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Saudi Journal of Kidney Diseases and Transplantation
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Year : 2009  |  Volume : 20  |  Issue : 3  |  Page : 488-492
Hepatitis C virus (HCV) infection in hemodialysis patients in the south of Jordan


1 Department of Internal Medicine, Royal Medical Services, Jordan
2 Dialysis Units, Royal Medical Services, Jordan

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   Abstract 

Hepatitis C Virus (HCV) infection is a serious public health problem throughout the world. Patients with chronic renal failure are exposed to this infection. This could be due to a failure to identify carriers of this disease or because of lack of implementing truly effective safety measures in the dialysis units. This study was carried out in order to determine the prevalence of HCV infec­tion and possible risk factors for acquiring it in patients on maintenance hemodialysis (HD). A total of 120 patients, 63 males (52%) and 57 females (42%), who were on regular HD in three military hospitals in the south of Jordan were studied during the period between January 2007 and April 2008. A total of 34 patients (28%) were HCV positive of whom, 20 were males (58%). The mean age of the study participants was 52.9 years. The means of age of HCV positive and negative patients were 51.5 and 54.4 years, respectively. Statistical analysis showed that four risk factors including history of blood transfusion, history of kidney transplantation, history of other surgeries and duration on HD, had an important role in acquiring HCV infection. Although the prevalence of HCV infection in our study patients is lower than in many other countries in the region, we believe that the prevalence is still high and reflects a serious challenge, which needs further research to identify the causes and to establish a well organized prophylactic program.

Keywords: Hepatitis C infection, Hemodialysis patients, South of Jordan

How to cite this article:
Al-Jamal M, Al-Qudah A, Al-Shishi KF, Al-Sarayreh A, Al-Quraan L. Hepatitis C virus (HCV) infection in hemodialysis patients in the south of Jordan. Saudi J Kidney Dis Transpl 2009;20:488-92

How to cite this URL:
Al-Jamal M, Al-Qudah A, Al-Shishi KF, Al-Sarayreh A, Al-Quraan L. Hepatitis C virus (HCV) infection in hemodialysis patients in the south of Jordan. Saudi J Kidney Dis Transpl [serial online] 2009 [cited 2020 Nov 26];20:488-92. Available from: https://www.sjkdt.org/text.asp?2009/20/3/488/50791

   Introduction Top


Hepatitis C virus (HCV) is a major public health problem, with an estimated global prevalence of 3% occurring in about 170 million persons worldwide. [1] An estimated 5-20% of HCV in­fected patients have or will develop hepatocellular carcinoma. The well known risk factors for HCV transmission include blood transfu­sions, organ transplantation, chronic hemodia­lysis (HD), drug injection, occupational exposure among healthcare workers, unprotected sex and vertical transmission. [2],[3]

The relationship between HCV infection and kidney disorders is well recognized. On the one hand, HCV infection has been associated with essential mixed cryoglobulinemia that may lead to membranoproliferative glomerulonephritis. [4] On other hand, patients with renal disease are at an increased risk of acquiring HCV. Infection with HCV is the most common liver disease in HD patients, while liver disease is a significant cause of morbidity in patients with end stage renal disease treated by dialysis or transplan­tation. [5] Many studies have been held worldwide in order to identify the measures which can lead to lower prevalence of HCV infection in HD pa­tients. Some authors have recommended to treat every dialysis patient as potentially infectious, strictly adhering to the "Universal Precautions for Prevention of HCV transmission", in order to prevent the spread of HCV in dialysis units. [6],[7]

The issue of isolation of HCV infected dialysis patients and the use of dedicated machines is controversial. Some reports do not support this concept, [8] while some other studies have repor­ted that the use of dedicated machines signifi­cantly lowers the incidence of HCV infection among dialysis patients. [9]


   Materials and Methods Top


The present study included all 120 patients on regular HD treatment in the three dialysis units located in the three military hospitals located in the south of Jordan from January 2007 to April 2008. The study also included patients who en­tered the dialysis program during the period of study. Relevant information regarding number of years on dialysis, number of blood transfu­sions, history of surgery and history of kidney transplantation was obtained from chart reviews and from questionnaires.

During the study period, strict adherence to "Universal Precautions for prevention of HCV transmission" was followed in all three dialysis units. Serum samples were tested for anti-HCV antibodies using third generation enzyme linked immunosorbent assay (ELISA).

Statistical analysis of the data and comparisons between groups were performed. P value < 0.05 was considered as significant.


   Results Top


The study involved 120 patients treated with HD, of who 63 were males (52%) and 57 were females (48%). The mean age of the study popu­lation was 52.9 years ranging from 14 to 84 years. HCV infection was detected in 34 patients (28%); they included 20 males (58%) and 14 females (42%) [Table 1]. The overall prevalence of HCV infection in male patients was 31.7% while it was 24% in females. The mean age of HCV po­sitive and HCV negative patients were 51.5 and 54.4 years, respectively [Table 2].

Regarding the duration on HD, we found that 49% of the study populations were being dia­lyzed for more than two years. The prevalence of HCV infection among this group was 46% as compared to 11.5% prevalence among patients on dialysis for less than two years.

A total of 82 study patients (68%) were trans­fused; among them, 28 were HCV positive (34%). The mean number of blood transfusions was 3.52 in HCV positive patients as compared to 1.8 in HCV negative patients [Table 3].

Six of our study patients underwent kidney transplant surgery and 50 other patients under­went other kinds of surgery. All patients who under went kidney transplantation were HCV positive and all had received multiple blood trans­fusions. On the other hand, 34% of the patients who underwent other surgeries were HCV po­sitive and 76% of them had received blood transfusions [Table 4].

The prevalence of HCV infection was highest in the HD unit of the Prince Zaid Hospital, followed by the Princess Haya Hospital and the lowest in Prince Ali Hospital being 36%, 32% and 16% respectively [Table 5]. In this context, we noted that the mean serum creatinine values in the three HD units correlated well with the prevalence of HCV infection in these units being 11.8 mg/dL in the Prince Zaid Hospital, 10.31 mg/dL in the Princes Haya Hospital and 9.55 in Prince Ali hos­pital. Furthermore, the mean serum creatinine was higher in HCV positive patients than in HCV negative patients, being 12.5 mg/dL and 8.07 mg/dL, respectively.


   Discussion Top


The prevalence of HCV infection among dia­lysis patients is generally much higher than that among healthy blood donors. [10],[11] Studies held in dialysis centers from different countries reveal that the prevalence ranges form 1 to > 80%. [11],[12],[13],[14],[15],[16] To a certain extent, this wide difference may re­flect the different prevalence rates of HCV in­fected individuals among the general population in these countries. However, the dialysis process itself and the level of hygienic standards followed influence the prevalence of HCV infection. [11],[17],[18]

In Jordan, the prevalence of HCV infection in the general population is not known, but it is available for some groups of the population such as healthy blood donors [19] and multi trans­fused patients with hereditary hemolytic anemia. [20]

An earlier study in six Ministry of Health HD units in Jordan reported the prevalence of HCV to be 34.6%. [21] Another recent multi-center study showed that the prevalence of HCV infection in HD units in Jordan was much lower than the previous study being 21%. [22] The results of the present study indicate that the prevalence of HCV infection in HD patients was between the results reported by previous studies conducted in Jordan. [21],[22] When compared to international data, the prevalence of HCV infection in HD pa­tients in the South of Jordan was much lower than in many other countries in our region such as Saudi Arabia, Egypt, Kuwait and Pakistan, [14],[16],[23],[24] but it was higher than in developed countries such as Netherlands, Spain, and Germany. [11],[13],[25]

The current study did not show any statisti­cally significant difference between male (31.7%) and female patients (24%) in the prevalence of HCV infection (P= 0.4). Duration on HD is considered one of the risk factors for acquiring HCV infection. Our present study showed a statistically significant difference in the preva­lence of HCV infection between patients who were on dialysis for more than two years, and patients who were on dialysis for less than two years being 46% and 11.5%, respectively (P= < 0.001).

The present study showed that 100% of kidney transplant patients had HCV infection, while only 25% of patients who did not undergo kid­ney transplantation were HCV positive. These data were statistically significant (P= < 0.001). Additionally, 34% of patients who under went other kinds of surgery were HCV positive, whereas only 17% of patients with negative surgical history were HCV positive (P= 0.03), thus signifying the role of surgery in the pre­valence of HCV infection in HD units. Blood transfusion(s) constitute a part of treat­ment in many HD patients. In this study, we ana­lyzed this factor, both independently and in com­bination with other risk factors for acquiring HCV infection. Our data showed that HCV in­fection was detected in 34% of patients who had received blood transfusion(s); on the other hand, 16% of HD patients who did not have history of receiving blood transfusion(s) were HCV posi­tive. This was statistically significant (P= 0.029). Furthermore, we noted that the number of trans­fusions was directly proportional to the preva­lence of HCV infection in our study group. This may be one of the significant factors deter­mining the high prevalence of HCV infection in kidney transplant recipients, in whom the mean number of blood transfusions was 5.0.


   Conclusion Top


Although the prevalence of HCV infection among patients on HD in our study was lower than that in many countries in our region, it still remains high. We believe that preventive mea­sures and adherence to "Universal Precautions for HCV Infection Control" remains a priority. Further detailed research on the role of blood transfusions in acquiring HCV infection is re­quired. If the presently known preventive mea­sures fail to reduce the prevalence of HCV infec­tion in HD patients, we recommend dialysis of infected patients using dedicated machines.

 
   References Top

1.Global Surveillance and Control of Hepatitis C. Report of WHO consultation organized in colla­boration with Viral Hepatitis Prevention Board. Antwerp, Belgium. J Viral Hepat 1999;6:35-47.  Back to cited text no. 1    
2.Yen T, Keefe EB, Ahmad A. The epidemiology of hepatitis C virus infection. J Clin Gastroenterol 2003;36:47-53.  Back to cited text no. 2    
3.Strader DB, Wright T, Thomas DL, Sheef LB. American Association for the Study of Liver Diseases: Diagnosis, Management, and treatment of Hepatitis C. Hematology 2004;39:1147-71.  Back to cited text no. 3    
4.Jonson CE, Hartwell P, Couser WG, et al. Membranoproliferative glomerulonephritis asso­ciated with hepatitis C virus infection. N Engl J Med 1993;328:465-70.  Back to cited text no. 4    
5.Fibrizi F, Poordad FF, Martin P. Hepatitis C infection and the patients with end stage renal disease. Herpetology 2002;36:3-10.  Back to cited text no. 5    
6.Centers for Disease control: which control measures should be taken when hemodialysis patients are suspected of having non A, non B, hepatitis? Atlanta, CDC, No 49: Hepatitis C Re­port. 1985, 3-4.  Back to cited text no. 6    
7.Gilli P, Moritti M, Soffritti S, Menini C. Anti -HCV positive patients in dialysis units. Lancet 1990;336:243-4.  Back to cited text no. 7    
8.Gilli P, Soffritti S, De Paoli Vitali E, Bendani PL. Prevention of Hepatitis C virus in Dialysis units. Nephron 1995;70:301-6.  Back to cited text no. 8    
9.Shamshirsaz AA, Kamgar M, Bekheirnia MR, et al. The role of hemodialysis machines dedi­cation in reducing hepatitis C transmission in dialysis setting in Iran: A multicentre prospec­tive interventional study. BMC Nephrol 2004;5: 13.  Back to cited text no. 9    
10.Fujiyama S, Kawano S, Sato S, et al. Changes in prevalence of anti-HCV antibodies associated with preventive measures among hemodialysis patients on dialysis staff. Hepatogastroenterol 1995;42:162-5.  Back to cited text no. 10    
11.Schneeberger PM, Vos J, Van Dijk WC. Prevalence of antibodies to hepatitis C virus in Dutch group of hemodialysis patients related to risk factors. J Hosp Infect 1993;25:265-70.  Back to cited text no. 11    
12.Mondelli MU, Smedile V, Piazz V, et al. Abnormal alanine aminotranferase activity re­flects exposure to hepatitis C virus in hemo­dialysis patients. Nephrol Dial Transplant 1991; 6:480-3.  Back to cited text no. 12    
13.Esteban JI, Esteban R, Vilandonin L, et al. Hepatitis C virus antibodies among risk groups in Spain. Lancet 1989;2:294-7.  Back to cited text no. 13    
14.Hassan AA, Khalil RY. Prevalence of three blood borne infections (HBV, HCV, HIV) among HD patients in Cairo. Saudi Kidney Dis & transplant Bull 1993;4:S72.  Back to cited text no. 14    
15.Al-Dhahry SH, Aghanashinikar PN, Al-Hassani MK, Buhl MK, Daar AS. Prevalence of antibodies to hepatitis C virus among Omani patients with renal disease. Infection 1993;21 (3):164-7.  Back to cited text no. 15    
16.Shaheen FA, Huraib S, Al-Rasheed RS, et al. Prevalence of Hepatitis C antibodies among hemodialysis patients in Western province of Saudi Arabia. Saudi J Kidney Dis Transpl 1993; 4:S73.  Back to cited text no. 16    
17.Simon N, Caurouce AM, Lemarrec N, Trepo, Ducamp. A Twelve year natural history of hepatitis C virus infection in hemodialysis pa­tients. Kidney Int 1994;46:504-11.  Back to cited text no. 17    
18.Keur I, Schneeberger P, vander Graaf Y, Vos J, Van Dijk W, Van Doorn LT. Risk factors for HCV infection in two dialysis units in the Netherlands. Neth J Med 1997;50:97-101.  Back to cited text no. 18    
19.National Blood Bank report. Amman, Jordan, Ministry of Health 1999.  Back to cited text no. 19    
20.Al-Sheyyab M, Bataiha A, EL-Kahteeb M: The prevalence of hepatitis B, hepatitis C, and HIV markers in Multi transfused patients. J Trop Pediatr 2001;47:239-92.  Back to cited text no. 20    
21.Bdour S. Hepatitis C infection in Jordanian hemodialysis units: Serological diagnosis and genotyping. J Med Microbiol 2002;51:700-4.  Back to cited text no. 21    
22.Batieha A, Abdallah S, Maghaireh M, et al. Epidemiology and cost of haemodialysis in Jordan. East Mediterr Health J 2007;13(3):654­63.  Back to cited text no. 22    
23.El-Rashid K. Hepatitis C virus infection in pa­tients on maintenance dialysis in Kuwait: epide­miological profile and efficacy of prophylaxis. Saudi Med J 2003;24(Supp2): S134.  Back to cited text no. 23    
24.Gul A, Igbal F. Prevalence of Hepatitis C in patient on maintenance hemodialysis. J Coll Physicians Surg Pak 2003;13:15-8.  Back to cited text no. 24    
25.Hinrichsen H; PHV Study Group. Prevalence and risk factors of hepatitis C virus infection in hemodialysis patients: A multicentre study in 2769 patients. Gut 2002;51:429-33.  Back to cited text no. 25    

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Correspondence Address:
Mohammed Al-Jamal
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