A very high prevalence of hepatitis C virus infection among patients undergoing hemodialysis in Kosovo: a nationwide study

Xhevat Jakupi,Maja M Lunar,Mario Poljak,Adriana Vince,Jana Mlakar,Katja Seme,Lul Raka,Ibrahim Rudhani

doi:10.1186/s12882-018-1100-5

Abstract

BackgroundPatients on hemodialysis are at high risk for hepatitis C virus (HCV) infection if measures for effective control of HCV infection in the hemodialysis environment are not implemented. Whereas in developed countries isolated small-scale outbreaks of HCV in hemodialysis units are occasionally reported, HCV transmission in the hemodialysis environment still represents a substantial problem in low-resource countries. This study systematically assessed the prevalence of HCV infection among all patients at all hemodialysis centers in Kosovo, determined the HCV genotype distribution, and reviewed the main risk factors associated with HCV infection in this group of patients.MethodsFrom January to March 2013, blood samples from all patients undergoing hemodialysis at all seven hemodialysis centers in Kosovo were collected. The samples were screened for the presence of anti-HCV antibodies, and seropositive samples were also tested for HCV RNA. Genotyping was performed by sequencing the core region of the HCV genome. Subsequently, face-to-face interviews were conducted with consented patients attending hemodialysis in December 2015 and with the management of all hemodialysis centers in Kosovo.ResultsThe overall seroprevalence of HCV infection among hemodialysis patients in Kosovo was 53.0% (354/668), ranging from 22.3 to 91.1% at different centers. HCV RNA was detected in 323/354 (91.2%) seropositive patients. The most frequent HCV genotype was genotype 1a (62.2%), followed by genotypes 4d (33.1%), 1b (4.0%), and 2c (0.7%). The duration of hemodialysis and receiving dialysis at more than one center were identified as independent significant predictors of anti-HCV positivity. Shortage of staff, lack of resources, and inconsistent use of hygienic precautions and/or isolation strategies were observed.ConclusionsThe prevalence of HCV infection among hemodialysis patients in Kosovo is extremely high. The relatively low prevalence of HCV infection in the general population, predominance of two otherwise rare HCV genotypes among hemodialysis patients, and longer history of hemodialysis as a predictor of HCV infection all indicate nosocomial transmission due to inappropriate infection control practices as the main transmission route.

Highlights

Patients on hemodialysis are at high risk for hepatitis C virus (HCV) infection if measures for effective control of HCV infection in the hemodialysis environment are not implemented
HCV Ribonucleic acid (RNA) was detected in 323/354 (91.2%) seropositive hemodialysis patients
The relatively low prevalence of HCV infection in the general Kosovar population, the significant increase in the anti-HCV prevalence among hemodialysis patients in recent years, the predominance of two otherwise rare HCV genotypes in the region, HCV infection associated with a longer duration of hemodialysis, and hemodialysis at more than one center indicate nosocomial transmission due to inappropriate infection control practices as the main HCV transmission route

Summary

Introduction

Patients on hemodialysis are at high risk for hepatitis C virus (HCV) infection if measures for effective control of HCV infection in the hemodialysis environment are not implemented. Up to 1% of the world’s population is estimated to be infected with HCV, corresponding to more than 71 million people with a viremic infection [3]. Most of the incident hepatitis C cases are due to acquisition and transmission among people that inject drugs, whereas in developing countries healthcare-associated transmission due to a poor standard of infection control and prevention remains the main route for HCV transmission [4, 5]. Patients on hemodialysis are at higher risk for HCV infection if measures for effective control of HCV infection in the hemodialysis environment are not implemented. Whereas in developed countries isolated small-scale HCV outbreaks in hemodialysis units are reported only occasionally, HCV transmission in the hemodialysis environment still represents a substantial problem in low-resource countries [7,8,9]

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Discussion

Conclusion