Hepatitis C Infection in Hemodialysis Patients, Makkah, Saudi Arabia

Abstract

Hepatitis C virus (HCV) infection is the most common cause of chronic liver disease in the world and evaluation of the epidemiology of HCV infection was made possible by the development of a serological assay to detect antibodies to epitopes of HCV. Hemodialysis (HD) is considered to be one of the main risk factors of HCV transmission. The prevalence of antibodies to HCV (anti-HCV) in patients undergoing maintenance dialysis therapy (MDT) was found to be one of the highest among different risk groups and there is wide variation in the prevalence of HCV infection among different dialysis units and countries. Therefore, the prevalence of anti-HCV was studied in patients undergoing MDT. The current study is a cross section one, where a sample of 361 HD patients were selected randomly from HD centres in three governmental hospitals in Makkah city and they were subjected to assessment for the prevalence of anti-HCV by using questionnaires in addition to clinical measurements. The overall prevalence of anti-HCV among HD patients was 49.9% according to clinical measurements and questionnaires. The overall prevalence of anti-HCV among HD patients in Makkah city (49.9%) was comparable to that reported from other parts of the Kingdom of Saudi Arabia (KSA) and it is almost similar to the already reported positivity rate of (43.2%) from the eastern region of KSA and southern regions of KSA (45.5%). However, Strict adherence to universal precautions as recommended by the Centre for Diseases Control (CDC), meticulous regular disinfection of HD machines, Strict isolation of HCV-positive patients, dedicated dialysis machines and nursing staff at new dialysis set-up could possibly be the reasons of relatively low anti-HCV positivity at the current study than that reported by Shaheen et al., from four centres in the western region of KSA, (72.3%) and that by Huraib et al.,  in their multi-centre study in KSA, (68%) as well as the mean national rate. On the other hand, the use of more sensitive third generation enzyme - linked immunosorbent assay (ELISA) technique, long duration on HD, multiple blood transfusions, patients with dialysis treatment in multi-centres, factors related to infrastructure, environment and operational system might be responsible for the high prevalence of anti-HCV found in this study than that reported by Saeed et al., from Riyadh and those observed in the central region of KSA. Although routes of transmission are still unclear, early detection of all infected patients is mandatory for HCV prophylaxis in HD patients. Furthermore, an intensive educational program for staff members, HD patients and proper evaluation of the HD situation are needed. Thus, observation of appropriate preventive measures by all HD-centres is paramount.