Prevalence and Risk Factors of Overt and Occult Hepatitis C Virus Infection among Chronic Kidney Disease Patients under Regular Hemodialysis in Egypt

Abstract

Background: hepatitis C virus (HCV) infection is a major health problem. It is more prevalent among chronic kidney disease (CKD) patients. Occult HCV infection, a new, entity has been described. Aims: to find out prevalence of occult HCV infection among CKD patients under regular hemodialysis (RHD) and to define epidemiology of HCV infection among them. Patients and Methods: a sample of 100 CKD patients under RHD was recruited. A questionnaire form was used to collect data. HCV-RNA was tested in serum to detect overt HCV infection patients. HCV-RNA was tested in peripheral blood mononuclear cells of undetected HCV-RNA patients’ serum to determine those with occult HCV infection. Rest of the patients was considered HCV free. Biochemical tests were done to all patients. Results: prevalence of overt and occult HCV infection among CKD patients under RHD was 34.0% and 27.3%, respectively. Liver and renal function tests were significantly higher among the overt and occult HCV patients compared to negative HCV patients. Liver function tests were significantly lower among the occult compared to overt HCV patients. Overt HCV patients had significant risk factors compared to negative HCV patients; age group 40-59 years (OR=9.34) and rural residence (OR=3.14). Also, significant clinical risk factors were the overweight, history of blood transfusion ≥5 times/year, history of nonmedical bloody manipulations, and history of IV drug abuse (OR=3.23, 5.96, 8.28, 7.08, respectively). Occult HCV patients had significant risk factors compared to negative HCV patients; age group ≥60 years and rural residence (OR=6.25 and 6.73, respectively). Significant clinical risk factor was the history of nonmedical bloody manipulations (OR=11.5). Conclusions and Recommendations: prevalence of overt- and occult HCV infection is high in CKD patients under RHD; this has important clinical and public health implications. There are many significant socio-demographic and clinical risk factors for these infections. A close monitoring of the HD patients and testing them for HCV-RNA in PBMCs yearly to adopted a proper management. Also, more studies on bigger number of patients are required to understand real epidemiology of this health problem.