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Saudi Journal of Kidney Diseases and Transplantation
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LETTER TO EDITOR Table of Contents   
Year : 2000  |  Volume : 11  |  Issue : 1  |  Page : 72-73
Hepatitis C in Dialysis Patients in Egypt: Relationship to Dialysis Duration, Blood Transfusion, and Liver Disease


1 Nephrology Department, Zagazig University Hospital, Cairo, Egypt
2 Microbiology and Immunology Department, Ain Shams University, Cairo, Egypt

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How to cite this article:
Hassan AA, Khalil R. Hepatitis C in Dialysis Patients in Egypt: Relationship to Dialysis Duration, Blood Transfusion, and Liver Disease. Saudi J Kidney Dis Transpl 2000;11:72-3

How to cite this URL:
Hassan AA, Khalil R. Hepatitis C in Dialysis Patients in Egypt: Relationship to Dialysis Duration, Blood Transfusion, and Liver Disease. Saudi J Kidney Dis Transpl [serial online] 2000 [cited 2019 Nov 12];11:72-3. Available from: http://www.sjkdt.org/text.asp?2000/11/1/72/36697
To the Editor:

Hepatitis C infection is widely distributed throughout the world. In western countries, the prevalence of HCV infection in the general population ranges from 0.5-3%. Saeed et al, reported a surprisingly high proportion (19.2%) among Egyptian volunteer blood donors residing in Riyadh, Saudi Arabia. Kamel et al, [2] examined HCV positivity in 2164 apparently healthy, male university students, aged 20-27, who each donated one unit of blood between January- May, 1992 in Egypt. The authors reported 10.9% positivity of HCV antibodies by ELISA test. The prevalence of HbsAg was 3.4% in the same group and HCV coinfection was in 1.3%. Among the high-risk groups for acquiring viral infections are patients maintained on hemodialysis (HD). Huraib, et al, [3] in a multi-center study, reported a prevalence of anti HCV of 68% among Saudi patients on hemodialysis. Herein we report our results on prevalence HCV antibodies among a cohort of 210 chronic dialysis patients in seven HD centers in different regions in Cairo, Egypt.

The median age of the patients was 48.4 years (range 15-70). All patients were on hemodialysis for a median duration of 26.5 month (range 6-114 month).

Hemodialysis filters were not reused and dialysis was performed with disposable kits, syringes and needles. Disinfecting of the dialysis machines included rinsing between sessions by circulating hot water (80°C) for 25 minutes. In all centers but one, no special precautions were adopted concerning patients with suspected HCV or patients with un­explained elevated enzymes. Dedicated machines for anti-HCV negative patients were used in only one center.

Data and blood samples were obtained from January 1996 to July 1996. All samples were tested for HCV antibodies using a second generation ELISA. Positive samples were further tested by a second generation RIBA to confirm the presence of anti-HCV. Transaminases were measured routinely every month or every third month at the six­dialysis centers.

Among the 210 patients tested with second generation HCV ELISA we found 169 (80%) ELISA positive patients. Supplemental testing with second generation HCV RIBA showed that 125 of 169 (73%) were RIBA positive, 15 were RIBA indeterminate and 29 were RIBA negative. Thus 125 (59%) were classified as anti-HCV positive, 15 (7%) patients as anti-HCV indeterminate and 70 (33%) as anti HCV negative. There was no statistically significant difference between dialysis centers concerning the prevalence of anti-HCV.

There were no statistically significant differences between anti-HCV positive, indeterminate and negative patients concer­ning sex, age, and number of renal trans­plants. There was a statistically significant difference in number of blood transfusion between anti-HCV positive and indeter­minate patients compared with anti-HCV negative patients (PO.05). All but four anti-HCV positive and indeterminate patients had received blood transfusions. Anti-HCV positive and indeterminate patients had been on dialysis for a longer period than anti-HCV negative patients (mean 345 months vs 26.5 months PO.05).

Correlation with elevations of transami­nases showed, as expected, that most of the anti-HCV positive patients had normal liver enzymes and that elevation of the liver enzymes did not correlate with HCV infection.

Not all the anti-HCV positive patients had history of blood transfusion; and not all transfused patients were anti-HCV positive, indicating a nosocomial route of infection. In the dialysis center where anti-HCV negative patients were isolated, no seroconversion was noticed over two years among those patients who were on erythropoietin and never transfused and never been dialyzed in other centers. Although hepatitis C infection is often subclinical or associated with a mild clinical course, it evolves into chronic infection in about 50% of cases.[4],[5] Our data confirmed the impression that transaminases are not a sensitive marker for ongoing HCV-replication in hemodialysis patients, an observation which is in agreement with the data reported by Bosmans's et al. [6]

We conclude that HCV infection among hemodialysis patients is a major problem. It's high prevalence among Egyptian hemo­dialysis patient should prompt dialysis centers to strictly adhere to universal infection control precautions, careful attention to hygiene, strict sterilization of dialysis machines, conventional cleansing and possibly using dedicated machines for anti-HCV negative patients.

 
   References Top

1.Saeed AA, Al-Admawi AM, Al-Rasheed A, et al. Hepatitis C virus infection in Egyptian volunteer blood donors in Riyadh. Lancet 1991 ;338:459-60.  Back to cited text no. 1  [PUBMED]  
2.Kamel MA, Ghaffar YA, Wasef MA, et al. High HCV prevalence in Egyptian blood donors. Lancet 1992;340:427.  Back to cited text no. 2    
3.Huraib S, Al-Rasheed R, Aldrees A, AL­Jefry, 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(S1):S73.  Back to cited text no. 3    
4.Dienstag JL, Alter HJ. Non- A, non- B hepatitis: evolving epidemiologic and clinical perspective. Semin Liver Dis 1986;6:67-81.  Back to cited text no. 4  [PUBMED]  
5.Alter HJ. The hepatitis C virus and its relationship to the clinical spectrum of NANB hepatitis. J Gastroenterol Hepatol 1990;5(Suppl l):78-94.  Back to cited text no. 5    
6.Bosnians JL, Nouwen EJ, Behets G, et al. Prevalence and clinical expression of HCV­genotypes in haemodialysis-patients of two geographically remote countries: Belgium and Saudi- Arabia. Clinical Nephrol 1997;47(4):256-62.  Back to cited text no. 6    

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Correspondence Address:
Ahmed Adel Hassan
Nephrology Department, Zagazig University Hospital, Cairo
Egypt
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PMID: 18209303

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