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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 : 136-139
Prevalence of Hepatitis C Antibodies Among Hemodialysis Patients in the Western Province of Saudi Arabia

1 Jeddah Kidney Center, Jeddah, Saudi Arabia
2 Department of Nephrology, College of Medicine, King Saud University, Riyadh, Saudi Arabia
3 Department of Gastroenterology, College of Medicine, King Saud University, Riyadh, Saudi Arabia
4 King Abdulaziz Hospital, Jeddah, Saudi Arabia
5 Ministry of Health, Riyadh, Saudi Arabia
6 Al Noor Hospital, Makkah, Saudi Arabia
7 King Faisal Hospital, Taif, Saudi Arabia

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We studied 408 patients on maintenance hemodialysis at four different centers in the Western province of Saudi Arabia to assess the prevalence of antibody against Hepatitis C Virus (HCV) and the possible risk factors. There were 212 males and 196 females with a mean age of 42.9 ± 13.9 years (range 12 to 75 years). They were on dialysis for a period between 3 to 140 months with a mean of 52.2 + 38 months. Assay for anti-HCV was made by second generation ELISA. A total of 295 patients (72.3%) tested positive. The prevalence rates varied considerably among the four centers studied and were as follows: the center at Jeddah, 62.7%; two centers at Makkah, 87% and 79.7% respectively and one center at Taif, 80.9%. A total of 311 patients had received varying number of blood transfusions. Of these, 230 (74%) were anti-HCV positive as against 97 patients who were never transfused of whom 65 (67%) were positive. This difference did not reach statistical significance (P = 0.22). Similarly, we found no significant correlation between the anti-HCV prevalence rates and serum alanine transaminase levels (P = 0.93). Our study further confirms that there are routes other than blood transfusion involved in the transmission of the HCV and there is a need to determine these routes in order to prevent the spread of this virus.

Keywords: Hepatitis C virus, Hemodialysis, Saudi Arabia.

How to cite this article:
Shaheen FA, Huraib SO, Al-Rashed R, Aldrees A, Arif M, Al Jeffry M, Tashkandy MA, Safwat M. Prevalence of Hepatitis C Antibodies Among Hemodialysis Patients in the Western Province of Saudi Arabia. Saudi J Kidney Dis Transpl 1995;6:136-9

How to cite this URL:
Shaheen FA, Huraib SO, Al-Rashed R, Aldrees A, Arif M, Al Jeffry M, Tashkandy MA, Safwat M. Prevalence of Hepatitis C Antibodies Among Hemodialysis Patients in the Western Province of Saudi Arabia. Saudi J Kidney Dis Transpl [serial online] 1995 [cited 2020 Jul 6];6:136-9. Available from: http://www.sjkdt.org/text.asp?1995/6/2/136/40854

   Introduction Top

The recent cloning of the genome of one of the non-A non-B hepatitis viruses designated as hepatitis C virus (HCV) and the development of recombinant anti-HCV assay has made it possible to evaluate the prevalence and significance of HCV infection in the general population as well as in potential high risk groups [1] .The majority of the results reported in literature since 1984 were based on the first generation C 100-3 anti-HCV Enzyme Linked Immunosorbent Assay (ELISA-I) and the reported prevalence rate among dialysis patients was 1 - 29% in different parts of the world [2],[3] and 41.9% in the Kingdom of Saudi Arabia [4] . This method of assay has proved to be associated with many false positive and false negative results. A second generation test (ELISA-II) that incorporates core antigen and a fusion of C-100-33 and C­33 antigens of the HCV genome was recently developed [5] . Also, more sensitive confirma­tory tests for the anti-HCV positive samples are now available.

In view of previous reports regarding an increased incidence of long-term sequelae in patients with positive HCV antibody [6],[7] a multi-center study was conducted in the Western region of the Kingdom of Saudi Arabia involving four HD centers; one in Jeddah, two in Makkah and one in Taif. The prevalence of HCV and the risk factors involved were assessed.

   Patients and Methods Top

A total of 408 patients on HD at four major Ministry of Health hospitals located in the Western region of the Kingdom of Saudi Arabia were studied. The centers were as follows: one from Jeddah (212 patients), one from Taif (68 patients) and two from Makkah (128 patients). The mean age of the study patients was 42.9 + 13.9 years (range 12 to 75 years). There were 212 males and 196 females in the study. All patients had end­stage renal disease and had been on HD for a mean duration of 52.2 ± 38 months (range 3 to 140 months). Patients were dialysed for 3 to 4 hours performed thrice weekly using cuprophane membrane dialyzer. Universal precautions for infection-control are routinely practiced in all these centers. None of the centers practice re-use of any of the disposables. Disinfection of the machine was performed by hot water rinsing and chemical disinfection performed at the end of the day (Jeddah center) or at the end of the week (the other centers). All serum samples were sent to the King Khaled University Virology Laboratory at Riyadh, where they were stored frozen at -20 °C until the anti-HCV assay was performed using second generation ELISA (Abbott Laboratories, North Chicago, IL). All anti-HCV positive samples were retested by Abbott HCV ELISA.

The patients also had estimation of serum alanine transferase (ALT) levels and the test was considered abnormal if it was at least 1.5 times the normal level. The Hepatitis B surface antigen (HBsAg) status was determined in all the study patients. The Chi­square test and Fisher's exact test were used for statistical analysis.

   Results Top

Among the 408 patients studied, 295 (72.3%) were found to be anti-HCV positive. The prevalence rate varied from one center to the other as shown in [Table - 1]. Of the 97 study patients who had never received blood transfusions, 65 were anti-HCV positive (67%). The remaining 311 patients had received varying number of blood transfusions and of them 230 (74%) were anti-HCV positive. This difference in the prevalence rates did not reach statistical significance (P=< 0.22, [Table - 2]). Similarly, no good correlation was found between ALT levels and anti-HCV positivity (P= 0.93) [Table - 3].

   Discussion Top

The 408 patients in our study were taken at random out of a larger number of patients (>1000) on HD at the four centers. Patients were 12-75 years of age and there was an almost equal number of males and females in the study. They were from multiple ethnic groups and were receiving HD treatment for variable durations of time. The overall prevalence (72.3%) of positive anti-HCV antibody in our study patients is very high when compared to reports from other parts of the world. The prevalence also varied between different centers (note that all the samples for anti-HCV detection were pro­cessed at one center). The prevalence was highest in the centers in the Makkah area and least in the center at Jeddah. No clear cause could be detected to account for this difference. Difference in prevalence rates have also been reported from different regions of Saudi Arabia: 34.8% to 53.7% in the Central Province [8],[9] , 46.5% in the Eastern Province [10] and 45.5% in the Southern Province [11] . In a multi-center study involving 22 centers in the Kingdom, prevalence rates between 14.5% and 94.7% were reported [12] . This high variation in the prevalence rates could indicate that probably universal infection-control precautions are not being applied uniformly in all centers and/or other regional, ethnic, environmental factors might have a role to play in the transmission of the virus.

In our study, there was no correlation , between blood transfusions and anti-HCV positivity. This is in agreement with other reports [13] though reports to the contrary also exist [14] . Nevertheless, HCV transmission through blood transfusion should be considered since the reported prevalence of anti-HCV antibody in healthy blood donors varies from 0.42% in Germany [15] up to 6.6% in China [16] . The overall prevalence of anti-HCV among voluntary blood donors in Saudi Arabia is about 2.2% [17] . Thus, screening of blood donors for anti-HCV is essential and those with positive results should be rejected.

The occurrence of a sizable number of anti-­HCV positive patients among those who had never received prior blood transfusions is a clear indicator that alternative modes of transmission exist. A common mode of spread could be present for both hepatitis B virus and HCV as evidence by a higher incidence of anti-HCV positivity in HBsAg positive individuals. Reports have indicated that HCV is found in association with hepatitis B in 11% to 29% patients [18] .

Cross-infection could be responsible for the high prevalence of anti-HCV in HD patients. Hence, the dialysis staff should observe all necessary precautions to prevent this. The allocation of separate HD machines for the anti-HCV positive patients could pose a real problem because of the large number of these patients. Since machine to patient transmission is not very well documented up to now, machine isolation may not be justified at the moment.

A high level of the serum transaminases did not significantly correlate to the positivity of anti-HCV in our study. Thus, a rise in transaminases alone may not be an indicator for the presence of HCV.

   Conclusion Top

The prevalence of anti-HCV antibodies is very high in the HD population in the Western Province of Saudi Arabia and the mode of spread is not very well defined. Blood transfusion has been considered a source of spread, but the high prevalence of anti-HCV antibody positivity in non-transfused patients makes environmental and other factors likely to play an important role in transmission of the infection. More detailed studies are required to know the exact mode of spread of HCV so that appropriate measures may be taken to prevent this serious disease from spreading.

   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  [PUBMED]  [FULLTEXT]
2.Zeldis JB, Depner TA, Kuramoto IK, Gish RG, Holland PV. The prevalence of hepatitis C virus antibodies among hemodialysis patients. Ann Intern Med 1990;112:958-60.  Back to cited text no. 2  [PUBMED]  
3.Oguchi H, Terashima M, Tokunaga S, et al. Prevalence of anti-HCV in patients on long-term hemodialysis. Nippon Jinzo Gakkai Shi1990;32:313-7.  Back to cited text no. 3  [PUBMED]  
4.Ayoola EA, Huraib S, Arif M, et al. Prevalence and significance of antibodies to hepatitis C virus among Saudi haemodialysis patients. J Med Virol 1991;35:155-9.  Back to cited text no. 4  [PUBMED]  
5.Pereira BJ, Milford EL, Kirkman RL, Levey AS. Transmission of hepatitis C virus by organ transplantation. N Engl J Med 1991;325:454-60.  Back to cited text no. 5  [PUBMED]  
6.Alter HJ. Chronic consequence of non­A, non-B hepatitis. In: Seeff LB, Lewis JH, (eds). Current perspectives in hepatology. New York, Plenum Medical Books, 1989;89-97.  Back to cited text no. 6    
7.Kiyosawa K, Akahane Y, Nagata A, Furuta S.Hepatocellular carcinoma after non-A, non-B posttransfusion hepatitis. Am J Gastroenterol 1984;79:777-81.  Back to cited text no. 7    
8.Saeed AA, Fairclough D, Al-Admawi AM, et al.Hepatitis C virus in Saudi Arabia: a preliminary Survey. Saudi Med J 1990;l 1:331-2.  Back to cited text no. 8    
9.Fakunle YM, Al-Mofarreh M, El'Karamany WM, et al. Prevalence of antibodies to hepatitis C virus in hemodialysis patients in Riyadh. Ann SaudiMed 1991;ll:504-6.  Back to cited text no. 9    
10.Fathalla SE, Al-Jama AA. Prevalance of hepatitis C viral antibodies in blood donors, pregnant women and haemodialysis patients in the Eastern Province of Saudi Arabia: a preliminary study. Saudi Med J 1993;14(3):265.  Back to cited text no. 10    
11.al Nasser MN, al Mugeiren MA, Assuhaimi SA, Obineche E, Onwabalili J, Ramia S. Seropositivity to hepatitis C virus in Saudi haemodialysis patients. Vox Sang 1992;62(2):94-7.  Back to cited text no. 11    
12.Huraib S, Al-Rasheed R, Aldrees A, Al-Jefry 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:S73.  Back to cited text no. 12    
13.Pauri P, Salvoni G, Vitolo W, et al. Risk factors and clinical expression of HCV infection in hemodialysis patients. Nephron 1992;61:313-4.  Back to cited text no. 13    
14.Pluvio M, Saggese A, Cirillo D, et al. Hepatitis C virus-related acute and chronic hepatitis in hemodialysis patients. Nephron 1992;61:322-3.  Back to cited text no. 14  [PUBMED]  
15.Kuhnl P, Seidl S, Stangel W, Beyer J, Sibrowski W, Flik J. Antibody to hepatitis C virus in German blood donors. Lancet 1989;2:324.  Back to cited text no. 15    
16.Tao QM, Wang Y, Wang H, Chen WR, Sun Y, Meng Q. Investigation of anti­HCV in 391 serum samples in China. Chin Med J Engl 1990;103(8):616-8.  Back to cited text no. 16    
17.Al-Mofarreh M, Fakunle YM, El­Karamany WM, et al. Prevalence of antibodies to Hepatitis C virusin blood donors in Riyadh. Ann Saudi Med1991;ll(5):501-3.  Back to cited text no. 17    
18.Sanchez-Tapias JM, Barrera JM, Costa J, et al.Hepatitis C virus infection in patients with nonalcoholic chronic liver disease. Ann Intern Med 1990;112(12):921-4.  Back to cited text no. 18    

Correspondence Address:
Faissal A.M Shaheen
Consultant Nephrologist and Director, Jeddah Kidney Center, King Fahd Hospital, Jeddah
Saudi Arabia
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PMID: 18583852

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