HCV-positive Hemodialysis Patients Research Articles

The transmission risk factors of hepatitis B and C infection in dental treating and tattooing among hemodialysis patients

For four decades, hepatitis often strikes hemodialysis (HD) patients. The seroprevalence of hepatitis infection in HD ranges from country to country. The study design of two parts, the first partisan estimate of the prevalence of hepatitis B virus (HBV) and hepatitis C virus (HCV) in Baghdad teaching hospital/departmentof HD, and the second part is an association between HBV, and HCV transmission and other suspected risk factors dental office and tattooing. A one hundred patients who underwent serum anti-HBC and anti-HCV examination at Baghdad teaching hospital/department of dialysis were enrolled in the study. The chemiluminescence assay has been used to test HBV and HCV antibodies, and an automated kinetic method was used for liver function tests. HCVAb was detected in thirty-five (35%) dialysis patients, and the total HBcAb and infection HBsAg were detected in five (5%) and zero (0%) respectively. No Co-infection was observed. Seroprevalence results related to transfusion requirement was 4 (7.4%) for total HBcAb, zero (0%) for HBsAg, and 32 (59.3%) for HCVAb. There was no significant difference between blood transfusion and non-transfusion in risk prevalence of total HBcAb and HBsAg, but the risk of HCV infection was significantly higher in the blood transfusion (p < 0.001). In the logit model analysis, the main risk factor for HCV infection in the entire sample was blood transfusion (OR = 20.8, 95% CI: 5.7-75.7, p < 0.001). The association between HCV transmission and risk behavior among patients that contribute its spread in society such as dental healthcare (DHC) (OR = 0.98, 95% CI: 0.925-1.615, p < 0.05) and tattoos (OR = 0.75, 95% CI: 0.503-1.119). A non-significant increase in alanine aminotransferase (ALT), aspartate aminotransferase (AST), and total bilirubin, while, non-significant decrease in albumin in HCV-positive hemodialysis patients compared with HCV-negative dialysis patients. Our findings indicate a high incidence of HCV virus infection in patients who received blood. However, no transmitting risk appeared from such patients when using dental tools or tattoos tools.

Treatment of hepatitis C infection among Egyptian hemodialysis patients: the dream becomes a reality.

New direct-acting antiviral drugs have become the corner-stone treatment for HCV infection: they show promising results with accepted side-effects and low dropout rates. One of the available regimens is paritaprevir/ombitasvir/ritonavir (PTV/OMV/RTV). Our aim was to study the efficacy and safety of this drug regimen among HCV-positive hemodialysis patients. This prospective single-center study was performed in the Urology and Nephrology Center, Mansoura University, Egypt. Ninety-six maintenance hemodialysis patients were screened for HCV antibodies. Positive results were found in 46 patients (47.9%). HCV PCR was assessed in all HCV-antibody-positive patients; positive results were found positive for 38 (82%); all patients were HCV genotype 4. Four patients were excluded due to advanced liver cirrhosis, liver malignancy, or metastatic breast cancer. Thirty-four patients were prescribed PTV/OMV/RTV for 3months to treat HCV. Mean age was 43.2 ± 11.9years. Most patients were male (67.6%). There was a rapid response to treatment: HCV PCR became negative by 4weeks after starting treatment. By 12 and 24weeks post-DAA therapy, there was a sustained viral response (SVR 12, SVR 24) in 100% of patients with improved liver-enzyme levels. The PTV/OMV/RTV regimen was safe and effectively treated Egyptian HCV-positive genotype-4 hemodialysis patients.

Prevalence of hepatitis C infection in hemodialysis patients: Report from 37 hemodialysis centers in Libya

Background/Aims: Data on the prevalence of hepatitis C virus (HCV) infection in Libya, and particularly among hemodialysis patients, are scarce. The aim of this study was to assess the prevalence of HCV infection among hemodialysis patients at 37 dialysis centers in Libya and review the demographic features in this group of patients. Patients and Methods: The present cross-sectional study included a total of 2325 patients who had spent at least 3 months in hemodialysis at 37 dialysis centers in different cities across the three main regions of Libya (Western, Eastern, and Southern regions). There were 1028 (44.2%) female and 1297 (55.8%) male with mean age 53.4 ± 15 years. Hypertension (36.4%), diabetes mellitus (33.3%), renal diseases (10.9%), genetic diseases (7.5%), and unclear reasons (12%) were diverse underlying causes of end-stage renal disease in these patients. Anti-HCV antibody was screened by a third-generation enzyme-linked immunosorbent assay technique. Results: The overall seroprevalence of HCV infection among hemodialysis patients in Libya was 16.7% (388/2325), ranging from 0% to 26.3% at different centers. The overall frequency of anti-HCV antibodies was higher in Western region (18.9%) than Eastern (18.3%) and Southern (6.1%) regions of Libya. It is noteworthy that the prevalence of HCV was 0% in numbers of dialysis centers across the three regions. The duration of hemodialysis was significantly longer in HCV-positive hemodialysis patients than in HCV-negative patients (P = 0.01). Hepatitis B surface antigen was positive in 92 hemodialysis patients (4%), of them 8 patients (8.7%) had coinfection with HCV infection. Conclusion: The present study showed an intermediate-prevalence rate of HCV infection among hemodialysis patients in Libya. The relatively low prevalence of HCV infection in the general Libyan population and HCV infection associated with a longer duration of hemodialysis indicate nosocomial transmission due to inappropriate infection control practices as the main HCV route of infection in these health-care settings.

Evaluation of hepcidin level in chronic hepatitis C Egyptian patients undergoing regular hemodialysis

BackgroundHepcidin, an acute phase reactant released from the liver, suppresses intestinal iron uptake and release from internal stores. It is related to pathogenesis of anemia of chronic illness including anemia of chronic renal failure which is considered a chronic inflammatory state as well as HCV infection. The main purpose of this study is to evaluate level of serum hepcidin and study the possible relations between serum hepcidin and markers of iron status in chronic hepatitis C Egyptian patients on regular hemodialysis.ResultsHepcidin was significantly elevated in hemodialysis patients than in control group [P < 0.01]. Levels of hemoglobin, hematocrit, ferritin, and iron were significantly elevated in HCV-positive hemodialysis patients than in HCV-negative hemodialysis patients [P < 0.001]. Hepcidin was non-significantly elevated in HCV-positive hemodialysis patients compared with HCV-negative hemodialysis patients. No significant correlations between hepcidin and any of the other studied parameters.ConclusionSerum hepcidin is elevated in hemodialysis patients than in control group, whereas hepcidin level is non-significantly elevated in HCV-positive hemodialysis patients compared with HCV-negative hemodialysis patients.

An Unbelievable Fact on “Dialysis Centers Without Hepatitis C Infection”

Hepatitis C virus (HCV) infection is the second viral cause for chronic liver disease (CLD) in the world and nearly 170 million people are infected worldwide (1, 2). The history of transfusion before 1992 (time of blood and blood products screening), illegal drug using, exposures among health care workers, unprotected multi-partner sexual contact, and chronic hemodialysis are known risk factors for HCV infection (3-5). HCV infection is a common infection in hemodialysis (HD) patients as well as dialysis centers (6). It is currently the major cause of CLD and mortality after kidney transplantation (7). Distribution of HCV infection among HD patients is not globally homogenous. We performed a multicenter study in Tehran in 2002 and the prevalence of HCV infection among HD patients was around 13% (8). We systematically reviewed all published and unpublished documents related to HCV infection prevalence in Iranian HD patients from April 2001 to March 2008 (9). Eighteen studies from 12 provinces (consisting of 49.02% of the total Iranian population) reported prevalence of HCV infection in Iranian HD patients. HCV infection prevalence in Iranian HD patients was 7.61% and showing that the burden has changed during the recent years (9). In 2006, we started a project for control of hepatitis C infection in dialysis patients (10). Iran Hepatitis Network (IHN), Ministry of Health and Medical Education (MOHME), many experts in hemodialysis and gastroenterology and infectious departments in many universities were involved in it in Iran. We presented main strategies for control of HCV infection in dialysis centers that consisted of: periodic screening of HCV in dialysis centers and reporting to MOHME for evaluation, distributing information to both patients and health staffs, training courses and congresses in various cities with more focus on the cities with higher HCV infection prevalence, treatment of HCV-positive patients with approved protocols, treatment according to a widely approved protocol, and putting HCV-positive HD patients in the top of waiting list for kidney transplantation (10). Changes in the epidemiology of HCV infection and decrease in the burden of liver diseases in HD patients has been reported according to the report of MOHME in Iran (11). The prevalence of HCV has decreased from 14.4% in 1999 to 4.5% in 2006 (11). Recently published articles of different centers from various parts of Iran showed the continuation of this burden decrease. Samimi-Rad et al. reported the prevalence of HCV antibody among HD patients around 5.0% in Yazd province and 5.4% in Markazi province (12, 13). Fortunately, the authors performed the molecular tests for all anti-HCV antibody-positive cases in their study. Zahedi et al. reported the prevalence of HCV antibody among HD patients around 7% in Kerman province (14) and Assarehzadegan et al. reported it 7.9% in Khuzestan province (15). In Zahedi et al. study, less than 50% of positive cases were HCV RNA-positive, meaning that less than 3.5% of their samples were HCV infected. I would like to mention that we should evaluate the epidemiology of HCV infection in addition to serological tests, using molecular tests such as RT-PCR, and ask the history of antiviral therapy in hemodialysis patients with anti-HCV Ab-positive results and consider the RT-PCR negative results as cured cases, not positive ones. This mistake might result in over-estimation of the prevalence of HCV infection in this high group. antiviral therapy; introduction of erythropoietin which has resulted in the decrease of transfusion needs; early transplantation; treatment of positive cases; training health staffs; and higher mortality of HD patient with HCV infection on hemodialysis. Finally, I would like to emphasize that we can imagine the “dialysis center without HCV” if we follow the standard infection precautions for control of HCV infection.

Long-Term Efficacy of Pegylated Interferon Alpha-2a in HCV-Positive Hemodialysis Patients

Hepatitis C virus (HCV) is prevalent in hemodialysis (HD) patients. The current "best therapy" for HCV-positive hemodialysis patients is not known. The aim of the present study was to evaluate the long-term efficacy of pegylated interferon (PEG-IFNalpha-2a) in HCV-positive hemodialysis (HD) patients. Twenty-five HCV-RNA-positive hemodialysis patients were included into the study. Twelve patients were allocated to the PEG-IFN treatment group (group 1). Six refused the therapy, and seven were not candidates for kidney transplantation and were allocated to the control group (group 2). All patients underwent chronic hemodialysis treatment for end-stage renal disease during the study period. Group 1 patients received PEG-IFN alpha-2a at a dose of 135 mug weekly for 48 weeks. The patients were prospectively followed up for a period of 192 weeks. Biochemical and virological responses were evaluated at 144 weeks after the completion of therapy. Results. Two patients in group 1 and five patients in group 2 died during 144 weeks of follow-up. SVR was observed in six patients (50%) in group 1 and one patient (1/13) (7.7%) in group 2. ALT levels were normal in 8/10 (80%) in group 1 and in 5/7 (70%) in group 2. In summary, our data showed that treatment of chronic HCV infection in dialysis patients with PEG-IFN alpha-2a at a dose of up to 135 mug weekly was well tolerated. Furthermore, SVR was achieved in half of patients at the end of 144 weeks of follow-up. Our results are encouraging for the administration of PEG-IFN alpha-2a in HCV-positive HD patients waiting for kidney transplantation.

Effects of hepatitis C virus infection on haematocrite and haemoglobin levels in Egyptian hemodialysis patients

Aim: Hepatitis C virus (HCV) infection is common among the Egyptians. This prevalence is higher among hemodialysis (HD) patients in whom anemia is a common finding. Recently, some case reports and few studies indicated that red cell status increased after hepatitis C viral infection among HD patients. The aim of our study is to investigate whether HCV-positive HD patients have higher hemoglobin (Hb) and hematocrit (HCT) values compared to HCV-negative patients. Methods: Ninety-nine chronic (HD) patients were the subject of this study. Their HCV status was determined by anti-HCV antibodies and confirmed with RNA polymerase chain reaction (PCR). Those with a history of blood transfusion or massive blood loss during the last 6 months were excluded from the study. Results: 70.7% of our patients tested positive for anti-HCV antibody (56.9 % were male). The mean age for HCV positive group was (40.41±14.17 years) while it was (47.35±19.18 years) for HCV negative group (P=0.08). HCV positive group has a longer hemodialysis duration (66.54 ± 43.92 months) compared to HCV negative patients (30.96±23.17 months, P=0.006). Mean Hb was similar in HCV-positive compared to HCV negative group (10.32±2.03 versus 10.22±1.52 gm/dl respectively) (P=0.63). Mean HCT values were also similar in both groups being 30.94± 6.089% in HCV positive versus 30.77± 4.53% in HCV negative group, respectively (P= 0.094). Fifty-five patients (39 HCV positive and 16 were HCV negative) received erythropoietin (EPO) therapy whilst only twenty patients received IV iron. Mean Erythropoietin dose was 5000±2236.06 Units/week in HCV- positive patients versus 6250±2720.29 Units /week in HCV - negative group (P=0.09). Liver function tests were normal except for alanine aminotransferase (ALT) that was significantly higher among HCV-positive compared to HCV-negative patients (31.75±36.4 vs 15.1±7.21 U/L, P=0.05). Conclusion: HCV-positive and HCV-negative Egyptian chronic hemodialysis patients have comparable hemoglobin as well as hematocrit levels and the erythropoietin dose was not influential as its lower value in HCV-positive patients did not reach a statistically significant level.

Significance of parenteral iron administration for HCV-positive hemodialysis patients

It is well recognized that parenteral iron administration is recommended for hemodialysis (HD) patients treated with rHuEPO. On the other hand, hepatic iron concentration increases in chronic hepatitis C, and iron reduction improves serum transaminase levels in these patients. We compared the rHuEPO doses with hematological parameters in HCV-positive (n = 7) and HCV-negative (n = 32) HD patients when parenteral low-dose iron was administered for one year (target ferritin level: 200-300 ng/ml, target hematocrit level: 30-33%). None of the parameters was significantly different between the groups at the start of the study. One year later, levels of hematocrit and serum ferritin significantly increased compared with those at the start in each group (HCV-positive group: 28.0 +/- 2.7-->31.3 +/- 1.5%, p < 0.01, 119.3 +/- 171.9-->303.3 +/- 77.7 ng/ml, p < 0.05, respectively, HCV-negative group: 26.8 +/- 2.2-->30.0 +/- 3.5%, p < 0.01, 69.8 +/- 100.5-->278.4 +/- 66.4 ng/ml, p < 0.01, respectively). Serum transaminase levels were not significantly different between the start and end points in the HCV-positive group, but 2 patients showed an increase in these levels. In the HCV-negative group, the rHuEPO dose at the end point was significantly reduced compared with that at the start (4,875 +/- 2,089-->4,031 +/- 2,203 IU/W, p < 0.05). In the HCV-positive group, however, it was difficult to reduce the rHuEPO dose in order to maintain the target hematocrit level (4,071 +/- 1,134-->3,857 +/- 1,464 IU/W, NS). We suggested that rHuEPO should be used together with parenteral iron administration, even in HCV-positive HD patients, because it is safe at low doses under careful observation.

New insights into the thrombopoietic status of patients on dialysis through the evaluation of megakaryocytopoiesis in bone marrow and of endogenous thrombopoietin levels

AbstractThe thrombopoietic status of patients with uremia remains unclear. This issue was addressed with particular reference to marrow megakaryocytopoiesis and endogenous thrombopoietin (TPO) levels. A study was conducted in 114 patients on hemodialysis, 43 patients on continuous ambulatory peritoneal dialysis, and 48 age-matched controls. Reticulated platelets, a marker of marrow megakaryocytopoiesis, were measured by flow cytometry. Serum TPO levels, platelet-associated IgG (PAIgG) levels, and hepatitis C virus (HCV) antibody titers were also measured by enzyme-linked immunosorbent assay. Circulating and reticulated platelet counts were significantly lower in the patients on dialysis than in the controls. Thrombocytopenia (less than 150 × 109/L) was most frequent in the HCV-positive hemodialysis patients, who had a higher incidences and higher PAIgG titers. The following results were obtained in the HCV-negative dialysis patients: (1) platelet counts chronologically decreased with years on hemodialysis; (2) platelet counts were associated with the reticulated platelet counts; (3) serum TPO levels were significantly elevated in the dialysis patients, responding to the decrease of reticulated platelets; (4) hematocrits had a positive correlation with serum TPO levels, and serum TPO levels were significantly higher in the patients on hemodialysis who did not require recombinant human erythropoietin therapy than in the other patients. In conclusion, thrombocytopenia is a frequent finding in patients on dialysis. The failure of megakaryocyte production could be the principal cause of the platelet reduction, and the peripheral destruction and sequestration of platelets may be concomitantly involved. Elevation of serum TPO may in part serve as an aid to erythropoiesis in dialysis patients.

Prevalence of subclinical cryoglobulinemia in maintenance hemodialysis patients and kidney transplant recipients.

We studied the prevalence and the clinical spectrum of cryoglobulinemia (Cryo) among 101 maintenance hemodialysis (HD) patients and 148 kidney transplant (KT) recipients, with or without chronic hepatitis C virus (HCV) infection. Cryo was present in 32% (16 of 50) of the HCV-positive HD patients, 5.9% (3 of 51) of the HCV-negative HD patients, 37.8% (28 of 74) of the HCV-positive KT recipients, and 27% (20 of 74) of the HCV-negative KT recipients. Cryoprecipitate in 56.3% (9 of 16) of the HCV-positive Cryo HD patients and 53.8% (14 of 26) of the HCV-positive Cryo KT recipients contained HCV-RNA. Interestingly, the cryocrit values among HD and KT patients were much lower than these in other reports on nonrenal failure cases. Also, the cryoglobulinemic syndrome (with purpura, arthralgia, etc.) in HD and KT patients with Cryo were not common (Tables 1 and 2). There was not correlation between Cryo and age,sex, and liver function. Only longer duration of end-stage renal disease was noted in these patients. In addition, we suggested that KT patients are more susceptible to having Cryo. Further studies are necessary to better define whether any other subclinical viral or nonviral chronic infection may induce Cryo in HCV-negative KT recipients.

Feasibility of interferon/ribavirin-combination therapy in HCV-positive hemodialysis patients

Feasibility of interferon/ribavirin-combination therapy in HCV-positive hemodialysis patients

Liver Disease Patterns in Hemodialysis Patients With Antibodies to Hepatitis C Virus

The present study correlated histopathology and diagnostic tests in hemodialysis patients with serologic markers for hepatitis C virus (HCY). Hepatitis C virus infection was found in 65 of 163 patients, as assessed by anti-c100-3 (ELISA 1), anti-c22-3, c33C (ELISA 2), and RIBA 2. Several histopathologic patterns were found in 33 liver samples from HCY-positive individuals: cirrhosis (n = 3), chronic active hepatitis (n = 14), chronic persistent hepatitis (n = 2), isolated hemosiderosis (n = 5), reactive hepatitis (n = 6), and others (n = 3). There was a positive correlation between time from the first aminotransferase peak and histologic damage (P = 0.015). However, the severity of liver disease did not correlate with the intensity of RIBA 2 positivity, mean levels or pattern of aminotransferases elevation, or markers of past hepatitis B virus infection. Moreover, aminotransferases were persistently normal in three patients with severe liver disease and were elevated in 10 patients with only mild changes. In 19 biopsied patients, the presence of plasma HCV RNA was examined by the polymerase chain reaction (PCR), which was positive in 15 of the 19 biopsy specimens. The ability of PCR positivity to predict the histologic severity of the disease was insufficient: four patients with minor liver damage had positive PCR and two patients with significant liver damage had negative PCR. No further correlations of PCR positivity were found with the other biochemical or immunologic markers of HCY infection. The present results suggest that (1) an elevated percentage of HCV-positive hemodialysis patients have severe histologic liver disease, which may not be suspected on clinical or biochemical grounds; (2) liver biopsy is the only method to accurately evaluate the degree of hepatic damage, and second-generation anti-HCV assays cannot be used as substitutes for liver biopsy; and (3) the presence of circulating HCV RNA cannot be predicted from other biochemical or serologic tests and is not significantly related to the severity of the histologic pattern.