High prevalence of Hepatitis C virus (HCV) has been reported among the dialysis patients throughout the world. No serious efforts were taken to investigate HCV in patients undergoing hemodialysis (HD) treatment who are at great increased risk to HCV. HCV genotypes are important in the study of epidemiology, pathogenesis and reaction to antiviral therapy. This study was performed to investigate the prevalence of active HCV infection, HCV genotypes and to assess risk factors associated with HCV genotype infection in HD patients of Khyber Pakhtunkhwa as well as comparing this prevalence data with past studies in Pakistan.
Methods
Polymerase chain reaction was performed for HCV RNA detection and genotyping in 384 HD patients. The data obtained was compared with available past studies from Pakistan.
Results
Anti HCV antibodies were observed in 112 (29.2%), of whom 90 (80.4%) were HCV RNA positive. In rest of the anti HCV negative patients, HCV RNA was detected in 16 (5.9%) patients. The dominant HCV genotypes in HCV infected HD patients were found to be 3a (n = 36), 3b (n = 20), 1a (n = 16), 2a (n = 10), 2b (n = 2), 1b (n = 4), 4a (n = 2), untypeable (n = 10) and mixed (n = 12) genotype.
Conclusion
This study suggesting that i) the prevalence of HCV does not differentiate between past and present infection and continued to be elevated ii) HD patients may be a risk for HCV due to the involvement of multiple routes of infections especially poor blood screening of transfused blood and low standard of dialysis procedures in Pakistan and iii) need to apply infection control practice.
Introduction
Hepatitis C virus (HCV) infection is a major public health problem, with an estimated global prevalence of 3% occurring in about 180 million carriers and approximately 4 million people have been newly infected annually. The prevalence of HCV infection among dialysis patients is generally much higher than healthy blood donors and general population. Studies held in dialysis centers from different countries revealed that prevalence ranges form 1-84.6% and there is a particular concern because HCV chronic infection causes significant morbidity and mortality among patients undergoing hemodialysis (HD).
In Pakistan currently, approximately 10 million people are suffering from this tremendous disease which cover 6% of the overall population. A high prevalence of HCV Ab (38% weighted average) was described in the studies of patients undergoing chronic dialysis in Pakistan. The spread of HCV in Pakistan is fuelled due to lack of education and awareness of disease, shortage of medically qualified and scientifically trained health care workers especially dentists, lack of health infrastructure such as use unsterilized instruments, use of high numbers of therapeutic injections and practice of daily face and armpit shaving in community barber shops. New HCV infection was evidently more frequent at dialysis centers with higher anti-HCV prevalence and failure in infection control measures. In some countries, both prevalence and incidence remain very high, indicating major ongoing nosocomial transmission, probably due to the limited resources available to treat a rapidly growing HD population.