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Saudi Journal of Kidney Diseases and Transplantation
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RENAL DATA FROM THE ARAB WORLD Table of Contents   
Year : 2010  |  Volume : 21  |  Issue : 6  |  Page : 1165-1168
Prevalence of hepatitis C virus infection among hemodialysis patients in a single center in Yemen


Faculty of Medicine and Health Sciences, Aden University, Aden, Yemen

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Date of Web Publication4-Nov-2010
 

   Abstract 

To evaluate the prevalence of anti-hepatitis C virus (HCV) among the hemodia­lysis patients and to identify the risk factors of infection in relation to age, sex, blood transfusions, duration of dialysis and primary cause of end stage-kidney disease. We studied 51 patients who were on chronic hemodialysis (HD) at the Al-Gamhourea Teaching Hospital, Aden, Yemen, du­ring Jan-Dec 2007. All the patients were tested for anti-HCV antibody, and we used 100 healthy blood donors as controls. The anti-HCV antibody prevalence rate among the HD patients was found to be significantly higher than that in the control group (62.7% and 0.8%, respectively). The prevalence rate of anti-HCV antibody was higher among men (64%) than that in women (35%). The anti-HCV antibody-positive patients were significantly older than the anti-HCV-anti­body-negative patients (66.5 ± 14.4 years versus 57.5 ± 15.4 years; P = 0.01). Diabetic nephro­pathy was a more frequent cause of end-stage renal disease among the anti-HCV antibody­positive patients (30%) than among the anti-HCV antibody-negative patients (19%). Among the anti-HCV-positive patients, 80% had received a blood transfusion, which was significantly higher than the 20% rate among the anti-HCV antibody-negative patients (P < 0.001).

How to cite this article:
Selm SB. Prevalence of hepatitis C virus infection among hemodialysis patients in a single center in Yemen. Saudi J Kidney Dis Transpl 2010;21:1165-8

How to cite this URL:
Selm SB. Prevalence of hepatitis C virus infection among hemodialysis patients in a single center in Yemen. Saudi J Kidney Dis Transpl [serial online] 2010 [cited 2019 Jul 22];21:1165-8. Available from: http://www.sjkdt.org/text.asp?2010/21/6/1165/72318

   Introduction Top


Hepatitis C virus (HCV) has been recognized as an emerging problem in dialysis patients, and viral hepatitis remains a major hazard for both patients and medical staff of hemodialysis (HD) units. [1],[3] The reported incidence of HCV antibody worldwide between HD patients ranges from 10.5% to 24%, [4],[5] while the prevalence of anti-HCV among dialysis patients varies in different countries (5-85%) worldwide, [6] and may exceed 95% in the Middle East. [7],[8],[9],[10]

The prevalence of HCV was found to be sig­nificantly increased in the older age group, du­ration on dialysis and number of blood trans­fusions. [11],[12] The prevalence of HCV infection and its associated risk factors among HD pa­tients has not been well documented in Aden.

The aim of this study is to determine the pre­valence of anti-HCV among the HD patients in our population and to identify its related risk factors of infection.


   Patients and Methods Top


The medical records of 51 patients (33 males and eight females) with renal failure, admitted to the HD unit in Al-Gamhouria Hospital, du­ring the period of one year (2007), were re­viewed and analyzed. Proportions were com­pared statistically using the chi-square test.

For each patient, the following variables were collected: age, sex, presence or absence of anti­HCV and HBsAg, history of blood transfusions, duration of dialysis and primary cause of end stage-renal disease (ESRD).

One hundred healthy males with no history of liver diseases, who volunteered for blood do­nation, were included as the control group.


   Results Top


The anti-HCV antibody prevalence rate among the HD patients in this study was found to be significantly higher than the control group (62.7-0.8%, respectively).

[Table 1] shows the risk factors for HCV infec­tion in the study patients. The prevalence rate of anti-HCV antibody was higher among men (64%) than among women (35%), with a ratio of male to female of 2:1. The anti-HCV anti­body-positive patients were significantly older than the anti-HCV-antibody-negative patients (66.5 ± 14.4 years versus 57.5 ± 15.4 years; P = 0.01). There was a significant difference in the number of blood transfusions between HCV-positive and HCV- negative patients (10.5 ± 6.7 vs. 4.0 ± 4.3 transfusions, P < 0.01). Anti­HCV-positive patients had been on dialysis for a longer period than anti-HCV-negative pa­tients (10.8 ± 4.8 vs. 5.3 ± 5.9 months, P < 0.01). The average prevalence of seropositivity to HCV infection (anti-HCV + ) was 62.7%, two­times higher than that observed for hepatitis B virus (HBV; 31%). Co-infection with HBsAg was observed in only 16 patients.
Table 1 :Comparison of HD patients regarding anti-HCV status.

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The major causes of chronic renal failure in the study patients included diabetes mellitus in 25 (48%), followed by hypertension in 15 (29%), glomerulonephritis in six (10%), pyelonephritis in five (9%) and unknown causes in 4%. Dia­betic nephropathy was found to be a more fre­quent cause of ESRD among the anti-HCV antibody-positive patients (30%) than among the ant-HCV antibody-negative patients (19%).


   Discussion Top


Patients on chronic HD have a high risk of acquiring HCV and HBV infections. Transfu­sions of unscreened blood, duration of dialysis and nosocomial transmission within HD units are implicated as the main transmission routes of HCV and HBV infections in HD patients. [13]

The prevalence of anti-HCV among dialysis patients varies in different countries, [13],[14] but may exceed 95% in some HD units. [10],[15] Re­sults obtained in this study indicated that the prevalence of HCV among HD patients is sig­nificantly higher than that seen in the control group (62.7% and 0.8%, respectively). This fin­ding suggests that HD plays an important role in the transmission of HCV infection. This fre­quency is also similar to that found in similar studies of tropical areas such as Qatar and Saudi Arabia, where anti-HCV was detected in 44.6% and 82.8% of the patients in HD, res­pectively. [9],[10] This is in agreement with our fin­dings, in which we found a high prevalence of anti-HCV (62.7%) among HD patients, which can be explained by the high endemism of vi­rus C hepatitis in this area. [11],[12],[13] However, the above results in contrast with data from Europe and the United States, where anti-HCV has been detected in less that 3% among HD patients. [14] This discrepancy could be due to the introduction of the screening program for blood donors in the United States and European countries, and subsequent elimination of anti­HCV and other blood-borne viral diseases po­sitive patients, thereby decreasing the preva­lence of blood-borne viral diseases. [15],[16],[17]

The prevalence rate of anti-HCV antibody was found to be higher among men than among women and in older patients, besides increased duration on dialysis, and it correlated with a history of blood transfusion, as reported in the literature. [18],[19]

The average prevalence of anti-HCV+ in our patients was two-times higher than that ob­served for HBV, and coinfection with HBV was observed in 30.7%, as reported else­ where. [19],[20] Also, in this study, diabetic nephro­pathy was found to be a more frequent cause of ESRD among the anti-HCV antibody-posi­tive patients, which is in agreement with other reports. [20],[21]

Blood-borne viral hepatitis is acquired during hemodialysis, where it has a strong relation­ship with the quantity of blood transfusion. We hope that with the introduction of screening for HCV and HBV markers in blood donors and the use of erythropoietin in treating ane­mic HD patients, together with strict adhe­rence to the universal infection control pre­cautions, a decline in the prevalence and inci­dence of both HCV and HBV infections in our HD population will occur.

In conclusion, nearly 63% of the HD patients in Aden were found to have evidence of HCV infection. Older age, blood transfusion, male gender, increased duration on dialysis and dia­betic nephropathy seemed to be risk factors for anti-HCV antibody positivity in our population.


   Acknowledgement Top


We would like to thank everybody who has contributed advice to the making and achieving of this article, in particular the medical and la­boratory technicians of the HD unit in Al­ Gamhourea Teaching Hospital, Aden.

 
   References Top

1.Hoofnagle JH. Course and outcome of hepa­titis C. Hepatology 2002;36(suppl-1):S21-9.  Back to cited text no. 1
    
2.Alter MJ. Prevention of spread of hepatitis C. Hepatology 2002;36(suppl-1):S93-8.  Back to cited text no. 2
    
3.World Health Organization. Weekly Epidemio­logical Report. 49;1999.  Back to cited text no. 3
    
4.Meyers CM, Seef LB, Breen CO, Hoofangle JH. Hepatitis C and renal disease: An update. Am J Kidney Dis 2003;42:631-57.  Back to cited text no. 4
    
5.Fabrizi F, Poordad FF, Martin P. Hepatitis C infection and the patients with end stage renal disease. Hepatology 2002;36(1):3-10.  Back to cited text no. 5
    
6.Huraib S, al-Rashed R, Aldrees A, Aljefry M, Arif M, al-Faleh FA. High prevalence and risk factors for hepatitis C in Saudi Arabia: A need for new strategies in dialysis practice. Nephrol Dial Transplant 1995;10(4):470-4.  Back to cited text no. 6
    
7.Jeffers LI, Perez GO, De Medina MD, et al. Hepatitis C infection in two urban haemo­dialysis units. Kidney Int 1990;38(2):320-2.  Back to cited text no. 7
    
8.Daniel AS, Constantin NT, Calhan J, James GO, Al-Fadeel M, Al-Ozeib H, Kennith CH. The epidemiology of hepatitis C virus antibody in Yemen. AM J Tropical Med Hyg 1992;46:63-8.  Back to cited text no. 8
    
9.Abboud O, Rashid A, Al-Kaabi S. Hepatitis C virus infection in hemodialysis patients in Qatar. Saudi J Kidney Dis Transpl 1995;6(2): 151-3.  Back to cited text no. 9
    
10.Al-Muhana FA. Hepatitis C virus infection among hemodialysis patients in the eastern region of Saudi Arabia. Saudi J Kidney Dis Transpl 1995;6(2):125-7.  Back to cited text no. 10
    
11.Saab S, Brezina M, Gitnick G, Martin P, Yee HF. Hepatitis C screening strategies in hemo­dialysis patients. Am J Kidney Dis 2001;38(1): 91-7.  Back to cited text no. 11
    
12.Kim WR. The burden of hepatitis C in the United States. Hepatology 2002;36(suppl-1): S30-4.  Back to cited text no. 12
    
13.Fambrizi F, Lungi G, Martin P. Hepatitis infection in hemodialysis: Recent discoveries. J Nephrol 2002;15(5):463-8.  Back to cited text no. 13
    
14.Anonymous. Recommendations for preventing transmission of infections among chronic hemodialysis patients. MMWR Recomm Rep 2001;27(RR-5):1-43.  Back to cited text no. 14
    
15.Mondelli MU, Cristina G, Felice G, Randonelli EG, Piazza V, Barbieri C. Anti-HCV positive patients in dialysis units. Lancet 1990;336 (8709):243-4.  Back to cited text no. 15
    
16.Nicolas S, Annie M, Nadine C, Christian Trepo, Stephan D. Twelve years natural history of hepatitis C virus infection in haemodialysis patients in France. Kidney Int 1994;46(2):504­11.  Back to cited text no. 16
    
17.Oguchi H, Miyasaka M, Tokunaga S, et al. Hepatitis virus infection (HBV and HCV) in eleven Japonese haemodialysis units. Clin Nephrol 1992;38(1):36-43.  Back to cited text no. 17
    
18.Medeiros MT, Lima JM, Lima JW, Campos Hde H, Medeiros MM, Coelho Filho JM. Prevalence and associated factors to hepatitis C in hemodialysis patients in Brazil. Rev Saude Publica 2004;38(2):187-93.  Back to cited text no. 18
    
19.Sypsa V, Psichogiou M, Katsoulidou A, et al. Incidence and patterns of hepatitis C virus seroconversion in a cohort of hemodialysis patients. Am J Kidney Dis 2005;45(2):334-43.  Back to cited text no. 19
    
20.Santos MA, Souto FJ. Infection by the hepatitis C virus in chronic renal failure pa­tients undergoing hemodialysis in Mato Grosso state, central Brazil: A cohort study. BMC Public Health 2007;7(147):32.  Back to cited text no. 20
    
21.Iwasa Y, Otsubo S, Sugi O, et al. Patterns in the prevalence of hepatitis C virus infection at the start of hemodialysis in Japan. Clin Exp Nephrol 2008;12(1):53-7.  Back to cited text no. 21
    

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Correspondence Address:
Salem Bin Selm
Associate Professor of Medicine, Faculty of Medicine and Health Sciences, Aden University
Yemen
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PMID: 21060200

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    Abstract
    Introduction
    Patients and Methods
    Results
    Discussion
    Acknowledgement
    References
    Article Figures
 

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