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Saudi Journal of Kidney Diseases and Transplantation
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Year : 2015  |  Volume : 26  |  Issue : 4  |  Page : 792-796
Prevalence of hepatitis C and B virus infections among hemodialysis patients in Karaj, Iran

Alborz University of Medical Sciences, Karaj, Iran

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Date of Web Publication8-Jul-2015

How to cite this article:
Tajbakhsh R. Prevalence of hepatitis C and B virus infections among hemodialysis patients in Karaj, Iran. Saudi J Kidney Dis Transpl 2015;26:792-6

How to cite this URL:
Tajbakhsh R. Prevalence of hepatitis C and B virus infections among hemodialysis patients in Karaj, Iran. Saudi J Kidney Dis Transpl [serial online] 2015 [cited 2022 Jan 26];26:792-6. Available from: https://www.sjkdt.org/text.asp?2015/26/4/792/160219
To the Editor,

The prevalence of hepatitis C and B virus (HCV and HBV, respectively) in hemodialysis patients is greater than that in the general population and varies in different countries. [1],[2],[3] The increased risk for hepatitis may be explained by the exposure to viruses from other patients, by the use of common equipment and by the administration of multiple blood transfusions before the availability of recombinant human erythropoietin. Inadequate infection control methods in the hemodialysis units and the suppressed immunity of patients may also increase the risk. [4],[5],[6] Both HBV and HCV synergize in accelerating the progression of disease to hepatic anomalies, including cirrhosis and cancer. [7],[8],[9],[10]

HBV and HCV prevalence in hemodialysis patients varies among different regions of the world [11] and also the prevalence of these infections varies among dialysis centers within a single country. [12],[13] We undertook a cross-sectional study to investigate the prevalence of HBV and HCV infection among maintenance hemodialysis patients and co-infection of both viruses. This was conducted at the Shariati and Shahid Bahonar Hospital hemodialysis unit, Karaj city, Alborz province of Iran from February to June 2010. All the 185 patients on long-term hemodialysis for end-stage renal disease in the study period were enrolled in this study. The study was approved by the Ethics Committee of the Alborz University of Medical Sciences and written, informed consent was obtained from each patient.

The relevant medical and socio-demographic characteristics such as age, gender, marital status and educational level, duration of dialysis, kidney transplantation and blood transfusion history were gathered using a questionnaire. Five milliliters of blood was drawn from each patient in a routine manner. The sera were then tested for HB surface antigens (HBsAg) and anti-HCV using specific enzyme-linked immune-sorbent assay (ELISA) kits (ULTRA kit, bioMerieux, France). Statistical analysis was performed by SPSS version 16 (SPSS Inc., Chicago, IL, USA). Chi square test and a Fischer's exact test were used to compare the categorical variables and Student's t-test and Mann-Whitney test were used to compare continuous variables (parametric and non-parametric) between the two groups. P <0.05 was considered to be a statistically significant level.

Of the total 185 patients studied, 104 (56.2%) were males and 81 (43.8%) were females. The mean (±SD) age of the participants was 54.89 (±15.54) (range: 8-84) years. Duration of hemodialysis (HD) was 42.13 ± 41.23 months and all HD patients had either two or three dialysis sessions per week. More than one-third (35.7%) of the patients were illiterate and 30.8% of the participants had primary education. Eleven (5%) HD patients had a history of kidney transplantation earlier and about 116 (63.7%) patients gave history of blood transfusion. Eleven HD patients (5.9%) were found to be anti-HCV positive [six males (54.5%) and five females (45.5%]. HBsAg was detected in 13 (7%) HD patients [11 males (84.6) and two females (15.4]. The overall prevalence of co-infection with both HCV and HBV was 1.6% [two males (66.7) and two females (33.3].

No significant relationship was found between HCV antibody positivity with gender, marital status, educational level, blood transfusion and kidney transplantation history (P>0.05) [Table 1]. The mean ± SD dialysis duration in anti-HCV-positive and anti-HCV-negative patients was 95.72 ± 102.03 and 38.74 ± 31.82 months, respectively, and the difference was statistically significant (P <0.05) [Table 1]. However, there was a significant relationship between HBsAg positivity with gender (P <0.05) [Table 2]. As in those with HCV antibody positivity, other parameters had no significant relationship with HBsAg positivity as well (P >0.05) [Table 2].
Table 1: Comparison of demographic variables and risk factors in hemodialysis patients with and without HCV infection.

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Table 2: Comparison of demographic variables and risk factors in hemodialysis patients with and without HBV infection.

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A study from the Kerman province of Iran has reported that 7% of HD patients were antiHCV and HBsAg positive. [14] In a systematic review, the prevalence of HCV infection has been estimated to be 7.6% in 12 provinces of Iran. [15] It should be mentioned that the prevalence of HCV in the Iran general population is <1%. [16] HD patients from three provinces, namely Khuzestan, [13] Guilan [17] and Qazvin, [18] had anti-HCV positivity of 7.9%, 11.9% and 6.7%, respectively. Among other countries around the world, the rate of HCV infection has been reported as 9.2% in Bahrain and Saudi Arabia, [19] 24% in Palestine, [20] 8.5% in Sudan, [21] 28% in Jordan, [22] 48% in Syria, [23] 20% in Turkey [24] and 5.9% in India. [25]

Our finding of HBV infection among 7% of HD patients is congruent with studies from the Kerman [14] and Uromiye [26] provinces. The seropositivity for HBsAg in those studies was 7% and 6.5%, respectively. [15],[26] However, there are several studies from other regions of our country that showed that the prevalence rate of HBV infection was lower than our results. For example, the HBsAg positivity prevalence rate among HD patients in the Khuzestan, [13] Guilan [17] and Qazvin [18] provinces has been reported as 5.1%, 1.4% and 3.1%, respectively. Mahdavizadeh et al found 64 (2.4%) HBsAg-positive patients in 2630 HD patients of Tehran province, Iran. [27] Alavian et al reported that the seropositivity for HBsAg decreased from 3.8% in 1999 to 2.6% in 2006. [8] It may be noted here that the HBV prevalence in the general population of Iran has been estimated to be 2.6%. Those findings show the higher prevalence of HBV among HD patients and also higher HBV among the HD patients in our study in compared with other studies from other areas of Iran.

HBV infection among HD patients in other parts of the world has been reported as 5.9% in Jordan, [28] 8.5% in Sudan, [21] 2% in Morocco, [29] 13.3% in Turkey, [30] 1.4% in India, [25] 8.3% in Kenya [31] and 6.3% in Thailand. [32]

We found co-infection for both HCV and HBV in 1.6% of HD patients. Joukar et al [17] reported a HCV and HBV co-infection prevalence rate of 0.38% and Zahedi et al [14] found anti-HCV and HBsAg positivity in 1.7% of HD patients.

Among the several risk factors that have been identified for HCV, in this study only duration of dialysis had a significant relationship with anti-HCV positivity. This has been reported in the studies by Assarehzadegan et al [13] and Joukar et al [17] as well. Carneiro et al and Gasim et al also showed in their study the relationship between anti-HCV positivity and the duration of dialysis. [21],[33] The risk of HCV infection increased annually by 10% for each year and treatment by hemodialysis. [34]

Our study also showed that infection with HBV prevalence was higher among male HD patients in comparison with women, which is similar to findings in Joukar et al study. [17]

In conclusion, HBsAg positivity had a significant relationship with only gender and antiHCV-positivity with longer dialysis duration (P <0.05). This study also showed that the prevalence of HBV and HCV infections in hemodialysis centers in Karaj, Alborz Province, is moderate to low. It could be further decreased by proper evaluation and strict screening, HBV vaccination of patients with end-stage renal disease before initiating hemodialysis, appropriate antiviral treatment and isolating the infected individuals.

Financial Support

This research project was done performed with financial support rom the Alborz University of Medical Sciences.

Conflict of interest: None declared

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Correspondence Address:
Dr. Ramin Tajbakhsh
Alborz University of Medical Sciences, Karaj
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DOI: 10.4103/1319-2442.160219

PMID: 26178560

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