Abstract
BackgroundIndividuals with end-stage renal disease have a higher risk of hepatitis C virus (HCV) acquisition during long-term hemodialysis (HD). Our report was designed to investigate HCV prevalence and genotype, in addition to the clinical use of HCV core antigen (HCVcAg), within multiple HD facilities in Thailand.MethodsThis cross‐sectional report was investigated between January and June 2019. HCV infection was assessed by anti-HCV and confirmed active infection by measuring HCV RNA and HCVcAg. HCV genotype was determined by phylogenetic analysis using nucleotide sequences of NS5B region.ResultsOverall, 140 of 3,305 (4.2%) patients in 15 dialysis centers had anti-HCV positive. Among them, HCV RNA was further assessed in 93 patients and was detectable in 59 (63.4%) persons. Considering HCV viremia, HCVcAg measurement exhibited high accuracy (96.8%), sensitivity (94.9%) and specificity (100%) in comparison with HCV RNA testing. Moreover, individuals infected with HCV received a longer duration of dialysis vintage when compared to anti-HCV negative controls. The major sub-genotypes were 1a, 1b, 3a, 3b, 6f and 6n. Regarding phylogenetic analysis, there were 7 clusters of isolates with high sequence homology affecting 17 individuals, indicating possible HCV transmission within the same HD centers.ConclusionsHCV frequency and common sub-genotypes in HD centers were different from those found in the Thai general population. HCVcAg might be an alternate testing for viremia within resource-limited countries. Enhanced preventive practices, dialyzer reuse policy and better access to antiviral therapy are crucial for HCV micro-elimination within HD facilities.
Highlights
Individuals with end-stage renal disease have a higher risk of hepatitis C virus (HCV) acquisition during long-term hemodialysis (HD)
Characteristics of the Participants Among 3,305 patients who were on chronic HD in the participating centers during the time of the study, 140 (4.2%) individuals were tested positive for anti-HCV antibodies
We showed that the prevalence of antiHCV antibodies among patients with end-stage renal disease (ESRD) was approximately 4.2%, which appeared to be similar to the report of the Renal Registry of Thailand (4%)[19] but was approximately 3 times higher than in the Thai general population with the same age group (1.5%) [3]
Summary
Individuals with end-stage renal disease have a higher risk of hepatitis C virus (HCV) acquisition during long-term hemodialysis (HD). Several extrahepatic manifestations have been shown to be associated to chronic HCV infection including insulin resistance, type 2 diabetes, cardiovascular diseases and chronic kidney disease (CKD) [4]. HCV-infected patients with CKD tend to have an accelerated rate of renal impairment leading to progressive end-stage renal disease (ESRD) and increased relatedcomplications [6]. With the advance of interferon-free direct-acting antivirals (DAAs), HCV therapy has been substantially changed as difficult-to-treat populations including patients with late-stage CKD could achieve sustained virological response (SVR) rates over 90% [7]. Current data have demonstrated that successful HCV antiviral therapy reduces the risk of cirrhosis and HCC and improves extrahepatic manifestations of HCV infection [7]
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