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Saudi Journal of Kidney Diseases and Transplantation
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RENAL DATA FROM THE ASIA - AFRICA Table of Contents   
Year : 2009  |  Volume : 20  |  Issue : 4  |  Page : 681-684
Prevalence of hepatitis C and B infection and HC V genotypes among hemodialysis patients in Khuzestan province, Southwest Iran


1 Department of Immunology, Faculty of Medicine, Ahwaz Joundishapur University of Medical Sciences, Ahwaz, Khuzestan, Iran
2 Jahad Daneshgahi Medical Center, Ahwaz, Iran
3 Microbiology Department, Virology Division, Mashhad University of Medical Sciences, Iran

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Date of Web Publication8-Jul-2009
 

   Abstract 

Hepatitis B (HBV) and C (HCV) virus infection are the most important infections transmitted by the parenteral route in hemodialysis patients. This study is the first report of prevalence of viral hepatitis and hepatitis C virus genotypes in southwest Iran among hemodialysis patients. A cross-sectional study was carried out among 214 hemodialysis patients of the Central hemodialysis unit, from March 2005 to August 2006. Serum samples were tested for HBsAg and anti-HCV using specific enzyme linked immunoassay (ELISA) kits and confirmed by PCR (HBV) and RT PCR (HCV). HCV genotypes were determined with HCV genotype specific primers using HCV genotype kit. Out of 214 hemodialysis patients, 34 were positive for anti-HCV (7.9%, 95% CI: 4.32-11.56) and 11 for HBsAg (5.1%, 95% CI: 2.18-8.1). The duration of treatment by hemo­dialysis was significantly associated with HBV and HCV positivity (P< 0.001). The predominant HCV genotype in the region was 1a (41.1%, 7/17), whilst genotypes 3a and 1b were found in 35.2% (6/17) and 23.5% (4/17) subjects, respectively. In conclusion although anti-HCV and HBsAg positivity in hemodialysis patients in Khuzestan province are smaller than those found in some other Iranian provinces and neighboring countries, they are still high. Enforcement of universal precautions in infection control, routine testing of patients, and serial determination of hepatic enzymes should be the common practice in dialysis centers in Iran.

Keywords: HBV, HCV, Hemodialysis

How to cite this article:
Assarehzadegan MA, Shakerinejad G, Noroozkohnejad R, Amini A, Rahim Rezaee S A. Prevalence of hepatitis C and B infection and HC V genotypes among hemodialysis patients in Khuzestan province, Southwest Iran. Saudi J Kidney Dis Transpl 2009;20:681-4

How to cite this URL:
Assarehzadegan MA, Shakerinejad G, Noroozkohnejad R, Amini A, Rahim Rezaee S A. Prevalence of hepatitis C and B infection and HC V genotypes among hemodialysis patients in Khuzestan province, Southwest Iran. Saudi J Kidney Dis Transpl [serial online] 2009 [cited 2014 Nov 28];20:681-4. Available from: http://www.sjkdt.org/text.asp?2009/20/4/681/53305

   Introduction Top


The prevalence of HCV in hemodialysis patients is higher than healthy population in Iran (5-24% versus 0.3) and most other countries, suggesting that dialysis patients may be at higher risk of acquiring HCV infection. [1],[2],[3]

Khuzestan province is located in the Southwest of Iran, a tropical area with an approximate popu­lation of 4.5 millions (census 2004). Seropreva­lance of Hepatitis E virus was reported earlier [4] however, no data exists concerning HBV and HCV infections in patients undergoing hemo­dialysis in this region. Therefore, the present study aims to assess the prevalence of hepatitis B and different genotypes of HCV in hemodia­lysis population of Khuzestan province.


   Subjects and Methods Top


Patients

This cross sectional study was performed from March 2005 to August 2006 in Khuzestan pro­vince on hemodialysis patients attending central hemodialysis unit. A total of 214 whole blood samples were collected from patients, after ob­taining an informed consent. Serum samples were separated from the whole blood, aliquots were stored at -70°C. Demographic data, such as age, duration of hemodialysis, and number of blood transfusions was obtained from patient records.

Laboratory assays

All sera were screened using HBsAg and Anti­HCV assays with commercial ELISA micro­plate kits (RADIM, Italy) according to the ma­nufacturer's instructions. Positive samples were confirmed using DNA polymerase chain reac­tion (PCR) and nested RT PCR for HBV and HCV, respectively.

All samples were submitted to DNA and RNA extraction using High pure viral nucleic acid kits (Roche, Germany), reverse transcription (Fermentas, Lithuania) by methods already des­cribed. [5] ,[6] HCV genotypes were determined with HCV genotype specific primers using HCV genotype kit (Sacace, Italy).

Statistical analysis

Prevalence, 95% confidence intervals (95% CI) and odds ratio were calculated by SPSS software version 11.0 (SPSS Inc., Chicago, IL). Data com­parisons were performed using the Chi square test and Fisher's exact test. The differences were considered significant if P< 0.05.


   Results Top


Two hundred and fourteen patients were tested, 135 (63.1%) males, and 79 (36.9%) females. The mean age was 37.3 ± 12.11 years (8 to 60 years).

Out of 214 hemodialysis patients, 34 (7.9%) were positive for anti-HCV (4.32-11.56) and 11 (5.1%) for HBsAg (2.18-8.1). The serological data for subjects are shown in [Table 1].

The duration of treatment by hemodialysis and, in turn, changing the hemodialysis machine were significantly associated with HBV and HCV positivity (P< 0.001 and P< 0.001, res­pectively). Patients under treatment for more than six years had greater risk of infection for HBV and HCV seropositivity, compared to sub­jects who had undergone less than three years (RR=9.08 and 11.03, respectively).

Moreover, The prevalence of anti-HCV was significantly higher in patients who received blood transfusion more than seven times com­pared to subjects without blood transfusion (RR=20.7, P< 0.001). Anti-HCV screening tests were introduced to blood banks in 1996 in Iran.

Age or sex had no correlation with anti HCV or HBsAg. The predominant HCV genotype in the region was 1a (41.1%, 7/17), whilst genotypes 3a and 1b were found in 35.2% (6/17) and 23.5% (4/17) subjects, respectively [Figure 1].


   Discussion Top


Hemodialysis patients are at high risk for he­patitis viral infections. [7] It is known that diffe­rent methods of control, cleaning and disinfec­tion of the hemodialysis membranes, machines, instruments and environmental surfaces may interfere with determined prevalence. [8] Preva­lence of HBV and HCV in hemodialysis pa­tients were reported by several authors ranging between 0.9% to 21.6% for HBV [9] ,[10] and 3.4% to 65.8% for HCV. [11] ,[12] ,[13]

This is the first report on the prevalence of HBV, HCV and genotyping of HCV among he­modialysis subjects of Khuzestan province, in Iran. We found a higher prevalence of anti­HCV and HBsAg compared to the developed countries. [9] ,[11]

Three HCV genotypes were identified in the hemodialysis patients in Khuzestan province: subtypes 1a, 3a and 1b. Subtype 1a was predo­minant similar to the recent report by Hosseini Moghaddam et al [7] from Tehran (28.8%). This finding is in contrast with global HCV geno­ types distribution [14] and the high frequency of genotype HCV 1a/1b plus HCV 4 and HCV 2/2a plus HCV 4 in hemodialysis patients living in neighboring countries, such as Bahrain and Saudi Arabia respectively, [15] sharing sea boarder with Khuzestan province. Moreover, the anti­HCV prevalence in our study was lower than that in these neighboring Arabic countries.

Studies from Iran have reported a prevalence from 5.5% to 55.9% in different cities. [16] Dura­tion of hemodialysis [9] ,[17] and molecular evidence to this effect for the nosocomial transmission of HCV within hemodialysis units was noted in several studies from Iran. [15] ,[18] In fact, our pa­tients undergoing HD for more than six years had 11.03 fold greater risk of HCV infection, compared to patients with duration of HD less than three years.

The results of our study also document that HCV positive subjects had a significantly higher frequency of transfusion (P< 0.001). It is im­portant to consider that, in spite of the syste­matic screening of blood donors; HBV and HCV blood transfusion still remains one of the sources of infection transmission. This highlights the importance of more stricter screening in order to improve blood transfusion safety. Noso­comial transmission of HCV and HBV is an important contributing factor to the spread of these viruses. [8] ,[19] Despite various infection con­trol procedures in HD patients prevalence and incidence rates of HBV and HCV are still sig­nificant. [17] ,[20] Studies have shown that strict asep­tic measures can virtually eliminate HCV conta­mination, even in units with a high prevalence of HCV infection. [21]

In conclusion, although anti-HCV and HBsAg positivity in hemodialysis patients in Khuzestan province are smaller than those found in some other Iranian provinces and neighboring coun­tries, they are still high. Simple measures such as enforced general asepsis rules, careful disin­fection and equipment sterilization, routine tes­ting of patients, serial determination of hepatic enzymes should be the common practice in dialysis centers in Iran.


   Acknowledgment Top


This study was supported by Khuzestan Jahad Daneshgahi Medical Center. The authors would like to thank Dr. Samadi for his advice on study design.

 
   References Top

1.Broumand B, Abdollah Shamshirsaz A, Kamgar M, et al. Prevalence of hepatitis C infection and its risk factors in hemodialysis patients in Tehran. Saudi J Kidney Dis Transpl 2002;13(4):467-72.  Back to cited text no. 1    
2.Rais-Jalali G, Hakjehdehi P. Anti HCV sero­positivity among hemodialysis patients of Iranian origin. Nephrol Dial Transplant 1999;14(8):2055-6.  Back to cited text no. 2    
3.Zali MR, Raoufi M, Nowroozi A. The prevalence of hepatitis C in normal population of 19-45 years old in Iran. 10th international symposium on viral hepatitis and liver disease, Center of Disease Control, Atlanta, Georgia. USA. April 10-13, 2000.  Back to cited text no. 3    
4.Assarehzadegan MA, shakerinejad G, Amini A, Rezaee SA. Seroprevalence of hepatitis E virus in blood donors in Khuzestan Province, Southwest Iran. Int J Infect Dis 2008;12(4):387-90.  Back to cited text no. 4    
5.Pham TN, MacParland SA. Hepatitis C virus persistence after spontaneous or treatment in­duced resolution of hepatitis C. J Virol 2004;78 (11):5867-74.  Back to cited text no. 5    
6.Liang TJ, Isselbacher KJ, Wands JR. Rapid identification of low level hepatitis B related viral genome in serum. J Clin Invest 1988;84(4): 1367-71.  Back to cited text no. 6    
7.Hosseini-Moghaddam SM, Keyvani H, Kasiri H, et al.. Distribution of hepatitis C virus genotypes among hemodialysis patients in Tehran: a multi­center study. J Med Virol 2006;78(5):569-73.  Back to cited text no. 7    
8.Busek SU, Baba EH, Tavares Filho HA, Pimenta L, Salomao A, Correa Oliveira R. Hepatitis C and Hepatitis B Virus Infection in Different Hemo­dialysis Units in Belo Horizonte, Minas Gerais, Brazil. Mem Inst Oswaldo Cruz Rio de Janeiro 2002;97(6):775-8.  Back to cited text no. 8    
9.Schneeberger PM, Keur I, van Loon AM, et al. The prevalence and incidence of hepatitis C virus infection among dialysis patients in the Nether­lands: a nationwide prospective study. J Infect Dis 2000;182(5):1291-9.  Back to cited text no. 9    
10.Todorov V, Boneva R, Ilieva P, Doichinova T, Donchev M. High prevalence of hepatitis C virus infection in Bulgaria. Nephron 1998;79(2):222-3.  Back to cited text no. 10    
11.Tokars JI, Miller ER, Alter MJ, Arduino MJ. Na­tional surveillance of dialysis associated diseases in the United States, 1997. Semin Dial 2000; 13 (2):75-85.  Back to cited text no. 11    
12.Valadutiu D, Cosa A, Neamtu A, et al. Infection with hepatitis B and C viruses in patients on maintenance dialysis in Romania and in former communist countries: yellow spots on a blank map? J Viral Hepatol 2000;7(4):313-9.  Back to cited text no. 12    
13.Somi MH, Keivani H, Ardalan MR, Farhang S, Pouri AA. Hepatitis C virus Genotypes in Pa­tients with End-Stage Renal Disease in East Azerbaijan, Iran. Saudi J Kid Dis Transpl 2008; 19(3):461-5.  Back to cited text no. 13    
14.Nguyen MH, Keeffe EB. Epidemiology and treatment outcomes of patients with chronic hepatitis C and genotypes 4 to 9. Rev Gastro­enterol Disord 2004;4 Suppl 1:S14-21.  Back to cited text no. 14    
15.Qadi AA, Tamim H, Ameen G, et al. Hepatitis B and hepatitis C virus prevalence among dialysis patients in Bahrain and Saudi Arabia: A survey by serologic and molecular methods. Am J Infect Control 2004;32(8):493-5.  Back to cited text no. 15    
16.Alavian SM, Adibi P, Zali MR. Hepatitis C virus in Iran: Epidemiology of an emerging infection. Arch Iran Med 2005;8(2):84-90.  Back to cited text no. 16    
17.Souza KP, Luz JA, Teles SA, et al. Hepatitis B and C in the Hemodialysis Unit of Tocantins, Brazil: Serological and Molecular Profiles. Mem Inst Os-waldo Cruz Rio de Janeiro 2003;98(5): 599-603.  Back to cited text no. 17    
18.Bdour S. Hepatitis C virus infection in Jordanian hemodialysis units: serological diagnosis and genotyping. J Med Microbiol 2002;51(8):700-4.  Back to cited text no. 18    
19.Carneiro MA, Martins RM, Teles SA, et al. Hepa­titis C prevalence and risk factors in hemodialysis patients in Central Brazil: a survey by polymerase chain reaction and serological methods. Mem Inst Os-waldo Cruz 2001;96(6):765-9.  Back to cited text no. 19    
20.Silva1 LK, Silva1 MBS, Rodart1 IF, et al. Preva­lence of hepatitis C virus (HCV) infection and HCV genotypes of hemodialysis patients in Salvador. Braz J Med Biol Res 2006;39(5):595-602.  Back to cited text no. 20    
21.Pereira BJ. Hepatitis C virus infection in dialysis: a continuing problem. Artif Organs 1999;23(1):51­60.  Back to cited text no. 21    

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Correspondence Address:
Mohammad Ali Assarehzadegan
Department of Immunology, Faculty of Medicine, Ahwaz University of Medical Sciences, Ahwaz, Khuzestan
Iran
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    Abstract
    Introduction
    Subjects and Methods
    Results
    Discussion
    Acknowledgment
    References
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