Hepatitis C virus [HCV] antibodies in patients with chronic renal failure and treated with regular hemodialysis and those treated with renal transplantation

ABSTRACT

This work was carried out to study the prevalence of hepatitis C Virus [HCV] infection, its associated risk factors and possible routes of transmission in chronic renal failure patients treated with either regular hemodialysis or renal transplantation. Seventy patients and 20 normal controls were included in this study. Patients were classified into 2 groups Group I 50 hemodialysis patients [HD group] and Group II 20 renal transplant recipients [RTR group]. Each individual was subjected to full clinical examination, estimation of serum alanine aminotransferase [ALT], testing for antibodies to hepatitis C virus [anti-HCV] by ELISA 2nd generation, screening for hepatitis B surface antigen [HBsAg], antibodies to hepatitis B surface antigen [anti-HBs] and core antigen [anti HBc] by modified ELISA technique. Anti-HCV was found in 72% of hemodialysis patients and 65% of renal transplant patients and in 15% of the control group. There was a significant correlation between the presence of anti-HCV and the duration on dialysis in HD and RTR groups [P < 0.05 in both], while no significant correlation was detected between HCV positive cases and the number of units of transfused blood in HD and RTR groups [P > 0.05 in both]. Serum ALT was elevated in patients with HCV infection, but there was no significant correlation between the presence of anti-HCV and elevated ALT level among the examined groups of patients [P > O.OS in both]. The prevalence of HCV infection was not correlated with the duration of renal transplantation [P>0.05] and the type of immunosuppressive therapy [P > 0.05]. Coinfection with HBV and HCV could occur, as previous infection with HBV was demonstrated. Anti-HBc was found in 33.3% and 30.8% of anti-HCV positive patients in both HD and RTR groups respectively. Anti-HBs was detected in 25% and 15.4% of anti HCV positive in HD and RTR groups. HBsAg was found in 5.6% of anti-HCV positive hemodialysis patients. From this study we concluded that there are high prevalence of antibodies to HCV in serum of these patients with CRF whether treated with regular hemodialysis or with renal transplantation. This may mean high prevalence of HCV infection in these patients. Also it is found that the duration of hemodialysis rather than the number of units of blood transfusion is the main risk factor and that the transmission in hemodialysis units is the most important rather than by blood transfusion although its importance. Also we may recommend [1] All the hygienic measures to prevent spread of hepatitis C virus infection in these patients and treatment of cases. [2] Separate dialysis machines should be used for anti-HCV positive patients as we do for HBsAg positive patients. [3] Routine application of PCR technique in these patients may be useful for accurate diagnosis of the HCV infection. [4] Retrospective study on large number of transplanted patients for all risk factors of HCV infection, in addition to study the causes of this relatively high prevalence of infection inbetween them