RENAL DATA FROM THE ARAB WORLD
|Year : 2007 | Volume
| Issue : 1 | Page : 101-106
|Hepatitis C virus infection in hemodialysis patients in Sudan: Two centers' report
HH El-Amin1, EM Osman1, MO Mekki2, MB Abdelraheem1, MO Ismail1, MEA Yousif1, AM Abass2, HS El-haj1, HK Ammar3
1 Dr Salma Center for Dialysis and Kidney Transplantation, University of Khartoum, Sudan
2 Khartoum Teaching Hospital, Federal Ministry of Health, Khartoum, Sudan
3 Ahfad University for Women and Epidemiological Laboratory, Khartoum, Sudan
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| Abstract|| |
Prevalence of HCV seropositivity among the hemodialysis population in Sudan is estimated to be around 34%. We undertook a cross sectional study in two major HD centers in Khartoum, Sudan for the prevalence of HCV seropositivity among the hemodialysis patients, during January to -March 2005. Testing for HCV antibodies was performed using 3 rd generation enzyme linked immunoadsorption assay (ELISA). A total of 236 patients were included in the study: 218 adults and 18 children. The mean age was 43.6 ± 15.6 years, and the majority was males: 71.6%. The cause of renal failure was unknown in 168 patients (71.2%). The mean HD duration was 36.6 ± 35.1 months. Prevalence of HCV seropositivity was 23.7%. Among 170 patients who were previously HCV seronegative, 30 (17.1%) seroconverted to positive in one year (estimated incidence: 63 new cases per year). HCV seropositivity was associated with longer duration of dialysis (p < 0.00001), previous surgery (p= 0.026), age of over 30 and years (p = 0.008), and dialysis in multiple centers (p= 0.005). We conclude that although HCV seropositivity in our study was lower than previously reported, it was still high among HD patients in Sudan. Nosocomial transmission of HCV among hemodialysis patients is a contributing factor.
Keywords: Hemodialysis, HCV, Chronic Renal, Failure.
|How to cite this article:|
El-Amin H H, Osman E M, Mekki M O, Abdelraheem M B, Ismail M O, Yousif M, Abass A M, El-haj H S, Ammar H K. Hepatitis C virus infection in hemodialysis patients in Sudan: Two centers' report. Saudi J Kidney Dis Transpl 2007;18:101-6
|How to cite this URL:|
El-Amin H H, Osman E M, Mekki M O, Abdelraheem M B, Ismail M O, Yousif M, Abass A M, El-haj H S, Ammar H K. Hepatitis C virus infection in hemodialysis patients in Sudan: Two centers' report. Saudi J Kidney Dis Transpl [serial online] 2007 [cited 2013 May 20];18:101-6. Available from: http://www.sjkdt.org/text.asp?2007/18/1/101/31856
| Introduction|| |
Hepatitis C virus (HCV) infection is a major health problem among hemodialysis (HD) patients in developing countries.  This could be due to the non-adherence to the strict universal infection control measures and the unavailability of vaccines to prevent hepatitis C infection. Moreover, the increased facilities and advanced hemodialysis techniques have prolonged patients' survival which increased their risk of acquiring HCV. 
In a survey done in Khartoum in the year 2001, HCV antibodies was detected in 0.4 % of blood donors and in 5.5% of multiply transfused patients.  Other reports among the general population from Western and Southern Sudan showed a prevalence of 2-3 %. ,
In patients on maintenance HD, viral hepatitis remains a major health problem not only for patients but also for dialysis staff . The onset and clinical diagnosis of HCV infection is often insidious and the majority of cases are detected incidentally during blood donation or routine HD screening.  Previous reports of the prevalence of HCV seropositivity from Sudan was 34% in 1994.
We aim in this study to evaluate the prevalence of HCV in the two largest HD centers in Khartoum, Sudan after more than a decade of improvement of the laboratory assays and expansion of the HD facilities in Sudan.
| Patients and Methods|| |
A cross sectional survey of patients on maintenance HD at Dr Salma's (SDKTC) and Khartoum (KDC) HD centers was conducted in the period from January to - Mar 2005.
A designed questionnaire was used for data collection; the data included: age, sex, cause of renal failure, duration of dialysis, previous blood transfusion, number of blood transfusions received and history of dialysis in multiple centers. Shared needles, tattooing, and previous HCV positivity were also recorded.
Antibodies against HCV were tested using 3 rd generation enzyme linked immunoadsorption assay (ELISA) (Intec products, INC. Cx1AMEN). HBsAg was also checked using auszyme monoclonal test.
All patients were on HD for 8-12 hours/ week. Disinfection of the machines was done according to the manufacturers' protocol. Dedicated machines were used for patients who were HCV seropositive in KDC but not in SDKTC, while patients who were hepatitis B virus seropositive were isolated in both centers.
Statistical analysis was done using SPSS program for windows version 10. All values, unless otherwise stated, are expressed as a mean ± SD. Independent 't' test was used to evaluate the association of continuous variables with HCV seropositivity. P-value of <0.05 was considered significant.
| Results|| |
A total 236 patients were enrolled in the study; 218 adult patients (110 in SDKTC and 108 in KDC) and 18 children (16 at SDKTC and 2 at KDC). There were 169 (71.6%) males and 67(28.4%) female. The mean age was 43.6 ± 15.6 years (range 11-76 years). The cause of renal failure was "unknown"in 168 (71.2%) patients, diabetes mellitus in 14(5.9%) patients, and HTN in 9 (3.8%), [Table - 1]. The mean duration of HD was 36.6 ± 35.1 months (range 0.5-168 months).
Prevalence of HCV seropositivity was 23.7%; (19.1% in KDC and 27.8% in SDKTC). All the children were HCV seronegative. HBV seropositivity was seen in 20 patients; all of them were dialyzed at SDKTC, [Table - 2].
Of the 236 patients enrolled for HCV incidence, 11 were initially HCV seropositive (4.7%), and 55 (23.3%) had unknown previous recorded serology for HCV; accordingly they were excluded from the study. All the remaining 170 patients were under followup for an average of 33.7 months. Among these 30 had seroconverted. This gives an estimated incidence of HCV infection of 63 new cases per year.
There were 62 staff members at SDKTC, all were screened and were found to be HCV seronegative.
There was no significant association between HCV seropositivity and gender (p = 0.406). There was significantly higher HCV seropositivity among patients who were over 30 years of age (p = 0.008).
Fifty six (32.9%) patients had previous surgery and this was significantly associated with hepatitis C seropositivity (p = 0.026).
The mean HD duration was significantly longer among HCV seropositive compared to HCV serongative patients ( p < 0.00001). One hundred and five (61.8%) patients had history of dialysis in multiple centers; this was significantly associated with HCV seropositivity (p = 0.005). Only eight patients had previous renal transplantation, and it was also found to be significantly associated with HCV seropositivity (p = 0.033).
The majority of our patients received blood transfusion (133 patients 78.2%), with 12 (18.5%) patients having received more than 10 units of blood. However, there was no significant association of blood transfusion or the number of units received with HCV seropositivity.
Thirteen (7.6 %) patients were HBsAg seropositive, of whom three had co-infection with HCV virus. There was no significant association between HCV sero-positivity and hepatitis B virus seropositivity. Other risk factors, namely previous jaundice (N= 46), shared needles (N= 1), and tattooing (N= 34), were not significantly associated with HCV seropositivity.
| Discussion|| |
Hepatitis C virus infection is a major health problem among HD patients as well as for dialysis staff. In this study we observed a prevalence of HCV seropositivity of 23.7% in HD patients; which is less than those previously reported in 1994,  and 2001.  The prevalence of HCV seropositivty in this study was also less than that reported from Saudi Arabia ,,,,,, Syria,  Tunisia, ,, Egypt, ,[ 21] Jordon,  Morocco,  Senegal,  Iran,  but similar to reports from Oman,  and Italy. 
However, our HCV prevalence of seropositivity was greater than that reported from Kenya, [ 28] South Africa,  Turkey, USA , and Mexico .In our study, HCV seropositivity was significantly associated with longer duration on dialysis, older age, previous surgery, and dialysis in multiple centers. This concurs with many regional and international reports, as longer duration on HD was shown to be a significant risk factor for HCV seropositivity among hemodialysis patients. ,,,,, , , , , ,,],,,,
Previous surgery was shown to be associated with hepatitis C seropositivity among hemodialysis patients in Italy,  and non dialysis patients in Turkey.  Dialysis in multiple centers was found to be significantly associated with higher HCV seropositivity in Saudi Arabia.
With regards to previous renal transplantation, there was small number of patients in our study who underwent previous transplantation, and so it was difficult to derive conclusions from the results. Previous renal transplantation was shown to be a risk factor for HCV seropositivity in reports from the USA.
HCV seropositivity was noted to be significantly higher among HD patients older than 30 years; This agrees with reports from USA,  and Saudi Arabia.
In our study, neither blood transfusion, nor the number of blood units received, were significantly associated with hepatitis C seropositivity. This agrees with previous report from SDKTC,  and with other regional, ,,,, and international reports. . However blood transfusion was shown to be a risk factor for hepatitis C seropositivity among hemodialysis patients in many other reports. , , , , , Patients' gender was not associated with HCV seropositivity in our studied population. This agrees with reports from Jordan,  and Syria. However male sex was reported to be associated with HCV seropositivity in one report from Saudi Arabia.
Other risk factors for HCV infection were not found to be associated with HCV seropositivity in our studied population, namely tattooing, shared needles and previous jaundice. This concurs with a previous report from Khartoum. 
We conclude that although the prevalence of HCV seropositivity found in our study was less than that reported previously from the same area, it continued to be elevated. Longer dialysis duration, previous surgery, age of 30 and more, and multiple dialysis center, were all associated risk factors. However, blood transfusion was not associated
with HCV seropositivity in our studied population. Nosocomial transmission seems to be an important route for transmission of HCV infection.
| References|| |
|1.||Alter HJ. Transmission pattern in hepatitis C virus infection. In: Nishioka K, ed. Viral hepatitis and liver disease. Springer Verlag 1993;445-9. |
|2.||Huraib SO. Hepatitis C in dialysis patients. Saudi J Kidney Dis Transplant 2003; 14(4):442-50. |
|3.||Isam KM, Hasabelgawi OA. Prevalence of hepatitisC virus antibodies in Khartoum State. A thesis submitted in the fulfillment of the requrirements of master degree in immunology. University of Khartoum, Khartoum, Sudan, 2001. |
|4.||Omer RE, Verhoef L, Vant. Veer P, et al. Peanut butter intake, GSTM-1 genotype and hepatocellular carcinoma: a casecontrol study in Sudan. Cancer causes control 2001;312:23-32. |
|5.||McCarthy MC, El Tigani A, Khalid IO, Hyams KC. Hepatitis B & C in Juba Southern Sudan; results of a serosurvey. Trans-R Soc-Trop-Med-Hyg 1994; 88:534-6. |
|6.||Alter MJ, Favero MS, Maynard JE. Impact of infection control strategies on the incidence of dialysis associated hepatitis in the United States. J Infect Dis 1986; 153: 1149-51. |
|7.||Shobokshi OA, Serebour FE, Skakni LI, Al-Jaser NM. The role of the laboratory in the diagnosis and management of chronic hepatitis patients. Saudi Med J 2003;24 supple2:S71-5. |
|8.||Sulieman SM, Fessaha S. Prevalence of hepatitis C virus infection in hemodialysis patients in Sudan. Saudi Med J 2003;24 Suppl2. |
|9.||Saxena AK, Panhotra BR. The vulnerability of middle aged and elderly patients to hepatitis C virus infection in high prevalence hospital based hemodialysis setting. J Am Geriatr Soc 2004;52 (2):242-6. |
|10.||Hussein MM, Mooij JM, Roujouleh H, et Sayed H. Observation in Saudi Arabian dialysis population over 13 year period. Nephrol Dial Transplant1994; 9 (8): 1072-6. |
|11.||el Mugeirren M, al-Faleh FZ, Ramia S, et al. Seropositivity to hepatitis C virus (HCV) in Saudi children with chronic renal failure maintained on hemodialysis. Ann Trop Paediatr 1992; 12(2): 217-9. |
|12.||Saxena AK, Panhotra BR. The impact of nurse understaffing on the transmission of hepatitis C virus in a hospital dased hemodialysis unit. Med Princ Pract 2004;13 (3):129-35. |
|13.||Fakunle YM, Al Mofffarreh M, El Karamani WM, etal. Prevalence of antibodies to hepatitis C virus in hemodialysis patients in Riyadh. Ann Saudi Med 1991; 11:504-6. |
|14.||Alfurah O, Sobh M, Buali A, et al. Hepatitis C virus infection in chronic hemodialysis patients: a clinicopathologic study. Nephrol Dial Transplant 1992;7:327-32. |
|15.||Kashem A, Nusairat I, Mohammad M, et al. Hepatitis C virus among hemodialysis patients in Najran: prevalence is more among multicenter visitors. Saudi J Kdney Dis Transplant 2003; 14(2):206-11. |
|16.||Othman B, Monem F. Prevalence of antibodies to hepatitis C virus among hemodialysis patients in Damascus, Syria. Infection 2001; 29(5): 262-5. |
|17.||Jemni S, Ikbel K, Kortas M, et al. Seropositivity to hepatitis C virus in Tunisian haemodialysis patients. Nouv Rev Fr Hematol. 1994;36(5):349-51. |
|18.||Hachicha J, Hammami A, Masmoudi H, et al. Viral hepatitis C in chronic hemodialyzed patients in southern Tunisia. Prevalence and risk factors. Ann Med Interne (Paris) 1995;146(5):295-8. |
|19.||Ben Othman S, Bouzgarrou N, Achour A, Bourlet T, Pozzetto B, Trabelsi A. High prevalence and incidence of hepatitis C virus infections among dialysis patients in the East-Centre of Tunisia Pathol Biol (Paris) 2004; 52(6):323-7. |
|20.||el Gohary A, Hassan A, Nooman Z, et al. High prevalence of hepatitis C virus among urban and rural population groups in Egypt. Acta Trop1995;59(2):155-61. |
|21.||Abdel Wahab MF, Zakaria S, Kamel M, et al. High seroprevalence of hepatitis C infection among risk groups in Egypt. Am J trop Med. 1994;51(5): 563-7. |
|22.||Bdour S. Hepatitis C virus infection in Jordanian haemodialysis units: serological diagnosis and genotyping. J Med Microbiol 2002 Aug;51(8):700-4. |
|23.||Benjelloun S, Bahbouhi B, Sekkat S, Bennani A, Hda N, Benslimane A. AntiHCV seroprevalence and risk factors of hepatitis C virus infection in Moroccan population groups. Res Virol 1996;147(4):247-55. |
|24.||Diouf ML, Diouf B, Niang A, et al Prevalence of hepatitis B and C viruses in a chronic hemodialysis center in Dakar. Dakar Med. 2000; 45 (1):1-4. |
|25.||Ansar MM, Kooloobandi A. Prevalence of hepatitis C virus infection in thalassemia and haemodialysis patients in north Iran-Rasht. J Viral Hepat 2002;9(5):390-2. |
|26.||al-Dhahry SH, Aghanashinikar PN, alHasani MK, Buhl MR, Daar AS. Prevalence of antibodies to hepatitis C virus among Omani patients with renal disease. Infection 1993;21(3):164-7. |
|27.||Fabrizi F, Lunghi G, Raffaele L, et al. Serologic survey for control of hepatitis C in haemodialysis patients: third-generation assays and analysis of costs. Nephrol Dial Transplant 1997;12(2):298-303. |
|28.||Otedo AE, Mc'Ligeyo SO, Okoth FA, Kayima JK. Seroprevalence of hepatitis B and C in maintenance dialysis in a public hospital in a developing country. S Afr Med J 2003; 93(5):380-4. |
|29.||Cassidy MJ, Jankelson D, Becker M, Dunne T, Walzl G, Moosa MR. The prevalence of antibodies to hepatitis C virus at two haemodialysis units in South Africa. S Afr Med J1995;85(10):996-8. |
|30.||Olut AI, Ozsakarya F, Dilek M. Seroprevalence of hepatitis C virus infection and evaluation of serum aminotransferase levels among haemodialysis patients in Izmir, Turkey. J Int Med Res 2005;33(6):641-6. |
|31.||Finelli L, Miller JT, Tokars JI, Alter MJ, Arduino MJ. National surveillance of dialysis-associated diseases in the United States, 2002. Semin Dial 2005;18(1):52-61. |
|32.||Natov SN, Lau JY, Bouthot BA, et al. Serologic and virology profiles of hepatitis C virus infection in renal transplant candidates. Am J Kidney Dis 1998;31(6): 920-7. |
|33.||Mendez-Sanchez N, Motola-Kuba D, Chavez Tapia NC, et al. Prevalence of hepatitis C virus infection among hemodialysis patients at a tertiary care hospital in Mexico City, Mexico. J Clin Microbiol 2004;42: 4321-2. |
|34.||Huraib S, al Rashed R, Aldrees A, Aljefry M, Arif A, al Faleh FA. High prevalence and risk factors for hepatitis C in haemodialysis patients in Saudi Arabia: a need for new dialysis strategies. Nephrol Dial Transplant 1995; 10 (4): 470-4. |
|35.||Al Shohaib SS, Abd Elaal MA, Zawawi TH, Abbas FM, Shaheen FA, Amoah E. The prevalence of hepatitis C virus antibodies among hemodiallysis patients in Jaddah area, Saudi Arabia. Saudi Med J 2003;24 suppl2: S125. |
|36.||Berneih B, Halepota MA, Mohamed AO, Parkaar J, Tabbakh A. Prevalence of hepatitis C virus antibodies in hemodialysis patients in Medinah AlMunawarah, Kingdom of Saudi Arabia. Saudi Med J 2003;24 supple 2: S125. |
|37.||Al Nasser MN, Al Mugeiren MA, Assuhaimi SA et al. Seropositivity to hepatitis C virus in Saudi haemodialysis patients. Vox Sang 1992; 62 (2): 94-7. |
|38.||Petrosillo N, Gilli P, Serraino D, et al. Prevalence of infected patients and understaffing have a role in hepatitis C virus transmission in dialysis. Am J Kidney Dis 2001;37(5):1004-10. |
|39.||Karaca C, Cakaloglu Y, Demir K, et al. Risk factors for the transmission of hepatitis C virus infection in the Turkish population. Dig Dis Sci 2006;51(2):365-9. |
|40.||Shaheen FA, Huraib SO, El-Rashid R, et al. Prevalence of hepatitis C virus antibodies among hemodialysis patients in Jeddah area, Saudi Arabia. Saudi Med J 2003;24 supple2:S125. |
|41.||Okuda K, Hayashi H, Kobayashi S, Irie Y. Mode of hepatitis C infection not associated with blood transfusion among chronic hemodialysis patients. J Hepatal 1995; 23(1): 28-31. |
|42.||Al-Muhanna F. Hepatitis C infection among hemodialysis patients in the Eastern region of Saudi Arabia. Saudi Med J 2003;24 supple2:S124. |
|43.||Morales MF, Lossi JS, Aldeerte TN, Noli D. prevalence and seorconversion to HCV in hemodialyzed patients and epidemiologic factors. Transplant Proc 1996; 28: 3402-5. |
|44.||DuBois DB, Gretch D, dela Rosa C, et al. Quantitation of hepatitis C viral RNA in sera of hemodialysis patients: genderrelated differences in viral load. Am J Kidney Dis 1994;24(5):795-801. |
M O Mekki
Khartoum Teaching Hospital, Federal Ministry of Health, Khartoum
[Table - 1], [Table - 2]
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