The incidence and prevalence of HCV among dialysis patients varies markedly from country to country and among dialysis centers within a single country. HCV prevalence is much higher in developing countries as compared to developed world. First paper in Pakistan in this line of literature was published in 1999 and till yet six different reports consisting of small sample size (ranging from 28-190) showed that an HCV percent prevalence of 26.02% among the HD population, rate of Prevalence become high in past as compared to recent studies. The prevalence rate of HCV in this study from Khyber Pakhtunkhwa stated that HCV infection was persistent public health concern in dialysis patients. This study comprised high prevalence rate might be due to large sample size as compared to rest of all.
A panel of 30 top gastroenterologists of the country met in 2004 at a conference and reported that 75%-90% of HCV Pakistani patients were harboring genotype 3a, followed by genotype 1, also confirmed in current and in other different Pakistani population.
The prevalence was higher among the males. High prevalence in male as compared to female could be due to their exposure to various HCV risk factors particularly barber community and multiple sexual exposures. In current study 3 was more prevalent in females and 1 in male, as stated in a study that genotype 1 was more common in male as compared to females. For HCV prevalence and genotype distribution statistically no significant difference was found between male (57.14%) and female patients, verified by other study. Old age groups were found more infected with HCV. It has been suspected that fragile health structure, unsterilized instruments and use of contaminated razor by barbers may be contributing to the spread of HCV.
Blood transfusion(s) constitute a part of treatment in many HD patients and thus exposed greatly to HCV [2,14,29]. The risk of hepatitis transmission through blood transfusion is considered to be high in Pakistani population due to a lack of appropriate screening of blood in past. Several studies confirmed the prevalence of HCV among people with a history of blood transfusion before the advent of blood screening procedures in Pakistan. Percentage prevalence of HCV was 4.95% ± 0.53% in the general adult population and 7.94 ± 1.49% in multi transfused population. The prevalence found in this study (75%) was greater than that estimated for general adult population in the country. The multitransfused patients in this study was more prone to HCV, also supported by various studies but could not recognizes as independent risk factor in other studies.
Needle sharing and household contacts were not significant risk factors in this study, similar to other literature. There is an indication that environment of dialysis treatment itself function as a vehicle in dissemination of HCV among HD patients. A high prevalence of patients with HCV infection in HD facilities has been considered a risk factor for transmission of the infection. Several reports have linked a high incidence of HCV infection in dialysis patients who shared dialysis machines in dialysis unit.