Impact of dedicated space, dialysis equipment, and nursing staff on the transmission of hepatitis C virus in a hemodialysis unit of the middle east.

Hepatitis C virus (HCV) infection is a significant health problem, as it can lead to chronic active hepatitis, liver cirrhosis, and hepatic carcinoma. Patients undergoing hemodialysis treatment are at increased risk of contracting HCV and other viral infections. This is primarily due to their impaired cellular immunity, underlying diseases, and blood exposure for a prolonged period. Transmission of viral hepatitis, and in particular HCV in dialysis units, has been showing a progressive increase worldwide, ranging between 5% in some western countries and up to 70% in some developing countries. The annual rate of HCV seroconversion in Saudi Arabia is 7% to 9%, while its prevalence is variable between 15% and 80%. This prevalence remained at almost 50% in recent years, despite the further increase in number of patients with end-stage renal disease and the expansion of dialysis services. The most prevalent genotypes in Saudi Arabia are genotype 4 followed by genotypes 1a and 1b, whereas genotypes 2a/2b, 3, 5, and 6 are rare. Genotypes 1 and 4 were associated with different histological grades of liver disease. Mixed infections with more than one genotype were observed in some studies. Isolation of dialysis machines and infected patients, together with strict application of infection-control policies and procedures and continuous education and training of nursing staff, remain the cornerstone in prevention and control of the spread of HCV infection in dialysis units. Interferon (INF)-alpha or pegylated INF, alone or in combination with ribavirin, have shown great promise in the treatment of chronic HCV in dialysis patients.

Hepatitis C in dialysis units: The Saudi experience

Occult hepatitis C virus infection (OCI) is a newly defined type of infection by the chronic hepatitis virus (HCV) distinguished by the existence of HCV RNA in liver tissue and/or peripheral blood mononuclear cells (PBMCs) in patients whose plasma are devoid of both positive serology and RNA. Patients on maintenance hemodialysis evince a higher HCV prevalence than the general population due to high nosocomial transmission by the dialysis units. We investigated the prevalence of occult HCV infection in patients attending our university hemodialysis centers for maintenance hemodialysis. Sixty-two CHD patients negative for serum HCV tests were enrolled in the study. PMNCs were tested by real-time PCR for the presence of HCV RNA. For the 62 patients, the average duration since starting dialysis was 32.7 months and the mean (SD) alanine transaminase and aspartate transaminase were 25.74 ± 9.75 and 28.81 ± 11.32 IU/l, respectively. Out of the 62 CHD patients negative for serum anti-HCV and HCV RNA patients, only three (4.84%) were shown to have HCV RNA in their PBMCs implying the diagnosis of OCI; their viral load range was 1.24–4.15 IU/ml. All three OCI-proven patients gave no history of hepatic disease. In this study, we found that patients considered to be free of HCV can have HCV replicating in their PBMCs. This awareness points to the possibility of HCV being transmitted from apparently uninfected persons. A positive HCV RNA detection in PBMCs is dependable in determining OCI among high-risk subjects particularly when a liver biopsy is not an option. HCV transmission can occur through hemodialysis units signaling incorrect application of infection control measures in our Egyptian dialysis units. Additional studies on hemodialysis patients are necessary to realize the true magnitude of OCI among this patient group and to highlight the importance of incorporating HCV viral assays in PBMCs into the diagnostic algorithm.

Prevalence of occult hepatitis C virus among hemodialysis patients in Tanta university hospitals: a single-center study.

We aimed to investigate hepatitis C virus (HCV) epidemiology among hemodialysis (HD) patients in the Middle East and North Africa (MENA). Our data source was an HCV biological measures database populated through systematic literature searches. Descriptive epidemiologic syntheses, effects meta-analyses and meta-regressions, and genotype analyses were conducted. We analyzed 289 studies, including 106 463 HD patients. HCV incidence ranged between 0 and 100% as seroconversion risk, and between 0 and 14·7 per 1000 person-years as incidence rate. The regional pooled mean estimate was 29·2% (95% CI: 25·6-32·8%) for HCV antibody positive prevalence and 63·0% (95% CI: 55·4-70·3%) for the viremic rate. Region within MENA, country income group, and year of data collection were associated with HCV prevalence; year of data collection adjusted odds ratio was 0·92 (95% CI: 0·90-0·95). Genotype diversity varied across countries with four genotypes documented regionally: genotype 1 (39·3%), genotype 2 (5·7%), genotype 3 (29·6%), and genotype 4 (25·4%). Our findings showed that one-third of HD patients are HCV antibody positive and one-fifth are chronic carriers and can transmit the infection. However, HCV prevalence is declining. In context of growing HD patient population and increasing HCV treatment availability, it is critical to improve standards of infection control in dialysis and expand treatment coverage.

https://www.cambridge.org/core/services/aop-cambridge-core/content/view/3DB5E50AAE27E33173BF3D52F93BC742/S0950268817002242a.pdf/div-class-title-epidemiology-of-hepatitis-c-virus-among-hemodialysis-patients-in-the-middle-east-and-north-africa-systematic-syntheses-meta-analyses-and-meta-regressions-div.pdf

Epidemiology of hepatitis C virus among hemodialysis patients in the Middle East and North Africa: systematic syntheses, meta-analyses, and meta-regressions.

Background: Type-2 diabetes has emerged as the commonest cause of end stage renal disease (ESRD) requiring long-term haemodialysis (HD) that constitutes a high-risk environment for the transmission of hepatitis C virus (HCV). The likelihood of acquiring HCV infection in this rapidly growing population on HD conceivably vulnerable to viral infections has not been well studied. The present study aims to determine the susceptibility of the patients with type-2 diabetes to HCV infection in a HD unit with high HCV prevalence. Methods: The records of 196 patients with ESRD enrolled on long-term HD at King Fahad Hospital and tertiary care centre, in Hofuf, Saudi Arabia, from November 1995 to November 2000, were retrospectively reviewed. HCV prevalence, seroconversion rates, history of blood transfusion, and time on dialysis (time span since initiation of HD therapy) were recorded and compared between the group of patients with type-2 diabetes, and the non-diabetic group. Results: The overall, HCV seroprevalence of 41.3% (81/196) and annual seroconversion rate of 8.26% were observed. Anti-HCV positivity was associated with longer time on dialysis. Of the 196 patients 54 (27.5%) had type-2 diabetes mellitus and 142 (72.5%) were non-diabetics. Patients with type-2 diabetes recorded higher HCV prevalence (57.4% vs 35.2%), and annual seroconversion rates (11.48% vs 7.04%) after a shorter period on dialysis (32.6 vs 50.6 months), as compared to those of the non-diabetic group. Conclusions: A significantly higher HCV prevalence [odds ratio (OR)-2.462, 95% CI (1.338-4.542)] and annual seroconversion rate [OR-2.483, 95% CI (1.241-4.946)] despite relatively shorter period on dialysis [OR-3.320, 95% CI (1.487-7.4810)] among patients with type-2 diabetes clearly point to the greater likelihood of their acquiring HCV infection even at an earlier stage than the non-diabetic patients, receiving treatment in a high prevalence HD unit.

The susceptibility of patients with type-2 diabetes to hepatitis C virus infection during long-term haemodialysis.

We studied 408 patients on maintenance hemodialysis at four different centers in the Western province of Saudi Arabia to assess the prevalence of antibody against Hepatitis C Virus (HCV) and the possible risk factors. There were 212 males and 196 females with a mean age of 42.9 ± 13.9 years (range 12 to 75 years). They were on dialysis for a period between 3 to 140 months with a mean of 52.2 + 38 months. Assay for anti-HCV was made by second generation ELISA. A total of 295 patients (72.3%) tested positive. The prevalence rates varied considerably among the four centers studied and were as follows: the center at Jeddah, 62.7%; two centers at Makkah, 87% and 79.7% respectively and one center at Taif, 80.9%. A total of 311 patients had received varying number of blood transfusions. Of these, 230 (74%) were anti-HCV positive as against 97 patients who were never transfused of whom 65 (67%) were positive. This difference did not reach statistical significance (P = 0.22). Similarly, we found no significant correlation between the anti-HCV prevalence rates and serum alanine transaminase levels (P = 0.93). Our study further confirms that there are routes other than blood transfusion involved in the transmission of the HCV and there is a need to determine these routes in order to prevent the spread of this virus.

Prevalence of hepatitis C antibodies among hemodialysis patients in the Western province of saudi arabia.

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Prevalence of hepatitis C antibodies among hemodialysis patients in the Western province of saudi arabia.