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| RENAL DATA FROM THE ASIA - AFRICA |    | | | | Year : 2009 | Volume : 20 | Issue : 4 | Page : 681-684 | | | Prevalence of hepatitis C and B infection and HC V genotypes among hemodialysis patients in Khuzestan province, Southwest Iran | | | Mohammad Ali Assarehzadegan1, Ghodratollah Shakerinejad2, Reza Noroozkohnejad1, Akram Amini2, SA Rahim Rezaee3
1 Department of Immunology, Faculty of Medicine, Ahwaz Joundishapur University of Medical Sciences, Ahwaz, Khuzestan, Iran
2 Jahad Daneshgahi Medical Center, Ahwaz, Iran
3 Microbiology Department, Virology Division, Mashhad University of Medical Sciences, Iran
Click here for correspondence address and email | Date of Web Publication | 8-Jul-2009 | | |      | |  Abstract | | | Hepatitis B (HBV) and C (HCV) virus infection are the most important infections transmitted by the parenteral route in hemodialysis patients. This study is the first report of prevalence of viral hepatitis and hepatitis C virus genotypes in southwest Iran among hemodialysis patients. A cross-sectional study was carried out among 214 hemodialysis patients of the Central hemodialysis unit, from March 2005 to August 2006. Serum samples were tested for HBsAg and anti-HCV using specific enzyme linked immunoassay (ELISA) kits and confirmed by PCR (HBV) and RT PCR (HCV). HCV genotypes were determined with HCV genotype specific primers using HCV genotype kit. Out of 214 hemodialysis patients, 34 were positive for anti-HCV (7.9%, 95% CI: 4.32-11.56) and 11 for HBsAg (5.1%, 95% CI: 2.18-8.1). The duration of treatment by hemodialysis was significantly associated with HBV and HCV positivity (P< 0.001). The predominant HCV genotype in the region was 1a (41.1%, 7/17), whilst genotypes 3a and 1b were found in 35.2% (6/17) and 23.5% (4/17) subjects, respectively. In conclusion although anti-HCV and HBsAg positivity in hemodialysis patients in Khuzestan province are smaller than those found in some other Iranian provinces and neighboring countries, they are still high. Enforcement of universal precautions in infection control, routine testing of patients, and serial determination of hepatic enzymes should be the common practice in dialysis centers in Iran. Keywords: HBV, HCV, Hemodialysis How to cite this article:
Assarehzadegan MA, Shakerinejad G, Noroozkohnejad R, Amini A, Rahim Rezaee S A. Prevalence of hepatitis C and B infection and HC V genotypes among hemodialysis patients in Khuzestan province, Southwest Iran. Saudi J Kidney Dis Transpl 2009;20:681-4 |
How to cite this URL:
Assarehzadegan MA, Shakerinejad G, Noroozkohnejad R, Amini A, Rahim Rezaee S A. Prevalence of hepatitis C and B infection and HC V genotypes among hemodialysis patients in Khuzestan province, Southwest Iran. Saudi J Kidney Dis Transpl [serial online] 2009 [cited 2014 Mar 3];20:681-4. Available from: http://www.sjkdt.org/text.asp?2009/20/4/681/53305 |
| Introduction | |  |
The prevalence of HCV in hemodialysis patients is higher than healthy population in Iran (5-24% versus 0.3) and most other countries, suggesting that dialysis patients may be at higher risk of acquiring HCV infection. [1],[2],[3]
Khuzestan province is located in the Southwest of Iran, a tropical area with an approximate population of 4.5 millions (census 2004). Seroprevalance of Hepatitis E virus was reported earlier [4] however, no data exists concerning HBV and HCV infections in patients undergoing hemodialysis in this region. Therefore, the present study aims to assess the prevalence of hepatitis B and different genotypes of HCV in hemodialysis population of Khuzestan province.
| Subjects and Methods | | |
Patients
This cross sectional study was performed from March 2005 to August 2006 in Khuzestan province on hemodialysis patients attending central hemodialysis unit. A total of 214 whole blood samples were collected from patients, after obtaining an informed consent. Serum samples were separated from the whole blood, aliquots were stored at -70°C. Demographic data, such as age, duration of hemodialysis, and number of blood transfusions was obtained from patient records.
Laboratory assays
All sera were screened using HBsAg and AntiHCV assays with commercial ELISA microplate kits (RADIM, Italy) according to the manufacturer's instructions. Positive samples were confirmed using DNA polymerase chain reaction (PCR) and nested RT PCR for HBV and HCV, respectively.
All samples were submitted to DNA and RNA extraction using High pure viral nucleic acid kits (Roche, Germany), reverse transcription (Fermentas, Lithuania) by methods already described. [5] ,[6] HCV genotypes were determined with HCV genotype specific primers using HCV genotype kit (Sacace, Italy).
Statistical analysis
Prevalence, 95% confidence intervals (95% CI) and odds ratio were calculated by SPSS software version 11.0 (SPSS Inc., Chicago, IL). Data comparisons were performed using the Chi square test and Fisher's exact test. The differences were considered significant if P< 0.05.
| Results | | |
Two hundred and fourteen patients were tested, 135 (63.1%) males, and 79 (36.9%) females. The mean age was 37.3 ± 12.11 years (8 to 60 years).
Out of 214 hemodialysis patients, 34 (7.9%) were positive for anti-HCV (4.32-11.56) and 11 (5.1%) for HBsAg (2.18-8.1). The serological data for subjects are shown in [Table 1].
The duration of treatment by hemodialysis and, in turn, changing the hemodialysis machine were significantly associated with HBV and HCV positivity (P< 0.001 and P< 0.001, respectively). Patients under treatment for more than six years had greater risk of infection for HBV and HCV seropositivity, compared to subjects who had undergone less than three years (RR=9.08 and 11.03, respectively).
Moreover, The prevalence of anti-HCV was significantly higher in patients who received blood transfusion more than seven times compared to subjects without blood transfusion (RR=20.7, P< 0.001). Anti-HCV screening tests were introduced to blood banks in 1996 in Iran.
Age or sex had no correlation with anti HCV or HBsAg. The predominant HCV genotype in the region was 1a (41.1%, 7/17), whilst genotypes 3a and 1b were found in 35.2% (6/17) and 23.5% (4/17) subjects, respectively [Figure 1].
| Discussion | | |
Hemodialysis patients are at high risk for hepatitis viral infections. [7] It is known that different methods of control, cleaning and disinfection of the hemodialysis membranes, machines, instruments and environmental surfaces may interfere with determined prevalence. [8] Prevalence of HBV and HCV in hemodialysis patients were reported by several authors ranging between 0.9% to 21.6% for HBV [9] ,[10] and 3.4% to 65.8% for HCV. [11] ,[12] ,[13]
This is the first report on the prevalence of HBV, HCV and genotyping of HCV among hemodialysis subjects of Khuzestan province, in Iran. We found a higher prevalence of antiHCV and HBsAg compared to the developed countries. [9] ,[11]
Three HCV genotypes were identified in the hemodialysis patients in Khuzestan province: subtypes 1a, 3a and 1b. Subtype 1a was predominant similar to the recent report by Hosseini Moghaddam et al [7] from Tehran (28.8%). This finding is in contrast with global HCV geno types distribution [14] and the high frequency of genotype HCV 1a/1b plus HCV 4 and HCV 2/2a plus HCV 4 in hemodialysis patients living in neighboring countries, such as Bahrain and Saudi Arabia respectively, [15] sharing sea boarder with Khuzestan province. Moreover, the antiHCV prevalence in our study was lower than that in these neighboring Arabic countries.
Studies from Iran have reported a prevalence from 5.5% to 55.9% in different cities. [16] Duration of hemodialysis [9] ,[17] and molecular evidence to this effect for the nosocomial transmission of HCV within hemodialysis units was noted in several studies from Iran. [15] ,[18] In fact, our patients undergoing HD for more than six years had 11.03 fold greater risk of HCV infection, compared to patients with duration of HD less than three years.
The results of our study also document that HCV positive subjects had a significantly higher frequency of transfusion (P< 0.001). It is important to consider that, in spite of the systematic screening of blood donors; HBV and HCV blood transfusion still remains one of the sources of infection transmission. This highlights the importance of more stricter screening in order to improve blood transfusion safety. Nosocomial transmission of HCV and HBV is an important contributing factor to the spread of these viruses. [8] ,[19] Despite various infection control procedures in HD patients prevalence and incidence rates of HBV and HCV are still significant. [17] ,[20] Studies have shown that strict aseptic measures can virtually eliminate HCV contamination, even in units with a high prevalence of HCV infection. [21]
In conclusion, although anti-HCV and HBsAg positivity in hemodialysis patients in Khuzestan province are smaller than those found in some other Iranian provinces and neighboring countries, they are still high. Simple measures such as enforced general asepsis rules, careful disinfection and equipment sterilization, routine testing of patients, serial determination of hepatic enzymes should be the common practice in dialysis centers in Iran.
| Acknowledgment | | |
This study was supported by Khuzestan Jahad Daneshgahi Medical Center. The authors would like to thank Dr. Samadi for his advice on study design.
| References | | |
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Correspondence Address:
Mohammad Ali Assarehzadegan
Department of Immunology, Faculty of Medicine, Ahwaz University of Medical Sciences, Ahwaz, Khuzestan
Iran
PMID: 19587521
[Figure 1]
[Table 1] | |
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