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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 : 132-135
Prevalence of Hepatitis C Virus Antibodies in Hemodialysis Patients in Madinah Al Munawarah

1 Department of Nephrology, King Fahad Hospital, Madinah Al Munawarah, Saudi Arabia
2 Department of Laboratory, King Fahad Hospital, Madinah Al Munawarah, Saudi Arabia

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This study was carried out to evaluate the prevalence of antibodies against hepatitis C virus (HCV) in our hemodialysis (HD) unit at Madinah Al Munawarah in Saudi Arabia. Fifty six of the 94 patients (60%) studied were positive for HCV, while none of the thirty staff members working in the same unit were positive. The positivity of HCV correlated significantly with duration on HD. No significant correlation was found with the number of blood transfusions, hepatitis B markers or liver enzymes.

Keywords: Hepatitis C, Hemodialysis, Madinah, Saudi Arabia.

How to cite this article:
Bernieh B, Allam M, Halepota A, Mohamed AO, Parkar J, Tabbakh A. Prevalence of Hepatitis C Virus Antibodies in Hemodialysis Patients in Madinah Al Munawarah. Saudi J Kidney Dis Transpl 1995;6:132-5

How to cite this URL:
Bernieh B, Allam M, Halepota A, Mohamed AO, Parkar J, Tabbakh A. Prevalence of Hepatitis C Virus Antibodies in Hemodialysis Patients in Madinah Al Munawarah. Saudi J Kidney Dis Transpl [serial online] 1995 [cited 2020 Jun 6];6:132-5. Available from: http://www.sjkdt.org/text.asp?1995/6/2/132/40853

   Introduction Top

Non-A, non-B (NANB) hepatitis, which is the major cause of transfusion associated hepatitis [1],[2],[3] , is known for years and is diagnosed on the basis of exclusion of other known causes of viral hepatitis. The cloning of the NANB hepatitis virus has permitted the development of serological assays to detect antibodies against what is now designated as Hepatitis C virus (HCV) [4],[5] . Antibodies against HCV have been demonstrated in 54% to 70% of patients with posttransfusion hepatitis [5],[6] . Hepatitis C virus Hospital, is a main cause of liver disease in patients on hemodialysis (HD) [7] . About 50% of patients infected by this virus develop chronic hepatitis and a substantial percentage of them may develop liver cirrhosis and hepatocellular carcinoma [8],[9],[10] . This study was performed to evaluate the prevalence of HCV antibodies in our HD patients and to assess the possible predisposing factors,

   Subjects and Methods Top

This study was carried out in November 1991.at the HD unit in King Fahd Hospital had Hospital, Madinah Al Munawarah, Saudi Arabia. Ninety four patients with end-stage renal disease on maintenance HD and thirty staff members working in the same dialysis unit were included in this study. The age, sex Nationality, date of starting HD and number of units of blood transfused were recorded for each patient. Hepatitis B markers and liver function tests were also studied. The screening for HCV antibodies was performed using second generation enzyme linked immunosorbent assay (ELISA) (Abbott) which detects antibodies to proteins expressed by putative structural and non­structural regions of the HCV genome. Reactive samples were analyzed again in duplicate using Abbott HCV supplemental assay. The HCV positive and negative subjects were compared in relation to duration on dialysis, blood transfusion status, liver function tests and presence of hepatitis B markers.

   Results Top

A total of 94 patients were studied of whom 42 were males and 52 females. The mean age of the study patients was 47.2 + 16.7 years. Thirty staff members were also studied whose mean age was 32.9 + 6.4 years and there were 14 males and 16 females in this group. Fifty six patients (60%) tested positive for anti-HCV antibodies. Of them, 21 were males (37.5%) and 35, females (62.5%). Forty six (82%) of the anti-HCV positive patients were Saudi nationals and 10 (18%) were non­Saudis. The duration on dialysis was significantly longer in the anti-HCV positive group (mean 50 months) than in the negative group (mean 24 months) (P= <0.001). Forty eight (85.7%) of the HCV positive patients had received varying number of blood transfusions in contrast to 33 (86.8%) of the anti-HCV negative patients [Table - 1]. There was no significant correlation between the number of transfusions and HCV positivity.

[Table - 2] shows the levels of liver enzymes and bilirubin in the anti-HCV positive and negative groups. There was no significant difference between the two groups. The prevalence of various hepatitis B markers in the study patients is presented in [Table - 3] and there was no significant difference between the two groups.

   Discussion Top

Since the introduction of an anti-HCV antibody assay [5] there have been several reports on the prevalence of HCV in HD patients. There is also some disagreement regarding its contributing risk factors [11],[12] . Our study reveals that the prevalence of anti­HCV antibodies among our HD patients is 60% which is considerably higher than that reported from other countries. In the USA, Jeffers, et al reported a prevalence of anti­HCV of 12% in their HD patients [13] . In Europe, the reported prevalence varies from 5.4% to 55% [11],[14],[15],[16],[17] . Also, it is to be noticed that our results are higher than that reported from other parts of the Kingdom where the prevalence is reported to be between 40.4% to 45% [18],[19],[20] . The reason of this higher preyalence of anti-HCV in our unit is not clear. The possible reasons for this may be:

The higher prevalence of anti-HCV(5.3%) among asymptomatic blood donors in our area (Al-Tuwaijri AS, et al,personal communication) than that reported both in other areas of Saudi Arabia (1.01% - 3.9%) [18],[19] as well as other parts of the world (0.46% to 1.2%) [21],[22] . Since routine screening of blood donors for anti-HCV antibody started in Madinah only in Nov 1991, substantial percentage of our HD patients were probably infected through blood transfusions received earlier.

Our center is the only HD unit in Madinah Al Munawarah, one of the two holy cities of Islam, and provides HD services for patients coming from all over the world during Hajj and for visiting, and some of these patients may originate from highly endemic areas.

There is a low rate of renal transplantation among our patients and this prolongs the duration on HD of our patients.

The present study indicates that the duration on HD is the major risk factor for HCV infection which is in agreement with many investigators [23],[24],[25],[26] . The HD procedure may predispose to cross-contamination. This is supported by the low prevalence of HCV infection among patients treated by peritoneal dialysis [27],[28] . The correlation between HCV infection and the number of blood transfusions received by the patients is controversial. Our findings are in agreement with other studies [24],[25],[26] regarding the insignificant correlation between the number of blood transfusions and anti-HCV positivity.

The different hepatitis B virus markers and liver enzymes showed no significant correla­tion with anti-HCV positivity and similar findings have been documented by others as well [24],[25] . None of our staff members had positive anti-HCV which means that the risk of contamination of medical staff is almost nil though there are some reports of a low risk of contamination among medical staff ranging from 0 to 2% [29],[30],[31] .

In conclusion, our study shows that there is a high prevalence of anti-HCV among our HD patients and this correlated positively only with the duration on HD. Preventive measures to stop the spreading of this dangerous viral infection among HD patients is urgently needed.

   References Top

1.Feinstone SM, Kapikian AZ, Purcell RH, Alter HJ, Holland PV. Transfusion-associated hepatitis not due to viral hepatitis type A or B. N Engl J Med 1975;292:767-70.  Back to cited text no. 1  [PUBMED]  
2.Alter HS, Holland PV, Morrow AG, Purcell RH, Feinstone SM, Moritsugu Y. Clinical and serological analysis of transfusion associated hepatitis. Lancet 1975;2:838-41.  Back to cited text no. 2    
3.Aach RD, Lander JJ, Sherman LA, et al. Transfusion transmitted viruses. Interim analysis of hepatitis among transfused and non transfused patients. In Vyas GN, Cohen SM, Schmid R, (eds). Viral hepatitis. Philadiphia. Franklin Institute Press, 1978:383-96.  Back to cited text no. 3    
4.Choo QL, Kuo G, Weiner AJ, Overby LR, Bradley DW, Houghton M. Isolation of a cDNA clone derived from a blood-borne non-A, Non-B viral hepatitis genome. Science 1989;244:359-62.  Back to cited text no. 4  [PUBMED]  [FULLTEXT]
5.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. 5  [PUBMED]  [FULLTEXT]
6.Alter HJ, Purcell RH, Shin JW, et al. Detection of antibody to hepatitis C virus in prospectively followed transfusion recipients with acute and chronic non-A, non-B hepatitis. N Engl J Med 1989;321:1494-500.  Back to cited text no. 6    
7.Alter MJ, Favero MS, Maynard JE. Impact of infection control strategies on theincidence of dialysis-associated hepatitis in the United States. J Infect Dis 1986;153:1149-51.  Back to cited text no. 7    
8.Bruix J, Barrera JM, Calvet X, et al. Prevalence of antibodies to hepatitis C virus in Spanish patients with hepatocellular carcinoma and hepatic cirrhosis. Lancet 1989;2:1004-6.  Back to cited text no. 8  [PUBMED]  
9.Colombo M, Kuo G, Choo QL, et al. Prevalence of antibodies to hepatitis C virus in Italian patients with, hepatocellular carcinoma. Lancet 1989;2:1006-8.  Back to cited text no. 9  [PUBMED]  [FULLTEXT]
10.Dienstag JL. Non-A, Non-B hepatitis. 1. Recognition, epidemiology and clinical features. Gastro-enterology 1983:85:439-62.  Back to cited text no. 10    
11.Esteban JI, Esteban R, Viladomiu L, et al. Hepatitis C virus antibodies in emodialysis patients. Lancet 1990;335:1409.  Back to cited text no. 11    
12.Zeldis JB, Depner TA, Kuramoto IK, Gish RG, Holland PV. The prevalence of hepatitis C virusantibodies among hemodialysis patients. Ann Intern Med 1990;112:958-60.  Back to cited text no. 12  [PUBMED]  
13.Jeffers LJ, Perez GO, de Medina MD, et al. Hepatitis C infection in two urban hemodialysis units. Kidney Int 1990;38:320-2.  Back to cited text no. 13  [PUBMED]  
14.Bracchi O, Orazi E, Lupi GP, Bronzieri C,Cornalba L, Grassi C. Hepatitis C: reality of arenal unit. Nephron 1992;61:369-70.  Back to cited text no. 14  [PUBMED]  
15.Mondelli MU, Cristina G, Piazza V, Cerino A,Villa G, Salvadeo A. High prevalence of antibodies to hepatitis C virus in hemodialysis units, using a second generation assay. Nephron 1992;61:350-l.  Back to cited text no. 15  [PUBMED]  
16.Gilli P, Moretti M, Soffritti S, et al. Non A, Non B hepatitis and anti-HCV antibodies in dialysis patients. Int J Artif Organs 1990;13(ll):737-41.27.  Back to cited text no. 16    
17.Kuhnl P, Roggendorf M, Sibrowski W, et al.Hepatitis C virus antibodies (HCV) in patientstreated with chronic hemodialysis. Beitr Infu-sionther 1990;26:27-9.  Back to cited text no. 17    
18.Alfurayh O, Sobh M, Buali A, et al. Hapatitis Cvirus infection in chronic hemodialysis patients, aclinico­pathologic study. Nephrol Dial Transplant1992;7:327-32.  Back to cited text no. 18  [PUBMED]  [FULLTEXT]
19.Ayoola EA, Huraib S, Arif M, et al. Prevalance and significance of antibodies to hepatitis C virus among Saudi hemodialysis patients. J Med Virol 1991;35:155-9.  Back to cited text no. 19  [PUBMED]  
20.Al Mugerien M, Al Faleh FZ, Ramia S, Al Rasheed S, Mohmoud MA, Al Nasser M. Seropositivity to hepatitis C virus (HCV) in Saudi children with chronic renal failure maintained on hemodialysis. Ann Trop Paediatr 1992;12:217-9.  Back to cited text no. 20    
21.Esteban JI, Esteban R, Viladomiu L, et al.Hepatitis C virus antibodies among risk groups in Spain. Lancet 1989;2:294-7.  Back to cited text no. 21  [PUBMED]  
22.Malaguti M, Capece R, Marciano M, Arena G, Luciani MP, et al. Antibodies to hepatitic C virus (anti-HCV): prevalance in the same geographical area in dialysis patients, staff members, and blood donors. Nephron 1992;61(3):346.  Back to cited text no. 22    
23.Hardy NM, Sandroni S, Danielson S, Wilson WJ. Antibody to hepatitis C virus increases with time on hemodialysis. Clin Nephrol 1992;38:44-8.  Back to cited text no. 23  [PUBMED]  
24.Giammaria V, De Meo F, Acitelli S, et al. HCV infection in hemodialyzed patients: incidence and correlation with dialytic age. Nephron 1992;61:335-6.  Back to cited text no. 24    
25.Da Porto A, Adami A, Susanna F, et al. Hepatitis C virus in dialysis units: a multicenter study. Nephron 1992;61:309-10.  Back to cited text no. 25  [PUBMED]  
26.Alter MJ, Favero MS, Moyer LA, Bland LA. National surveillance of dialysis associated diseases in the United States 1989. ASAIO Trans 1991;37:97-109.  Back to cited text no. 26  [PUBMED]  
27.Huang CC, Wu MS, Lin DY, Liaw YF. The prevalence of hepatitis C virus antibodies in patient treated with continuous ambulatory peritoneal dialysis. Perit Dial Int 1992;12:31-3.  Back to cited text no. 27  [PUBMED]  [FULLTEXT]
28.Chan TM, Lok AS, Cheng IK. Hepatitis C infection among dialysis patients: a comparison between patients on maintenance haemodialysis and continuous ambulatory peritoneal dialysis. Nephrol Dial Transplant 1991;6:944-7.  Back to cited text no. 28  [PUBMED]  
29.Niu MT, Alter MJ, -Kristensen C, Margolis HS. Outbreak of hemodialysis-associated non A, non B hepatitis and correlation with antibody to hepatitis C virus. Am J Kidney Dis 1992;19:345-52.  Back to cited text no. 29    
30.Petrarulo F, Maggi P, Sacchetti A, Pallotta G, Dagostino F, Basile C. HCV infection occupational hazard at dialysis units and virus spread among relatives of dialyzed patients. Nephron 1992;61:302-3.  Back to cited text no. 30  [PUBMED]  
31.Oguchi H, Miyasaka M, Tokunaga S, et al. Hepatitis virus infection (HBV and HCV) in eleven Japanese hemodialysis units. Clin Nephrol 1992;38:36-43.  Back to cited text no. 31  [PUBMED]  

Correspondence Address:
Bassam Bernieh
Department of Nephrology, King Fahad Hospital, Madinah Al Munawarah
Saudi Arabia
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PMID: 18583851

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