepatitis C Virus Antibodies Among Hemodialysis Patients in Jeddah Area, Saudi Arabia. Saudi J Kidney Dis Transpl [serial online] 1995 [cited 2020 Sep 18];6:128-31. Available from: http://www.sjkdt.org/text.asp?1995/6/2/128/40852

   Introduction Top

Hepatitis C virus (HCV) has recently been identified as a major cause of non-A, non-B hepatitis (NANBH) [1] . Hepatitis C is of clinical importance because: (a) t is commonly associated with chronic liver disease and cirrhosis [2] , (b) it is possibly associated with hepatocellular carcinoma [3] , (c) controversy exists over using anti-HCV positive organ donors [4],[5] and (d) there is an creased risk for development of chronic hapatitis in anti-HCV positive renal transplant recipients [6] .

The reported prevalence of anti-HCV antibody world-wide among dialysis patients has ranged from 1.7% [7] to 55% [8] . However, studies from dialysis units in theKingdom of Saudi Arabia (KSA) have reported prevalence rates of 34.8% to 53.7%46.5%; 45.5% and 72.3% from the central [9],[10] , eastern [11] , southern [12] , and western [13] regions, respectively. In their study, Shaheen, et al [13] reported anti-HCV prevalence of 62.7% from Jeddah. Huraib, etal [14] , in a multi-center study of 22 hemodialysis (HD) units in KSA reported a prevalence rate ranging from 14.5 to 94.7%.

The aim of this study was to evaluate the prevalence of anti-HCV in three different dialysis units in Jeddah and to examine the risk of infection in relation to the duration of dialysis, history of blood transfusion and demographic data, for the purpose of adopting practical measures to stop or minimize he spread of HCV infection among dialysis patients.

   Materials and Methods Top

During August and September 1992, we evaluated 139 patients undergoing maintenance HD at three renal units in Jeddah, KSA. All HD patients registered at National Guard King Khalid Hospital, n=18, and King Fahd Military Hospital, n = 47, were enrolled in this study whereas 74 patients were randomly selected from 350 patients registered at the dialysis center of King Fahd Hospital. For each patient, information on demographic data, dialysis and blood transfusion history was collected. Alanine amino-transferase (ALT) was measured using Boehringer Mannheim reagent (IFCC recommended) on Hitachi 717 chemistry analyzer. Hepatitis B surface antigens (HBsAg) and antibodies to HBc were measured using microparticle enzyme immunoassay and testing for anti-HCV was done using second generation HCV enzyme linked immunosor-bent assay (ELISA-2), Abbott Laboratories, North Chicago, IL, and samples repeatedly reactive for anti-HCV had neutralization peptide supplemental assays as previously described [15] . Statistical analysis was performed using chi square test with Yates correction where applicable. A note was made on the disinfection procedure of the dialysis machines. Adherence to universal precautions in the three dialysis centers was recorded by an independent observer using a check list. All units disinfect the dialysis machines according to the manufacturer's instructions using daily heat method, weekly bleach and bi-monthly citric acid. Adherence to the universal precautions by dialysis staff was comparable in the three centers.

   Results Top

The results of this study are shown on [Table - 1]. Seventy three out of 139 patients studied, (52.5%), were positive for anti-HCV. There was a strong association between long duration of dialysis, i.e. > 3 years and anti­HCV positivity, (P<0.05) and also between elevated ALT levels and anti-HCV reactivity, (P<0.05). We found no association between history of blood transfusions, exposure to hepatitis B virus, age, gender, ethnicity and anti-HCV positivity in the group examined.

   Discussion Top

The prevalence rate of anti-HCV in HD patients in this study, 52.5%, is comparable to that reported from other parts of the KSA. However, it is lower than that reported by Shaheen, et al [13] , from four centers in the Western region of KSA, (72.3%) and that by Huraib, et al [14] in their multi-center study, (68%). The use of more sensitive second generation ELISA technique in our study could partially explain our higher prevalence rate than that reported earlier by Saeed, et al [9] from Riyadh. An increased prevalence of anti­HCV in patients on dialysis for longer periods of time has been previously reported [13],[14],[16],[17] . We also found a very strong association between the duration of dialysis (> 3 years) and the prevalence of anti-HCV, (P<0.05). It has been reported that dialysis treatment could be a specific, independent risk factor for HCV infection [18] and that home HD might confer some protection against HCV transmission [19] . Our finding of a significant association between anti-HCV seropositivity and elevated ALT levels is similar to that reported by others [17] .

Blood transfusion is known to carry a risk of HCV transmission [20] . Data on correlation between anti-HCV positivity and history of blood transfusion in dialysis patients is conflicting. Whereas, some workers reported positive correlation [13],[14],[17],[21] others found none [16],[18] . Our results are in agreement with the latter group. Also, Huraib, et al noted that 62.6% of dialysis patients who had not received any blood transfusions, were positive for anti-HCV [14] . In this study, we found no association between anti-HCV positivity and age, gender or nationality of the patient. This was in agreement with that reported by Ayoola, et al [21] although other workers reported increased prevalence of anti-HCV in male and elderly dialysis patients [13],[17] . Also, there was no correlation between markers for HBV and prevalence of anti-HCV, a finding which is similar to that reported earlier [15] . Our data suggest that HD by itself may carry an independent risk for HCV transmission. While the exact mode of HCV transmission through dialysis remains to be elucidated, it is reasonable to designate separate dialysis machines for anti-HCV positive patients. It would be of interest to follow-up the seronegative patients to see the impact of their isolation on seroconversion rate.

   Acknowledgment Top

The authors would like to thank Mr. Angel C. Talledo for typing the manuscript.

   References Top

1.Kuo G. Choo QL, Alter HJ, et al. An assay for circulating antibodies to a major etiologic virus of human non-A, non-B hepatitis. Science 1989;244:362-4.  Back to cited text no. 1    
2.Cuthbert JA. Hepatitis C. Am J Med Sci 1990;299:346-55.  Back to cited text no. 2  [PUBMED]  
3.Kew MC, Houghton M, Choo QL, Kuo G. Hepatitis C virus antibodies in Southern African blacks with hepatocellular carcinoma. Lancet 1990;335:873-4.  Back to cited text no. 3  [PUBMED]  [FULLTEXT]
4.Wright TL. Hepatitis C virus infection and organ transplantation. Prog Liver Dis 1993;1:215-30.  Back to cited text no. 4    
5.Roth D, Fernandez JA, Babischkin S, et al. Detection of Hepatitis C virus infection among cadaver organ donors: evidence for low transmission of disease. Ann Intern Med 1992;117:(6):470-5.  Back to cited text no. 5    
6.Chan TM, Lok AS, Cheng IK, Chan RT. A prospective study of hepatitis C virus infection among renal transplant recipients. Gastroenterol-ogy 1993;104:(3):862-8.  Back to cited text no. 6    
7.Conlon PJ, Walshe JJ, Smyth EG, McNamara EB, Donohoe J, Carmody M. Lower prevalence of anti-hepatitis C antibody in dialysis and renal transplant patients in Ireland. Ir J Med Sci 1993;162(4):145-7.  Back to cited text no. 7    
8.Mondelli MU, Cristina G, Piazza V, Cerino A,Villa G, Salvadeo A. High prevalence of antibodies of hepatitis C virus in hemodialysis units using a second generation assay. Nephron 1992:61(3):350-1.  Back to cited text no. 8    
9.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.  Back to cited text no. 9    
10.Fakunle YM, Al-Mofarreh M, El­Karamany WM, Ezzat HO, Al-Shora B, El-Dress AZ. Prevalence of antibodies to hepatitis C virus in hemodialysis patients in Riyadh. Ann Saudi Med 1991;5(2):504-6.  Back to cited text no. 10    
11.Fathalla SE, Al-Jama AA. Prevalence of hepatitis C viral antibodies in blood donors, pregnant women and hemodialysis patients in the Eastern Province of Saudi Arabia: a preliminary study. Saudi Med J 1993;14(3):265.  Back to cited text no. 11    
12.Al Nasser MN, Al Mugeiren MA, Assuhaimi SA, Obineche E, OnwabaliliJ, Ramia S. Seropositivity to hepatitis C virus in Saudi hemodialysis patients. Vox Sang 1992;62(2):94-7.  Back to cited text no. 12    
13.Shaheen FAM, Huraib S, Al-Rasheed R, et al. Prevalence of hepatitis C antibodies among hemodialysis patients in the Western Province of Saudi Arabia (abstract). Saudi Kidney Dis Transplant Bull 1993;4:73.  Back to cited text no. 13    
14.Huraib S, Al-Rasheed R, Aldress A, Al­Jefry M, Arif M, Faleh FA. High prevalence and risk factors for hepatitis C in Saudi Arabia: a need for new Strategies in dialysis practice (abstract).Saudi Kidney Dis Transplant Bull 1993;4:73.  Back to cited text no. 14    
15.Alter HJ. New kit on the block: evaluation of second-generation assays for detection of antibody to the hepatitis C virus. Hepatology 1992;15:350-3.  Back to cited text no. 15  [PUBMED]  
16.Hardy NM, Sandroni S, Danielson S, Wilson WJ. Antibody to hepatitis C virus increases with time on hemodialysis. Clin Nephrol 1992;38(l):44-8.  Back to cited text no. 16    
17.Dentico P, Buongiorno R, Volpe A, et al. Prevalence and incidence of hepatitis C virus (HCV) in hemodialysis patients: study of risk factors. Clin Nephrol 1992;38(l):49-52.  Back to cited text no. 17    
18.Vitale C, Tricerri A, Marangella M, et al. Epidemiology of hepatitis C virus infection in dialysis units: first-versus second-generation assays. Nephron 1993;64:315-6.  Back to cited text no. 18  [PUBMED]  
19.Pascual J, Teruel JL, Liano F, Ortuno J. Home hemodialysis protects against hepatitis C virus transmission (Letter). Nephron 1993;64:314.  Back to cited text no. 19    
20.van der Poel CL, Reesink HW, Schaasberg W, et al. Infectivity of blood seropositive for hepatitis C virus antibodies. Lancet 1990;335:558-60.  Back to cited text no. 20  [PUBMED]  [FULLTEXT]
21.Ayoola EA, Huraib SO, Arif M, et al. Prevalence and significance of antibodies to hepatitis C virus among Saudi hemodialysis patients. J Med Virol 1991;35(3):155-9.  Back to cited text no. 21    

Correspondence Address:
Saad S Al Shohaib
Consultant Nephrologist, National Guard King Khaled Hospital, P.O. Box 9515, Jeddah 21423
Saudi Arabia
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PMID: 18583850

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