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Abstract
Hepatitis C virus (HCV) infection is a major concern in hemodialysis (HD) units due to its high prevalence and the associated morbidity and mortality. We carried out a cross-sectional study to evaluate the incidence and potential risk factors of seroconversion to anti-HCV positivity in a group of patients on maintenance HD at a tertiary hospital in Cameroon. Patients on HD for at least 3 months with a negative baseline serology for anti-HCV antibodies tested with a third -generation ELISA were included. The study period was March and April 2010. Serological testing was done with a third- generation ELISA (Monolisa anti-HCV plus version 2, Biorad). Relevant patient data was noted. The percentage of seroconverts to anti-HCV positivity was noted and factors associated with seroconversion sought for. Standard statistical tests were used for analysis. A p-value<0.05 was used to characterize statistically significant results. A total of 40 patients (70% males) were elligible. The mean age was 48±13yrs, median duration on dialysis = 17 months (IQR12-25.7), median number of blood units transfused=5 (IQR 3-18.5). Ten of the 40 developed anti-HCV antibodies on dialysis (cumulative incidence rate 25%). A longer duration on dialysis (14 vs. 27 months, p=0.003); and a higher number of blood units received (19.5 vs. 5 units, p<0.001) were significantly associated with seroconversion. The cumulative seroconversion rate of HCV antibodies is very high in this study when compared to western countries. Blood transfusions and the non-adherence to universal infection control measures appear to be the main determinants of this nosocomial infection.
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References
- Kalantar-Zadeh K, Kilpatrick RD, McAllister CJ, et al. Hepatitis C virus and death risk in hemodialysis patients. J. Am Soc; Nephrol 2007; 18:1584-1593
- Nakayama E, Akiba T, Marumo F, Sato C. Prognosis of anti-hepatitis C virus antibody- positive patients on regular hemodialysis therapy. J. Am. Soc. Nephrol 2000; 11: 1896-1902
- Pereira BJ, Natov SN, Bouthot BA, et al. Effects of hepatitis C infection and renal transplantation on survival in end-stage renal disease. The New England Organ bank hepatitis C study group. Kidney Int 1998; 53:1374-1381
- Stehman-Breen CO, Emerson S, Gretch D, Johnson RJ. Risk of death among chronic dialysis patients infected with hepatitis C virus. Am J Kidney Dis 1998; 32: 629-634
- Fissell R, Bragg-Gresham J, Woods J, et al. Patterns of hepatitis C prevalence and seroconversion in hemodialysis units from three continents: The DOPPS Kidney Int 2004; 65:2335- 2342
- Jadoul M, Poignet JL, Geddes C, et al. The changing epidemiology of hepatitis C virus (HCV) infection in hemodialysis: European multicenter study. Nephrol. Dial. Transplant 2004; 19(4): 904-909
- Seyed-Moayed Alavian. A shield against a monster: Hepatitis C in hemodialysis Patients. World J.Gastroenterol 2009; 15(6): 641-646
- Jadoul M. Epidemiology and mechanisms of transmission of the hepatitis C virus in hemodialysis. Nephrol Dial Transplant 2000; 15 (suppl 8): 39-46
- Ayed K, Gorgi Y, Ben Abdallah, et al. Hepatitis C virus infection in hemodialysis patients from Tunisia: national survey by serological and molecular methods. Transplant Proc 2003 ; 35: 2573-2575
- Izopet J, Sandres-Saune K, Kamar N, et al. Incidence of HCV infection in French hemodialysis centers: a prospective study. J Med Virol 2005; 77: 70-76
- Taskapen H, Oymak O, Dogukan A, Utas C. Patient to patient transmission of hepatitis C virus in hemodialysis units. Clin Nephrol 2001; 55: 477-481
- Agarwal SK, Dash SC, Gupta S, Pandey RM. Hepatitis C virus infection in hemodialysis: the ‘no isolation’ policy should not be generalized. Nephron Clin Pract 2009; 111: c 133-c140
- El-Amin H.H, Osman E M, Mekki MO, et al. Hepatitis C virus infection in hemodialysis patients in Sudan: Two centers’ study. Saudi J kidney Dis Transplant 2007; 18(1): 101-106
- Hmaied F Ben Mamou M, Saune-Sandres K, Rostaing L, et al. Hepatitis virus infection among dialysis patients in Tunisia: incidence and molecular evidence for nosocomial transmission. J.Med. Virol 2006: 78: 185-191
- Chen Yuqiang, Wang Niansong, Sheng Xiaohua, et al. Hepatitis C virus infection in uremic patients on maintenance hemodialysis: A follow up study for 150 months. Afr. J. Microbiol. Res 2011; 5(22): 3677-3683
- Salama G, Rostang L, Sandres K, Rostaing Izopet J. Hepatitis C virus infection in French hemodialysis units: A multicenter study. J Med Virol 2000; 61: 44-51
- Hardy NM, Sandroni S, Danielson S, et al. Antibody to hepatitis C virus increases with time on hemodialysis. Clin.Nephrol 1992; 38:44-48
- Jadoul M, Cornu C, Van Ypersele de Strihou C and the UCL Collaborative Group. Universal precautions prevent hepatitis C virus transmission: a 54 month follows up of the Belgian Multicenter Study. Kidney Int 1998 ; 53(4): 1022-1025
- Pujol F.H., Ponce JG, Lema MG, et al. High incidence of hepatitis C virus infection in hemodialysis patients in units with high prevalence. J. Clin Microbiol 1996; 34:1663-1666
- Hinrichsen H, Leimenstoll G, Stegen G, et al. Prevalence of and risk factors for hepatitis C infection in hemodialysis patients: A multicentre study in 2796 patients. Gut 2002; 51: 429-433
- Petrosillo N, Gilli P, Serraino D, et al. Prevalence of infected patients and understaffing has a role in hepatitis C virus transmission in dialysis. Am J Kidney Dis 2001; 37: 1004-1010
- Arenas MD, Sanchez-Paya J, Barril G, et al. A multicentric survey of the practice of hand hygiene in haemodialysis units: factors affecting compliance. Nephrol Dial Transplant 2003; 2:1164-1171,
- Espinosa M, Martn-Malo A, Ojeda R, Santamara R, Soriano S. Marked reduction in the prevalence of hepatitis C virus infection in hemodialysis patients: causes and consequences. Am J. Kidney. Dis 2004; 43(4): 685-689
- Barril G, Traver JA. Decrease in the hepatitis C virus (HCV) prevalence in hemodialysis patients in Spain: effect of time, initiating HCV prevalence studies and adoption of isolation measures. Antiviral Res 2003; 60: 129-134
- S.K. Agarwal. Hemodialysis of Patients with HCV Infection: Isolation has a Definite Role. Nephron Clin Pract 2011; 117: c328-c332
- Center for Disease Control and prevention. Recommendations for preventing transmission of infections among chronic hemodialysis patients. MMWR. Recomm. Rep 2001; 50:1-43
- Jadoul M, Cornu C, Van Ypersele de Strihou C and the UCL Collaborative Group. Incidence and risk factors for hepatitis C seroconversion in hemodialysis. A prospective study. Kidney Int 1993; 44:1322-1326
- Jadoul M. Transmission routes of HCV infection in dialysis. Nephrol Dial Transplant 1996; 11 (suppl 4): S36-S38
- Ginou E, Chevaliez S, Challine D et al Determinant role of environmental contamination and noncompliance to standard precautions in the risk of hepatitis C virus transmission in a Hemodialysis Unit. Clin Infect Dis. 2008; 47(5): 627-633
- Saxena AK, Panhotra BR. The impact of nurse understaffing on the transmission of hepatitis C virus ina hospital -based hemodialysis Unit. Med Princ Pract. 2004; 13(3):129-135
- Khan S, Attanllah S, Ali I, et al. Rising burden of Hepatitis C virus in hemodialysis. Virology journal 2011; 8: 438 Doi: 10.1186/1743-422X-8-438
- Soliman A, Abd Elaziz M, El Lawindi M. Evaluation of an isolation program of Hepatitis C virus infected Hemodialysis patients in some hemodialysis centers in Egypt. ISRN Nephrology Volume 2013 Article ID 395467, 5 pages. doi.org/10.5402/2013/395467.
- Caramelo C, de Sequera P, Lopez MD, Ortiz A. Hand borne mechanisms of dissemination of hepatitis C virus in dialysis units: basis for new addenda to the present preventive strategies. Clin Nephrol 1999; 51: 59-60
- Alfurayh O, Sabeel A, Al Ahdal MN, et al. Hand contamination with hepatitis C virus in staff looking after hepatitis C-positive hemodialysis patients. Am. J Nephrol 2000; 20: 103-106, 2000.
- Valtuile R, Moretto H, Lef L, Rendo P, Fernandez JL. Decline of high hepatitis C virus prevalence in a hemodialysis unit with no isolation measures during a 6-year follow up. Clin Nephrol 2002; 57: 371-375
- Madhava V, Burgess C, Drucker E. Epidemiology of chronic hepatitis C virus infection in sub-Saharan Africa. Lancet Infect Dis 2002; 2: 293-302
- Mbanya D, Binam F, Kaptue L. Transfusion outcome in a resource limited setting in Cameroon: a five-year evaluation. Int. J Infect Dis 2001; 5(2): 70-73
- Bello B.T, Raji Y.R, Sanusi I, Braimoh R.W, Amira O.C, Mabayoje O.M. Challenges of providing maintenance hemodialysis in a resource poor country-Experience from a single teaching hospital in Lagos, Southwest Nigeria.
- Hemodialysis International 2013; Feb.3 doi:10.1111/hdi.12024
- El-Ottol A, Elmanama A, Ayesh B. Prevalence and risk factors of Hepatitis B and C viruses among hemodialysis patients in Gaza Strip, Palestine. Virology Jounal 2010; 7:210
- Saraladevi Naicker. The Burden of End-stage renal disease in sub-Saharan. Nephrol 2010; 74(suppl. 1): S13-S16
- Njouom R, Pasquier C, Ayouba A, et al. Hepatitis C virus infection among pregnant women in Yaounde, Cameroon: Prevalence, viremia, and genotypes. J Med Virol 2003; 69(3):384-390
- Khodir S, Alghateb M, Okasha K, El-Saed Shalaby S. Prevalence of HCV infections among Hemodialysis Patients in Al Gharbiyah Governate, Egypt. Arab Journal of Nephrology and Transplantation 2012; 5(3):145-147
- Arenas MD, Sanchez–Paya J. Standard precautions in hemodialysis: the gap between theory and practice. Nephrol Dial Transplant 1999; 14: 823-825
- Dussol B, Chicheporhche C, Cantaloube JF. Detection of Hepatitis C infection by Polymerase Chain Reaction among Hemodialysis patients. Am J Kidney Dis 1993; 22: 574-580
- Donahue JG, Munoz A, Ness PM, et al. The declining risk of post-transfusional hepatitis C virus infection. N Engl J Med 1992; 327: 369-373
- Diffo C. ‹Prévalence des hépatites B, C et co-infection avec le VIH chez les hémodialysés chronique de l’Hôpital General de Douala›. MD thesis, Faculty of Medicine & Biomedical Sciences, University of Yaounde 1, 2003
- Kidney Disease: Improving Global Outcomes. KDIGO Clinical Practice Guidelines for Prevention, diagnosis, evaluation and treatment of Hepatitis C in Chronic Kidney Disease. Kidney Int 2008; 73(Suppl. 109): S1-S99
- Baccari M, Rizzolo L, Ottolenghi A, Sorgato G. Hepatitis C virus screening strategies in Hemodialysis Units. Nephrol Dial Transplant 2002; 17: 1536
- Fabrizi F, Martin P. Occult Hepatitis C virus infection in Hemodialysis. J Am Soc. Nephrol 2010; 19: 2248-2250
References
Kalantar-Zadeh K, Kilpatrick RD, McAllister CJ, et al. Hepatitis C virus and death risk in hemodialysis patients. J. Am Soc; Nephrol 2007; 18:1584-1593
Nakayama E, Akiba T, Marumo F, Sato C. Prognosis of anti-hepatitis C virus antibody- positive patients on regular hemodialysis therapy. J. Am. Soc. Nephrol 2000; 11: 1896-1902
Pereira BJ, Natov SN, Bouthot BA, et al. Effects of hepatitis C infection and renal transplantation on survival in end-stage renal disease. The New England Organ bank hepatitis C study group. Kidney Int 1998; 53:1374-1381
Stehman-Breen CO, Emerson S, Gretch D, Johnson RJ. Risk of death among chronic dialysis patients infected with hepatitis C virus. Am J Kidney Dis 1998; 32: 629-634
Fissell R, Bragg-Gresham J, Woods J, et al. Patterns of hepatitis C prevalence and seroconversion in hemodialysis units from three continents: The DOPPS Kidney Int 2004; 65:2335- 2342
Jadoul M, Poignet JL, Geddes C, et al. The changing epidemiology of hepatitis C virus (HCV) infection in hemodialysis: European multicenter study. Nephrol. Dial. Transplant 2004; 19(4): 904-909
Seyed-Moayed Alavian. A shield against a monster: Hepatitis C in hemodialysis Patients. World J.Gastroenterol 2009; 15(6): 641-646
Jadoul M. Epidemiology and mechanisms of transmission of the hepatitis C virus in hemodialysis. Nephrol Dial Transplant 2000; 15 (suppl 8): 39-46
Ayed K, Gorgi Y, Ben Abdallah, et al. Hepatitis C virus infection in hemodialysis patients from Tunisia: national survey by serological and molecular methods. Transplant Proc 2003 ; 35: 2573-2575
Izopet J, Sandres-Saune K, Kamar N, et al. Incidence of HCV infection in French hemodialysis centers: a prospective study. J Med Virol 2005; 77: 70-76
Taskapen H, Oymak O, Dogukan A, Utas C. Patient to patient transmission of hepatitis C virus in hemodialysis units. Clin Nephrol 2001; 55: 477-481
Agarwal SK, Dash SC, Gupta S, Pandey RM. Hepatitis C virus infection in hemodialysis: the ‘no isolation’ policy should not be generalized. Nephron Clin Pract 2009; 111: c 133-c140
El-Amin H.H, Osman E M, Mekki MO, et al. Hepatitis C virus infection in hemodialysis patients in Sudan: Two centers’ study. Saudi J kidney Dis Transplant 2007; 18(1): 101-106
Hmaied F Ben Mamou M, Saune-Sandres K, Rostaing L, et al. Hepatitis virus infection among dialysis patients in Tunisia: incidence and molecular evidence for nosocomial transmission. J.Med. Virol 2006: 78: 185-191
Chen Yuqiang, Wang Niansong, Sheng Xiaohua, et al. Hepatitis C virus infection in uremic patients on maintenance hemodialysis: A follow up study for 150 months. Afr. J. Microbiol. Res 2011; 5(22): 3677-3683
Salama G, Rostang L, Sandres K, Rostaing Izopet J. Hepatitis C virus infection in French hemodialysis units: A multicenter study. J Med Virol 2000; 61: 44-51
Hardy NM, Sandroni S, Danielson S, et al. Antibody to hepatitis C virus increases with time on hemodialysis. Clin.Nephrol 1992; 38:44-48
Jadoul M, Cornu C, Van Ypersele de Strihou C and the UCL Collaborative Group. Universal precautions prevent hepatitis C virus transmission: a 54 month follows up of the Belgian Multicenter Study. Kidney Int 1998 ; 53(4): 1022-1025
Pujol F.H., Ponce JG, Lema MG, et al. High incidence of hepatitis C virus infection in hemodialysis patients in units with high prevalence. J. Clin Microbiol 1996; 34:1663-1666
Hinrichsen H, Leimenstoll G, Stegen G, et al. Prevalence of and risk factors for hepatitis C infection in hemodialysis patients: A multicentre study in 2796 patients. Gut 2002; 51: 429-433
Petrosillo N, Gilli P, Serraino D, et al. Prevalence of infected patients and understaffing has a role in hepatitis C virus transmission in dialysis. Am J Kidney Dis 2001; 37: 1004-1010
Arenas MD, Sanchez-Paya J, Barril G, et al. A multicentric survey of the practice of hand hygiene in haemodialysis units: factors affecting compliance. Nephrol Dial Transplant 2003; 2:1164-1171,
Espinosa M, Martn-Malo A, Ojeda R, Santamara R, Soriano S. Marked reduction in the prevalence of hepatitis C virus infection in hemodialysis patients: causes and consequences. Am J. Kidney. Dis 2004; 43(4): 685-689
Barril G, Traver JA. Decrease in the hepatitis C virus (HCV) prevalence in hemodialysis patients in Spain: effect of time, initiating HCV prevalence studies and adoption of isolation measures. Antiviral Res 2003; 60: 129-134
S.K. Agarwal. Hemodialysis of Patients with HCV Infection: Isolation has a Definite Role. Nephron Clin Pract 2011; 117: c328-c332
Center for Disease Control and prevention. Recommendations for preventing transmission of infections among chronic hemodialysis patients. MMWR. Recomm. Rep 2001; 50:1-43
Jadoul M, Cornu C, Van Ypersele de Strihou C and the UCL Collaborative Group. Incidence and risk factors for hepatitis C seroconversion in hemodialysis. A prospective study. Kidney Int 1993; 44:1322-1326
Jadoul M. Transmission routes of HCV infection in dialysis. Nephrol Dial Transplant 1996; 11 (suppl 4): S36-S38
Ginou E, Chevaliez S, Challine D et al Determinant role of environmental contamination and noncompliance to standard precautions in the risk of hepatitis C virus transmission in a Hemodialysis Unit. Clin Infect Dis. 2008; 47(5): 627-633
Saxena AK, Panhotra BR. The impact of nurse understaffing on the transmission of hepatitis C virus ina hospital -based hemodialysis Unit. Med Princ Pract. 2004; 13(3):129-135
Khan S, Attanllah S, Ali I, et al. Rising burden of Hepatitis C virus in hemodialysis. Virology journal 2011; 8: 438 Doi: 10.1186/1743-422X-8-438
Soliman A, Abd Elaziz M, El Lawindi M. Evaluation of an isolation program of Hepatitis C virus infected Hemodialysis patients in some hemodialysis centers in Egypt. ISRN Nephrology Volume 2013 Article ID 395467, 5 pages. doi.org/10.5402/2013/395467.
Caramelo C, de Sequera P, Lopez MD, Ortiz A. Hand borne mechanisms of dissemination of hepatitis C virus in dialysis units: basis for new addenda to the present preventive strategies. Clin Nephrol 1999; 51: 59-60
Alfurayh O, Sabeel A, Al Ahdal MN, et al. Hand contamination with hepatitis C virus in staff looking after hepatitis C-positive hemodialysis patients. Am. J Nephrol 2000; 20: 103-106, 2000.
Valtuile R, Moretto H, Lef L, Rendo P, Fernandez JL. Decline of high hepatitis C virus prevalence in a hemodialysis unit with no isolation measures during a 6-year follow up. Clin Nephrol 2002; 57: 371-375
Madhava V, Burgess C, Drucker E. Epidemiology of chronic hepatitis C virus infection in sub-Saharan Africa. Lancet Infect Dis 2002; 2: 293-302
Mbanya D, Binam F, Kaptue L. Transfusion outcome in a resource limited setting in Cameroon: a five-year evaluation. Int. J Infect Dis 2001; 5(2): 70-73
Bello B.T, Raji Y.R, Sanusi I, Braimoh R.W, Amira O.C, Mabayoje O.M. Challenges of providing maintenance hemodialysis in a resource poor country-Experience from a single teaching hospital in Lagos, Southwest Nigeria.
Hemodialysis International 2013; Feb.3 doi:10.1111/hdi.12024
El-Ottol A, Elmanama A, Ayesh B. Prevalence and risk factors of Hepatitis B and C viruses among hemodialysis patients in Gaza Strip, Palestine. Virology Jounal 2010; 7:210
Saraladevi Naicker. The Burden of End-stage renal disease in sub-Saharan. Nephrol 2010; 74(suppl. 1): S13-S16
Njouom R, Pasquier C, Ayouba A, et al. Hepatitis C virus infection among pregnant women in Yaounde, Cameroon: Prevalence, viremia, and genotypes. J Med Virol 2003; 69(3):384-390
Khodir S, Alghateb M, Okasha K, El-Saed Shalaby S. Prevalence of HCV infections among Hemodialysis Patients in Al Gharbiyah Governate, Egypt. Arab Journal of Nephrology and Transplantation 2012; 5(3):145-147
Arenas MD, Sanchez–Paya J. Standard precautions in hemodialysis: the gap between theory and practice. Nephrol Dial Transplant 1999; 14: 823-825
Dussol B, Chicheporhche C, Cantaloube JF. Detection of Hepatitis C infection by Polymerase Chain Reaction among Hemodialysis patients. Am J Kidney Dis 1993; 22: 574-580
Donahue JG, Munoz A, Ness PM, et al. The declining risk of post-transfusional hepatitis C virus infection. N Engl J Med 1992; 327: 369-373
Diffo C. ‹Prévalence des hépatites B, C et co-infection avec le VIH chez les hémodialysés chronique de l’Hôpital General de Douala›. MD thesis, Faculty of Medicine & Biomedical Sciences, University of Yaounde 1, 2003
Kidney Disease: Improving Global Outcomes. KDIGO Clinical Practice Guidelines for Prevention, diagnosis, evaluation and treatment of Hepatitis C in Chronic Kidney Disease. Kidney Int 2008; 73(Suppl. 109): S1-S99
Baccari M, Rizzolo L, Ottolenghi A, Sorgato G. Hepatitis C virus screening strategies in Hemodialysis Units. Nephrol Dial Transplant 2002; 17: 1536
Fabrizi F, Martin P. Occult Hepatitis C virus infection in Hemodialysis. J Am Soc. Nephrol 2010; 19: 2248-2250