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Hepatitis C Virus Infection among Chronic Renal Failure Patients Pre – Dialysis Therapy in
Hodiedah City, Yemen
Mansoor Shueai Al Awfi1,2*, Mohammed Amood Al-Kamarany2,3, Rasheed Mohsen1, Mohammed Al Hilali1, Waleed Al Khader1, Saleem Al Jafari1, Mona Galeb1, Hanan Al Amodi1 and Balqis Moad1
1Department of Medical Laboratory, Faculty of Medicine and Health Sciences, Hodiedah University, Yemen.
2Tihama Foundation for Medical – Pharmaceutical Studies and Research, Hodeidah, Yemen.
3Department of Pharmacy Practice, Faculty of Clinical Pharmacy, Tropical Medicine Center, Hodeidah University, P.O.Box 3114, Hodeidah, Yemen.
Authors’ contributions
This work was carried out in collaboration between all authors. Author MSAA designed the study and wrote the manuscript. Author MAAK performed the data analysis and contributed in revision of the manuscript. Authors RM, MAH, WAK, SAJ, MG, HAA and BM collected the data. All authors read and approved the final manuscript.
Article Information
DOI: 10.9734/MRJI/2017/28632 Editor(s):
(1)Grzegorz Cieslar, Department and Clinic of Internal Diseases, Angiology and Physical Medicine, Medical University of Silesia, Poland.
(2)Lachhman Das Singla, Department of Veterinary Parasitology, College of Veterinary Science, Guru Angad Dev Veterinary and Animal Sciences University, India.
(3)Prof. En Tao Wang, Departamento de Microbiología, Escuela Nacional de Ciencias Biológicas, Instituto Politécnico Nacional, México and State Key Laboratory of Agrobiotechnology and College of Biological Sciences, China Agricultural University, Beijing, China (Invited professor).
Reviewers:
(1)Anonymous, Manipal University, India.
(2)Rodolfo Valtuille, Salvador University, Brazil.
(3)Sarwat Fatima, Deccan College of Medical Sciences, India.
(4)Rubina Naqvi, Sindh Institute of Urology and Transplantation, Pakistan.
Complete Peer review History:http://www.sciencedomain.org/review-history/17188
Received 29th July 2016 Accepted 17th November 2016 Published 10th December 2016
ABSTRACT
Background: Hepatitis C virus (HCV) infection is a significant problem in hemodialysis patients, which poses difficulty in the management of the patients in the renal dialysis unit.
Original Research Article
Objective: This study aimed to detect and determine the prevalence of HCV in renal failure pre- dialysis patients (for the first time) in the renal dialysis center of Hodiedah city, Yemen.
Methods: The demographic data of 278 renal failure patients collected retrospectively for a period of 4 years and eight months from January 2011 to September 2015. All patients screened for HCV antibodies using one-step cassette style anti-HCV device. The positive samples were confirmed by enzyme linked immunosorbent assay (ELISA). The demographic data of patients were recorded namely sex, age, education, residence and occupation.
Results: Out of 278 patients, three cases (1.07%) were found having HCV infection. Out of the three positive patients, two cases (1.18%) were males and one case (0.92%) was female. Two cases of 132 patients (1.54%) were found in the 21- 40 age group and one case of 114 patients (0.88%) found in the 41- 60 age group. No prevalence was observed in the age group of < 20 years and > 60 years. HCV was detected in one case (0.79%) of 127 urban residence patients and in 2 cases (1.32%) of 151 rural residence patients. The prevalence of HCV was showed among non- educated subjects (two cases = 1.54%) and in educated subjects (one case = 0.68%). Out of 252 non-occupant patients, three cases (1.19%) were found to be positive HCV antibodies. No prevalence was observed in 26 occupant patients.
Conclusion: In conclusion, pre dialysis screening for HCV was an effective strategy taken to ensure containment of hospital acquired infection (HAI) by isolation of patients in certain machine.
Keywords: Renal; chronic; acute; failure; HCV.
1. INTRODUCTION
Hepatitis C virus (HCV) is a single stranded positive sense RNA virus with a genome of 9.6 kb in length, and belongs to family Flaviviridae and genus Hepacivirus [1]. HCV infection is a major public health problem with an estimated global prevalence of 3%, there are about 180 million carriers and approximately 4 million people are newly infected annually [2].
HCV infection in dialysis patients represents a significant health problem for dialysis units, both in term of containing the spread of infection, and following the clinical progression of infected patients. Dialysis patients are a group at particularly high risk of acquiring HCV infection because of nosocomial spread. The natural history of HCV in dialysis patients remains controversial because the course of HCV typically extends over decades, while dialysis patients have higher morbidity and mortality rates than those reported in the general population limiting long-term follow-up. Liver disease due to HCV infection is a significant cause of morbidity and mortality in end-stage renal disease patients treated with dialysis or transplantation [1,3].
HCV infection is a major health problem in Yemen. The world health organization (WHO) classification considers Yemen as a high endemic area [4]. The prevalence of HCV infection in Yemenis is 1.8% in the general population, 0.2 to 3.0% in blood donors, 8.5% in pregnant women, 40 - 62.7% in hemodialysis
patients and 74.1% among patients with acute and chronic liver disease [5].
Adequate data on prevalence of HCV in renal failure patients admitted for hemodialysis for the
first time is lacking. Therefore, this study aimed to determine the prevalence of HCV in
renal failure pre- dialysis patients (for the first time) in renal dialysis center of Hodiedah city, Yemen.
2. METHODS
2.1 Study Area and Design
Our study is an observational analytic study with collection of a retrospective data from the patients' medical handbooks. This study was carried out in dialysis center in Hodiedah city in western of Yemen.
2.2 Sample Size
The demographic and geographical data of 278 renal failure patients admitted to our center for hemodialysis for the first time were collected for a period of 4 years and eight month from January 2011 to September 2015.
2.3 Study Population
Studied population stratified by the age, gender, occupation, residence and education. The demographic characteristics of study population showed in Table 1.
2.4 Sample Analysis Techniques
All chronic renal patients admitted for the first time to our dialysis center screened for HCV antibodies by using one-step cassette style anti- HCV device (Rapid Anti-HCV Test, Intec, China).
Positive samples were confirmed by enzyme linked immunosorbent assay (DRG, HCV antibodies, USA).
Table 1. Demographic characteristics of study population
Variable Number (n=278) (%) Age (years)
< 20 21- 40 41-60
> 60
13 130 114 21
4.68 46.76 41.01 7.55 Gender
Male Female
169 109
60.79 39.21 Occupation
Occupant Non occupant
26 252
9.35 90.65 Residence
Rural Urban
151 127
54.32 45.68 Education
Educated Non educated
148 130
53.24 46.76 2.4.1 Rapid test
The HCV rapid test is a qualitative membrane based immunoassay for the detection of HCV antibody in serum or plasma with sensitivity >
99.53 and specificity 99.78. During testing, the serum or plasma specimen is reacted with the recombinant HCV antigen coated particles making a mixture migrates upward on the membrane by capillary action to react with recombinant HCV antigen on the membrane and generate a colored line. To serve as a procedural control, a colored line will always appear in the control line region considered as internal positive procedural control.
2.4.2 Enzyme linked immunosorbent assay (ELISA)
ELISA test is immunoassay for the detection of HCV antibody with specificity of > 98% and sensitivity of 100%. Microplate was coated with HCV-specific antigens that captured HCV antibodies if present in sample. The bound HCV antibodies is detected by the addition of anti IgG
and M antibody labeled with peroxidase (HRP) that acted on the substrate/chromogenic mixture generating an optical signal proportional to the amount of anti HCV antibodies present in the sample. A check was carried out on the controls and the calibrator whenever the kit was used, in order to verify whether their optical density values were as expected.
2.5 Data Analysis
Demographic and laboratory results data entered and analyzed using Excel Software 2010. The statistical methods used could not be applied for such small subgroups of patients (one or two patients in particular subgroup were infected with HCV). Therefore, we used descriptive analysis namely the percentage because of the small number of subject infected with HCV.
3. RESULTS
The general characteristics of the patients and the obtained results were summarized in Table 2.
Out of the total 278 patients, three subjects (1.07%) were HCV infected. Out of the three HCV positive patients, two (1.18%) were males and one (0.92%) was female. Two cases (1.54%) were found in the 132 patients of 21- 40 age group and one case (0.88%) was found in the 114 patients of 41- 60 age group. No prevalence was observed in the age group of < 20 years and
> 60 years. HCV was detected in one case (0.79%) of the 127 urban residence patients and in 2 cases (1.32%) of the 151 rural residence patients. The HCV was detected in two cases (1.54%) of the 130 non-educated subjects and in one case (0.68%) of the 148 educated patients.
Out of the 252 non-occupant patients, three cases (1.19%) were found to be positive for HCV antibodies.
4. DISCUSSION
The detection of anti-HCV in dialysis units is differed worldwide, ranging from 1% to 63% [6].
We obtained the demographic data of chronic kidney failure patients admitted to dialysis and renal diseases center of Hodeidah city for the first time in the past 4 years. In the present study, the prevalence of HCV antibodies was 1.07% in the studied population.
In Yemen, there is no published study on the prevalence of HCV in predialytic patients, while the prevalence of HCV in general population was 1.3% [7]. Several previous studies in Yemen
revealed a higher prevalence of HCV in chronic renal failure during dialysis process. One study performed in hemodialysis units in some of the public hospitals in Sana,a city evidenced that the overall prevalence of positive HCV antibody among hemodialysis patients is 22.5% [8].
Another previous study carried out at the Al- Gamhourea Teaching Hospital, Aden, Yemen reported that the anti-HCV prevalence rate among the hemodialysis patients was 62.7% [9].
Table 2. HCV antibodies among studied population
Variable Number (n=278) HCV (+)
Age (years) No. %
< 20 21- 40 41-60
> 60
13 130 114 21
0 2 1 0
0.00 1.54
0.88 0.00
Total 278 3 1.07
Gender Male Female
169 109
2 1
1.18 0.92
Total 278 3 1.07
Occupation Occupant Non occupant
26 252
0 3
0.00 1.19
Total 278 3 1.07
Residence Rural Urban
151 127
2 1
1.32 0.79
Total 278 3 1.07
Education Educated Non educated
148 130
1 2
0.68 1.54
Total 278 3 1.07
Worldwide, few studies performed to detect the prevalence of HCV in chronic renal failure in predialysis period. Lemos et al. [10] reported that the prevalence of HCV in a large cohort of predialysis patients in Brazil was 3.9%. This prevalence rate is more than that found in our study and that may due to the difference in numbers of the predialysis patients.
López-Alcorocho and his colleagues [11] showed 17.1% of the prevalence of HCV in patients with chronic renal failure before entering into a hemodialysis program (predialysis). Sit et al. [12]
reported 7% seroprevalence of hepatitis C viruses in patients with chronic kidney disease in the predialysis stage at a university hospital in Turkey. Espinosa et al. [13] found 2.8%
prevalence of HCV infection in predialysis
patients included in the maintenance hemodialysis program.
More studies in other countries reported prevalence of HCV antibodies in hemodialysis to be 64% in Macedonia [14], 14.9% in Iran [15], 1.11% in India [16], 0.02% in South of India [17], 6.7% in Mexico [18], 7.0% in German [19], 2.9%
and 3.4% in Netherlands [20], 5.4% in British [21], 60% in Morocco [22] and 26.6% in Vietnam [23].
The high prevalence in previous studies may be due to the excessive number of transfusions, the duration of dialysis treatment and the environment of dialysis that play a role in the dissemination of the virus among the patients in dialysis centers [24]. The low prevalence of infection could attributed to stringent infection control practices applied by the health care providers including the doctors and nurses, effective waste management practices and strict universal precautions followed.
In the present study, HCV was detected in few subjects predialysis namely in males (2 cases) and females (1 case). On the other mean, HCV in predialysis patients was less.
5. CONCLUSION
HCV was detected in few patients with CRF predialytic namely 1.07%. This screening is an effective strategy taken to ensure containment of hospital acquired infection (HAI) by isolation of patients in certain machine.
COMPETING INTERESTS
Authors have declared that no competing interests exist.
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© 2017 Al Awfi et al.; This is an Open Access article distributed under the terms of the Creative Commons Attribution License (http://creativecommons.org/licenses/by/4.0), which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.
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