Abstract
Background: Hemodialysis [HD] patients are more prone to blood-borne viruses, such as hepatitis B virus [HBV], hepatitis C virus [HCV], and, to a lesser extent, Human Immunodeficiency Virus [HIV]. Chronic HBV and HCV infections are associated with liver cirrhosis, hepatocellular carcinoma, and early graft failure after kidney transplantation. As there was no recent information, this study aimed to evaluate the prevalence of HBV, HCV, and HIV infection in HD patients in Fars province, southern Iran. This could help health policymakers to run more effective infection control practices for reducing such blood-borne virus infections, if necessary.
Methods: This cross-sectional study was performed on 906 HD patients in Fars province, southern Iran. A total of 906 blood samples were obtained from patients and diagnostic tests of HBV, HCV, and HIV were done. Demographic data and some other information, such as duration of dialysis, were extracted from the patients’ medical records. Data were analyzed in SPSS, version 18.
Results: Out of the patients enrolled in the study, 547 [60.4%] were male and 359 [39.6%] female. The mean ± SD age of the patients was 58.0 ± 15.8 years. The prevalence of HBV, HCV, and HIV infection was 0.88%, 0.55% and 0.44%, respectively. HIV-infected subjects were significantly younger than the HIV-negative group [P <0.017].
Conclusion: It seems that Fars is among the provinces with low HBV and HCV prevalence in HD patients in comparison to other provinces of Iran. On the other hand, HIV prevalence here is higher than other provincial studies. Strict adherence to preventive infection control measures is recommended in HD centers.
Keywords: HIV, hepatitis B virus, hepatitis C virus, hemodialysis, Iran, prevalence, ESRD, adult.
Graphical Abstract
[1]
Santos MG, Danguilan R, Que ET, Balmaceda RP, Padilla BS. Prevalence of hepatitis B and hepatitis C in haemodialysis patients. 1998; pp. 101-4.
[2]
Elamin S, Abu-Aisha H. Prevention of hepatitis B virus and hepatitis C virus transmission in hemodialysis centers: review of current international recommendations. Arab J Nephrol Transplant 2011; 4(1): 35-47.
[http://dx.doi.org/10.4314/ajnt.v4i1.63154] [PMID: 21469594]
[http://dx.doi.org/10.4314/ajnt.v4i1.63154] [PMID: 21469594]
[3]
Rotter M, Mayhall C. Hospital epidemiology and infection controlHandwashing and Hand Disinfection: Lippincott Williams Wilkins Philadelphia. 1999; pp. 1339-55.
[4]
Stanaway JD, Flaxman AD, Naghavi M, Fitzmaurice C, Vos T, Abubakar I, et al. The global burden of viral hepatitis from 1990 to 2013: findings from the Global Burden of Disease Study 2013. The Lancet 2016; 388: 1081-8.
[5]
Lavanchy D. Worldwide epidemiology of HBV infection, disease burden, and vaccine prevention. J Clin Virol 2005; 34(Suppl. 1): S1-3.
[http://dx.doi.org/10.1016/S1386-6532[05]00384-7] [PMID: 16461208]
[http://dx.doi.org/10.1016/S1386-6532[05]00384-7] [PMID: 16461208]
[6]
Manns MP, Buti M, Gane E, et al. Hepatitis C virus infection. Nat Rev Dis Primers 2017; 3: 17006.
[http://dx.doi.org/10.1038/nrdp.2017.6] [PMID: 28252637]
[http://dx.doi.org/10.1038/nrdp.2017.6] [PMID: 28252637]
[7]
Ribot S, Rothstein M, Goldblat M, Grasso M. Duration of hepatitis B surface antigenemia [HBs Ag] in hemodialysis patients. Arch Intern Med 1979; 139(2): 178-80.
[http://dx.doi.org/10.1001/archinte.1979.03630390036015] [PMID: 434972]
[http://dx.doi.org/10.1001/archinte.1979.03630390036015] [PMID: 434972]
[8]
Gomaa AI, Khan SA, Toledano MB, Waked I, Taylor-Robinson SD. Hepatocellular carcinoma: epidemiology, risk factors and pathogenesis World journal of gastroenterology: WJG 2008.
[http://dx.doi.org/10.3748/wjg.14.4300]
[http://dx.doi.org/10.3748/wjg.14.4300]
[9]
Fabrizi F, Takkouche B, Lunghi G, Dixit V, Messa P, Martin P. The impact of hepatitis C virus infection on survival in dialysis patients: meta-analysis of observational studies. J Viral Hepat 2007; 14(10): 697-703.
[http://dx.doi.org/10.1111/j.1365-2893.2007.00868.x] [PMID: 17875004]
[http://dx.doi.org/10.1111/j.1365-2893.2007.00868.x] [PMID: 17875004]
[10]
Ridruejo E, Díaz C, Michel MD, et al. Short and long term outcome of kidney transplanted patients with chronic viral hepatitis B and C. Ann Hepatol 2010; 9(3): 271-7.
[http://dx.doi.org/10.1016/S1665-2681[19]31636-9] [PMID: 20720267]
[http://dx.doi.org/10.1016/S1665-2681[19]31636-9] [PMID: 20720267]
[11]
Fabrizi F, Martin P, Dixit V, Kanwal F, Dulai G. HBsAg seropositive status and survival after renal transplantation: meta-analysis of observational studies. Am J Transplant 2005; 5(12): 2913-21.
[http://dx.doi.org/10.1111/j.1600-6143.2005.01113.x] [PMID: 16303005]
[http://dx.doi.org/10.1111/j.1600-6143.2005.01113.x] [PMID: 16303005]
[12]
Liaw Y-F, Chu C-M. Hepatitis B virus infection. Lancet 2009; 373(9663): 582-92.
[http://dx.doi.org/10.1016/S0140-6736[09]60207-5] [PMID: 19217993]
[http://dx.doi.org/10.1016/S0140-6736[09]60207-5] [PMID: 19217993]
[13]
Gower E, Estes C, Blach S, Razavi-Shearer K, Razavi H. Global epidemiology and genotype distribution of the hepatitis C virus infection. J Hepatol 2014; 61(1)(Suppl.): S45-57.
[http://dx.doi.org/10.1016/j.jhep.2014.07.027] [PMID: 25086286]
[http://dx.doi.org/10.1016/j.jhep.2014.07.027] [PMID: 25086286]
[14]
Control CfD. Prevention recommendations for preventing transmission of infections among chronic hemodialysis patients. MMWR 2001; 50: 1-43.
[http://dx.doi.org/10.1037/e548302006-001]
[http://dx.doi.org/10.1037/e548302006-001]
[15]
Edey M, Barraclough K, Johnson DW. Review article: Hepatitis B and dialysis. Nephrology [Carlton] 2010; 15(2): 137-45.
[http://dx.doi.org/10.1111/j.1440-1797.2009.01268.x] [PMID: 20470270]
[http://dx.doi.org/10.1111/j.1440-1797.2009.01268.x] [PMID: 20470270]
[16]
Baumert TF, Fauvelle C, Chen DY, Lauer GM. A prophylactic hepatitis C virus vaccine: A distant peak still worth climbing. J Hepatol 2014; 61(1)(Suppl.): S34-44.
[http://dx.doi.org/10.1016/j.jhep.2014.09.009] [PMID: 25443345]
[http://dx.doi.org/10.1016/j.jhep.2014.09.009] [PMID: 25443345]
[17]
Isnard Bagnis C, Couchoud C, Bowens M, et al. Epidemiology update for hepatitis C virus and hepatitis B virus in end-stage renal disease in France. Liver Int 2017; 37(6): 820-6.
[http://dx.doi.org/10.1111/liv.13367] [PMID: 28107607]
[http://dx.doi.org/10.1111/liv.13367] [PMID: 28107607]
[18]
Diouf ML, Diouf B, Niang A, et al. [Prevalence of hepatitis B and C viruses in a chronic hemodialysis center in Dakar]. Dakar Méd 2000; 45(1): 1-4.
[PMID: 14666779]
[PMID: 14666779]
[19]
Djalalinia S, Ramezan Ghorbani N, Tajbakhsh R, et al. Hepatitis B virus infection in Iranian hemodialysis patients: A systematic review and meta-analysis. Iran J Kidney Dis 2018; 12(1): 1-9.
[PMID: 29421769]
[PMID: 29421769]
[20]
Ghorbani NR, Djalalinia S, Modirian M, et al. Prevalence of hepatitis C infection in Iranian hemodialysis patients: An updated systematic review and meta-analysis J Res Med Sci 2017; 22
[21]
Burdick RA, Bragg-Gresham JL, Woods JD, et al. Patterns of hepatitis B prevalence and seroconversion in hemodialysis units from three continents: the DOPPS. Kidney Int 2003; 63(6): 2222-9.
[http://dx.doi.org/10.1046/j.1523-1755.2003.00017.x] [PMID: 12753311]
[http://dx.doi.org/10.1046/j.1523-1755.2003.00017.x] [PMID: 12753311]
[22]
Fissell RB, Bragg-Gresham JL, Woods JD, et al. Patterns of hepatitis C prevalence and seroconversion in hemodialysis units from three continents: the DOPPS. Kidney Int 2004; 65(6): 2335-42.
[http://dx.doi.org/10.1111/j.1523-1755.2004.00649.x] [PMID: 15149347]
[http://dx.doi.org/10.1111/j.1523-1755.2004.00649.x] [PMID: 15149347]
[23]
Onyekwere C, Ogbera A. Pattern of hepatitis and HIV infection among dialysis patients in Urban Hospitals in Lagos Nigeria; implication for control. Niger Med Pract 2007; 51: 100-2.
[24]
Thompson SC, Boughton CR, Dore GJ. Blood-borne viruses and their survival in the environment: is public concern about community needlestick exposures justified? Aust N Z J Public Health 2003; 27(6): 602-7.
[http://dx.doi.org/10.1111/j.1467-842X.2003.tb00606.x] [PMID: 14723407]
[http://dx.doi.org/10.1111/j.1467-842X.2003.tb00606.x] [PMID: 14723407]
[25]
Nwaiwu CA, Egro FM, Smith S, Harper JD, Spiess AM. Seroconversion rate among health care workers exposed to HIV-contaminated body fluids: The University of Pittsburgh 13-year experience. Am J Infect Control 2017; 45(8): 896-900.
[http://dx.doi.org/10.1016/j.ajic.2017.03.012] [PMID: 28449921]
[http://dx.doi.org/10.1016/j.ajic.2017.03.012] [PMID: 28449921]
[26]
Alavian SM, Bagheri-Lankarani K, Mahdavi-Mazdeh M, Nourozi S. Hepatitis B and C in dialysis units in Iran: changing the epidemiology. Hemodial Int 2008; 12(3): 378-82.
[http://dx.doi.org/10.1111/j.1542-4758.2008.00284.x] [PMID: 18638096]
[http://dx.doi.org/10.1111/j.1542-4758.2008.00284.x] [PMID: 18638096]
[27]
Hasanjani Roushan MR, Farokhtabar S, Bayani M, Siadati S. Epidemiological aspects of hepatitis B and C and human immunodeficiency viruses among hemodialysis patients in Mazandaran Province, Iran. Nephrourol Mon 2016; 8(3): e37878.
[http://dx.doi.org/10.5812/numonthly.37878] [PMID: 27570757]
[http://dx.doi.org/10.5812/numonthly.37878] [PMID: 27570757]
[28]
Kalantari H, Ebadi S, Yaran M, Maracy MR, Shahshahan Z. Prevalence and risk factors of hepatitis B and C viruses among hemodialysis patients in Isfahan, Iran. Adv Biomed Res 2014; 3: 73.
[http://dx.doi.org/10.4103/2277-9175.125869] [PMID: 24627881]
[http://dx.doi.org/10.4103/2277-9175.125869] [PMID: 24627881]
[29]
Zahedi MJ, Darvish Moghaddam S, Alavian SM, Dalili M. Seroprevalence of hepatitis viruses B, C, D and HIV infection among hemodialysis patients in Kerman Province, South-East Iran. Hepat Mon 2012; 12(5): 339-43.
[http://dx.doi.org/10.5812/hepatmon.5969] [PMID: 22783346]
[http://dx.doi.org/10.5812/hepatmon.5969] [PMID: 22783346]
[30]
Assarehzadegan MA, Shakerinejad G, Noroozkohnejad R, Amini A, Rahim Rezaee SA. Prevalence of hepatitis C and B infection and HC V genotypes among hemodialysis patients in Khuzestan province, southwest Iran. Saudi J Kidney Dis Transpl 2009; 20(4): 681-4.
[PMID: 19587521]
[PMID: 19587521]
[31]
Liu YB, Xie JZ, Zhong CJ, Liu K. Hepatitis C virus infection among hemodialysis patients in Asia: a meta-analysis. Eur Rev Med Pharmacol Sci 2014; 18(21): 3174-82.
[PMID: 25487925]
[PMID: 25487925]
[32]
Ashkani-Esfahani S, Alavian SM, Salehi-Marzijarani M. Prevalence of hepatitis C virus infection among hemodialysis patients in the Middle-East: A systematic review and meta-analysis. World J Gastroenterol 2017; 23(1): 151-66.
[http://dx.doi.org/10.3748/wjg.v23.i1.151] [PMID: 28104991]
[http://dx.doi.org/10.3748/wjg.v23.i1.151] [PMID: 28104991]
[33]
Mohammad A, Aliasghar S, Afchangi A. Hepatitis B and hepatitis C in multi-center hemodialysis patients in Tehran. Indian J Appl Res 2016; 5: 417-8.
[34]
Dadmanesh M, Hosseinzadeh M, Keyvani H, et al. Evaluation of prevalence and risk factors of hepatitis g virus infection among hemodialysis patients referred to Iranian army hospitals in tehran during 2012-2013. Hepat Mon 2015; 15(1): e18322.
[http://dx.doi.org/10.5812/hepatmon.18322] [PMID: 25741370]
[http://dx.doi.org/10.5812/hepatmon.18322] [PMID: 25741370]
[35]
Campos-Outcalt D. Hepatitis C: new CDC screening recommendations. J Fam Pract 2012; 61(12): 744-6.
[PMID: 23313992]
[PMID: 23313992]
[36]
Lok AS, Chien D, Choo QL, et al. Antibody response to core, envelope and nonstructural hepatitis C virus antigens: comparison of immunocompetent and immunosuppressed patients. Hepatology 1993; 18(3): 497-502.
[http://dx.doi.org/10.1002/hep.1840180305] [PMID: 7689528]
[http://dx.doi.org/10.1002/hep.1840180305] [PMID: 7689528]
[37]
Farci P, Alter HJ, Govindarajan S, et al. Lack of protective immunity against reinfection with hepatitis C virus. Science 1992; 258(5079): 135-40.
[http://dx.doi.org/10.1126/science.1279801] [PMID: 1279801]
[http://dx.doi.org/10.1126/science.1279801] [PMID: 1279801]
[38]
Yuki N, Hayashi N, Ohkawa K, et al. The significance of immunoglobulin M antibody response to hepatitis C virus core protein in patients with chronic hepatitis C. Hepatology 1995; 22(2): 402-6.
[http://dx.doi.org/10.1016/0270-9139[95]90557-x] [PMID: 7543432]
[http://dx.doi.org/10.1016/0270-9139[95]90557-x] [PMID: 7543432]
[39]
Moini M, Ziyaeyan M, Aghaei S, et al. Hepatitis C virus [HCV] infection rate among seronegative hemodialysis patients screened by two methods; HCV core antigen and polymerase chain reaction. Hepat Mon 2013; 13(6): e9147.
[http://dx.doi.org/10.5812/hepatmon.9147] [PMID: 24032048]
[http://dx.doi.org/10.5812/hepatmon.9147] [PMID: 24032048]
[40]
Colin C, Lanoir D, Touzet S, Meyaud-Kraemer L, Bailly F, Trepo C. Hepatitis Group. Sensitivity and specificity of third-generation hepatitis C virus antibody detection assays: an analysis of the literature. J Viral Hepat 2001; 8(2): 87-95.
[http://dx.doi.org/10.1046/j.1365-2893.2001.00280.x] [PMID: 11264728]
[http://dx.doi.org/10.1046/j.1365-2893.2001.00280.x] [PMID: 11264728]
[41]
Wang C, Sun J, Zhu B, et al. Hepatitis B virus infection and related factors in hemodialysis patients in China - systematic review and meta-analysis. Ren Fail 2010; 32(10): 1255-64.
[http://dx.doi.org/10.3109/0886022X.2010.517354] [PMID: 20954991]
[http://dx.doi.org/10.3109/0886022X.2010.517354] [PMID: 20954991]
[42]
Katayama K, Sato T, Do SH, et al. Hepatitis B virus infection in hemodialysis patients in Japan: Prevalence, incidence and occult hepatitis B virus infection. Hepatol Res 2015; 45(12): 1211-9.
[http://dx.doi.org/10.1111/hepr.12492] [PMID: 25599580]
[http://dx.doi.org/10.1111/hepr.12492] [PMID: 25599580]
[43]
Bahri F, Kargar Kheirabad A, Ghasemzadeh I, Shoja S, Gouklani H. Hepatitis Viruses B and D and Human Immunodeficiency Virus infections in hemodialysis patients in the south of Iran: prevalence and genotypes. Hepat Mon 2016; 16(1): e32971.
[http://dx.doi.org/10.5812/hepatmon.32971] [PMID: 27110260]
[http://dx.doi.org/10.5812/hepatmon.32971] [PMID: 27110260]
[44]
Joukar F, Besharati S, Mirpour H, Mansour-Ghanaei F. Hepatitis C and hepatitis B seroprevalence and associated risk factors in hemodialysis patients in Guilan province, north of Iran: HCV and HBV seroprevalence in hemodialysis patients. Hepat Mon 2011; 11(3): 178-81.
[PMID: 22087139]
[PMID: 22087139]
[45]
Mittal G, Gupta P, Thakuria B, Mukhiya GK, Mittal M. Profile of hepatitis B virus, hepatitis C virus, hepatitis d virus and human immunodeficiency virus infections in hemodialysis patients of a tertiary care hospital in uttarakhand. J Clin Exp Hepatol 2013; 3(1): 24-8.
[http://dx.doi.org/10.1016/j.jceh.2013.02.003] [PMID: 25755468]
[http://dx.doi.org/10.1016/j.jceh.2013.02.003] [PMID: 25755468]
[46]
Tourret J, Tostivint I, du Montcel ST, et al. Outcome and prognosis factors in HIV-infected hemodialysis patients. Clin J Am Soc Nephrol 2006; 1(6): 1241-7.
[http://dx.doi.org/10.2215/CJN.02211205] [PMID: 17699354]
[http://dx.doi.org/10.2215/CJN.02211205] [PMID: 17699354]
[47]
Su Y, Yan R, Duan Z, et al. Prevalence and risk factors of hepatitis C and B virus infections in hemodialysis patients and their spouses: a multicenter study in Beijing, China. J Med Virol 2013; 85(3): 425-32.
[http://dx.doi.org/10.1002/jmv.23486] [PMID: 23341370]
[http://dx.doi.org/10.1002/jmv.23486] [PMID: 23341370]
[48]
Abumwais J, Idris O. Prevalence of hepatitis C, hepatitis B, and HIV infection among hemodialysis patients in Jenin District [Palestine]. Indian J Virol 2010; 4: 38-44.
[http://dx.doi.org/10.21859/isv.4.2.38]
[http://dx.doi.org/10.21859/isv.4.2.38]
[49]
Gökengin D, Doroudi F, Tohme J, Collins B, Madani N. HIV/AIDS: trends in the Middle East and North Africa region. Int J Infect Dis 2016; 44: 66-73.
[http://dx.doi.org/10.1016/j.ijid.2015.11.008] [PMID: 26948920]
[http://dx.doi.org/10.1016/j.ijid.2015.11.008] [PMID: 26948920]
[50]
Alimohamadi Y, Tabatabaee H, AfsarKazerooni P, Vahedi S, Enaami M, Teimourizad A. Epidemiologic characteristics of HIV- positive patients referring to behavioral diseases consultation center in Shiraz, Iran. Med J Islam Repub Iran 2014; 28: 147.
[PMID: 25695005]
[PMID: 25695005]
[51]
Leylabadlo HE, Baghi HB, Fallahi L, Kafil HS. From sharing needles to unprotected sex: a new wave of HIV infections in Iran? Lancet HIV 2016; 3(10): e461-2.
[http://dx.doi.org/10.1016/S2352-3018[16]30158-8] [PMID: 27687040]
[http://dx.doi.org/10.1016/S2352-3018[16]30158-8] [PMID: 27687040]
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