Abstract
It has recently been demonstrated that there is a very high prevalence of hepatitis C virus (HCV) infection among hemodialysis patients in Kosovo with HCV subtype 1 being the most prevalent subtype. In this study, we further detail the molecular epidemiology of HCV outbreaks occurring in seven dialysis centers in Kosovo. In total, 273 samples obtained from HCV RNA positive patients undergoing hemodialysis at one of the seven centers in Kosovo were selected for this study: 171 subtype 1a samples, 91 subtype 4d samples, and 11 subtype 1b samples. A partial HCV NS5B region was amplified and sequenced. Subtype-specific phylogenetic analyses were performed with the inclusion of control sequences and transmission clusters were identified. NS5B sequences were successfully obtained in 257/273 (94.1%) of samples; 162 subtype 1a, 84 subtype 4d, and 11 subtype 1b sequences. Phylogenetic analyses showed a high degree of phylogenetic clustering of HCV sequences subtyped 1a (99.4%), 1b (63.6%), and 4d (76.2%). Distinct phylogenetic clusters of sequences obtained from hemodialysis patients were observed for all three subtypes studied. In addition, several smaller clusters within the large clusters were identified, mainly from a single dialysis center. Phylogenetic analyses confirmed nosocomial transmission during dialysis as a major factor in the spread of HCV at the seven dialysis centers in Kosovo.
Highlights
It has recently been demonstrated that there is a very high prevalence of hepatitis C virus (HCV) infection among hemodialysis patients in Kosovo with HCV subtype 1 being the most prevalent subtype
Partial sequences of the HCV NS5B region were generated from 257/273 (94.1%) of samples obtained from dialysis patients: 162 HCV subtype 1a sequences, 84 subtype 4d sequences, and 11 subtype 1b sequences (Table 1)
87.0% (141/162) of subtype 1a sequences obtained from dialysis patients in Kosovo were part of a transmission cluster with approximate likelihood ratio test (aLRT) > 0.9 and 99.4% (161/162) of 1a sequences were found in clusters with aLRT > 0.8
Summary
It has recently been demonstrated that there is a very high prevalence of hepatitis C virus (HCV) infection among hemodialysis patients in Kosovo with HCV subtype 1 being the most prevalent subtype. We further detail the molecular epidemiology of HCV outbreaks occurring in seven dialysis centers in Kosovo. Methodology: In total, 273 samples obtained from HCV RNA positive patients undergoing hemodialysis at one of the seven centers in Kosovo were selected for this study: 171 subtype 1a samples, 91 subtype 4d samples, and 11 subtype 1b samples. Distinct phylogenetic clusters of sequences obtained from hemodialysis patients were observed for all three subtypes studied. Conclusions: Phylogenetic analyses confirmed nosocomial transmission during dialysis as a major factor in the spread of HCV at the seven dialysis centers in Kosovo. Prevention of HCV transmission in dialysis centers is of utmost importance because HCV positivity among patients on maintenance dialysis has been shown to be a significant independent risk factor for death, mainly due to liver and cardiovascular diseases [10]
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