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Saudi Journal of Kidney Diseases and Transplantation
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Year : 2007  |  Volume : 18  |  Issue : 1  |  Page : 101-106
Hepatitis C virus infection in hemodialysis patients in Sudan: Two centers' report


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 2014 Jul 24];18:101-6. Available from: http://www.sjkdt.org/text.asp?2007/18/1/101/31856

   Introduction Top


Hepatitis C virus (HCV) infection is a major health problem among hemodialysis (HD) patients in developing countries. [1] 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. [2]

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. [3] Other reports among the general population from Western and Southern Sudan showed a prevalence of 2-3 %. [4],[5]

In patients on maintenance HD, viral hepatitis remains a major health problem not only for patients but also for dialysis staff [6]. 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. [7] Previous reports of the prevalence of HCV seropositivity from Sudan was 34% in 1994.[8]

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 Top


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

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 Top


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 Top


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, [8] and 2001. [3] The prevalence of HCV seropositivty in this study was also less than that reported from Saudi Arabia [9],[10],[11],[12],[13],[14],[15] Syria, [16] Tunisia, [17],[18],[19] Egypt, [20],[ 21] Jordon, [22] Morocco, [23] Senegal, [24] Iran, [25] but similar to reports from Oman, [26] and Italy. [27]

However, our HCV prevalence of sero­positivity was greater than that reported from Kenya, [ 28] South Africa, [29] Turkey,[30] USA [31],[32] and Mexico [33].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. [15],[16],[17],[18],[19], [22], [24], [29], [32], [34],[35],],[36],[37],[38],[39]

Previous surgery was shown to be associated with hepatitis C seropositivity among hemodialysis patients in Italy, [38] and non dialysis patients in Turkey. [39] Dialysis in multiple centers was found to be significantly associated with higher HCV seropositivity in Saudi Arabia.[15]

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.[32]

HCV seropositivity was noted to be significantly higher among HD patients older than 30 years; This agrees with reports from USA, [44] and Saudi Arabia.[9]

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, [8] and with other regional, [16],[18],[35],[36],[40] and international reports. [41]. However blood transfusion was shown to be a risk factor for hepatitis C seropositivity among hemodialysis patients in many other reports. [15], [22], [24], [29], [42],[43] Patients' gender was not associated with HCV sero­positivity in our studied population. This agrees with reports from Jordan, [22] and Syria.[16] However male sex was reported to be associated with HCV seropositivity in one report from Saudi Arabia.[34]

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. [8]

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 Top

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Correspondence Address:
M O Mekki
Khartoum Teaching Hospital, Federal Ministry of Health, Khartoum
Sudan
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    Tables

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