Saudi Journal of Kidney Diseases and Transplantation

LETTER TO THE EDITOR
Year
: 2011  |  Volume : 22  |  Issue : 4  |  Page : 806--807

The seroprevalence of anti-HCV in high-risk dialysis patients


Salem A Bin Selm 
 Medical Department, Faculty of Medicine and Health Sciences, Aden University, Aden, Yemen

Correspondence Address:
Salem A Bin Selm
Medical Department, Faculty of Medicine and Health Sciences, Aden University, Aden
Yemen




How to cite this article:
Bin Selm SA. The seroprevalence of anti-HCV in high-risk dialysis patients.Saudi J Kidney Dis Transpl 2011;22:806-807


How to cite this URL:
Bin Selm SA. The seroprevalence of anti-HCV in high-risk dialysis patients. Saudi J Kidney Dis Transpl [serial online] 2011 [cited 2021 Apr 18 ];22:806-807
Available from: https://www.sjkdt.org/text.asp?2011/22/4/806/82713


Full Text

To the Editor,

Hepatitis C virus (HCV) is a positive-stranded RNA agent identified as the main cause of post-transfusion non-A, non-B hepatitis (PTH), before routine blood screening was made mandatory, early in 1990. In underdeveloped or developing countries, acquisition of HCV infection is mainly nosocomial due to the prevailing low health-care standards. [1],[2] The major route of HCV infection in developed countries is through the use of intravenous drugs (IVDU), [3] while in developing countries, it is still through the post-transfusion and nosocomial routes. [4]

This study was conducted to identify the prevalence of HCV among high-risk groups of patients admitted to the medical wards at the Al-Gamhourea Teaching Hospital in Aden, and to assess the risk factors and modes of transmission of HCV infection in these patients. Serum samples of 316 high-risk consecutive patients (200 males and 116 females), aged 18-60 years, from different medical units of our hospital were studied between 2006 and 2007. The patients' sera were examined for HCV at the Central Laboratory of the hospital, and they were assigned to three groups: (a) 142 patients with liver disease (LDP) (80 males and 62 females; 28-60 years of age), (b) 143 patients on dialysis (DP) (89 males and 54 females, 38-60 years of age) and (c) 31 multi-transfused adults with sickle cell anemia (SCA) (all male, 18-30 years old).

These patients were subject to regular follow-up at the medical clinic. Serological tests for hepatitis B surface antigen (HBsAg), hepatitis B core antibody HBcAb and anti-human immunodeficiency virus (HIV) were determined by the second-generation ELISA test. Statistical analyses were performed using SPSS 12.0 (SPSS Inc.) for Windows.

Of the 316 patients studied, 138 (43.7%) were found to be positive for anti-HCV antibody. The main demographic and biochemical characteristics of the study groups are shown in [Table 1]. The sero-prevalence rate (positive anti-HCV) was 47.2% among patients with chronic liver disease, 35.7% in patients on dialysis and 64.5% in the SCA group. All studied subjects were Yemeni nationals. The most likely mode of HCV transmission was parenteral exposure. About 53% of the LDP group had history of receiving blood transfusion(s), while 47% had a probable different nosocomial source of infection through intravenous infusions, surgery, contaminated equipment, etc. Among the 51 DP (34 males and 17 female, 38-60 years of age), the mean duration on dialysis treatment was 10.5 ± 5.8 months. These patients acquired hepatitis C probably through contaminated intravenous catheters or other equipment. In addition, a history of past blood transfusion was elicited from 41 (80%) of these patients. There were 20 multi-transfused adults with SCA, all male, 18-30 years old, who had received multiple transfusions since their childhood, as part of their therapy. Other hepatitis B markers (HBsAg +/- Anti-HBc IgG) were positive in 23 patients (16.7%), in addition. Thus, the overall sero-positive rate in our study patients was 76.2%, of whom 23 (16.7%) were positive for hepatitis B and anti-HCV while 32.5% were positive for only the hepatitis B markers. The prevalence of anti-HCV was significantly higher in the SCA group as compared with the HD group (64.5% vs. 35.7%, P = 0.032) and the LDP group (64.5% vs. 47.2%, P <0.001). The mean age and age distribution did not differ between the DP and the LDP groups (55.9% vs. 54.9%), while patients in the SCA group were significantly younger (P <0.001).

Prior to 1990, blood transfusion was associated with a high risk of HCV infection. [5] After systematic screening of blood, post-transfusion hepatitis C has decreased dramatically. [6] The main transmission route of hepatitis C in developed countries is through the use of intravenous drug use. [7] The high prevalence of anti-HCV (>35%) in our study is in accordance with the literature. [8],[9],[10] The relatively higher prevalence of anti-HCV positivity in SCA (64.5%) and LDP (47.2%) patients, in the present study, suggests that major exposure to HCV probably occurred many years ago, before 1990, when HCV infection was more widespread, as it was unknown and uncontrolled. The fact that these patients received blood products prior to the implementation of routine screening for HCV explains our findings. [11] The risk of infection in hemodialysis patients appears to correlate with the duration on hemodialysis and the number of transfusions.{Table 1}

References

1Alter MJ, Kruszon-Moran D, Nainan OV, et al. The prevalence of hepatitis C virus infection in the United States, 1988 through 1994. N Engl J Med 1999;341:556-62.
2Legler TJ, Riggert J, Simson G, et al. Testing of individual blood donations for HCV RNA reduces the residual risk of transfusion-transmitted HCV infection. Transfusion 2000;40: 1192-7.
3Frank C, Mohamed MK, Strickland GT, Lavanchy D, Arthur RR, Magder LS. The role of parenteral antischistosomal therapy in the spread of hepatitis C virus in Egypt. Lancet 2000;355:887-91.
4Akbari A, Imanieh MH, Karimi M, Tabatabaee HR. Hepatitis C Virus Antibody Positive Cases in Multitransfused Thalassemic Patients in South Iran. Hep Mon 2007;7:63-6.
5Fried MW, Shiffman ML, Reddy KR, Smith C, Marinos G, Goncales FL. Peginterferon alfa-2a plus ribavirin for chronic hepatitis C virus infection. N Engl J Med 2002;347: 975-82.
6Hadziyannis SJ, Sette H, Morgan TR, Balan V, Diago M, Marcellin P. Peginterferon-alpha2a and ribavirin combination therapy in chronic hepatitis C: a randomized study of treatment duration and ribavirin dose. Ann Intern Med 2004;140:346-55.
7Dominguez A, Bruguera M, Vidal J, Plans P, Salleras L. Community-based seroepidemiological survey of HCV infection in Catalonia, Spain. J Med Virol 2001;65:688-93.
8Sugimoto K, Kaplan DE, Ikeda F, Ding J, Schwartz J, Nunes FA. Strain-specific T-cell suppression and protective immunity in patients with chronic hepatitis C virus infection. J Virol 2005;79:6976-83.
9Okuda K, Hayashi H, Yokozeki K, Irie Y. Destruction of hepatitis C virus particles by haemodialysis. Lancet 1996;347:909-10.
10Farmakis D, Giakoumis A, Polymeropoulos E, Aessopos A. Pathogenetic aspects of immune deficiency associated with beta-thalassemia. Med Sci Monit 2003;9:RA19-22.
11Rehermann B. Interaction between the hepatitis C virus and the immune system. Semin Liver Dis 2000;20:127-41.