Non-A, non-B is a major form of hepatitis in haemodialysis (HD) patients. Hepatitis C virus (HCV) has been recently identified as the leading cause of non-A, non-B hepatitis in HD. A variable prevalence of hepatitis in HD has appeared in the literature, ranging between 1% and 29% in the Western world, and between 30% and 54% in Saudi Arabia, but all these reports used first-generation ELISA. Using second-generation enzyme immunoassay, we conducted a multi-centre study involving 22 HD centres all over Saudi Arabia in order to establish the prevalence and risk factors for HCV in HD patients in Saudi Arabia. A total of 1147 patients were studied, with a mean age of 43.4 +/- 15.3 years. Five hundred and eighty were males and 567 were females. The overall prevalence rate of positive anti-HCV was 68%, with a range from as low as 14.5%, to 94.7%. To our knowledge, this is the highest value reported among dialysis patients world-wide. A positive correlation was found between anti-HCV positivity and male sex (P = 0.005), longer duration on dialysis (P = 0.002) and blood transfusion (P = 0.003). However, interestingly 62.6% of the patients who had not had blood transfusion had anti-HCV antibodies. HCV antibodies were also found more frequently in Egyptians, Pakistanis and Yemenis than in Saudis. A comparison between those centres with low prevalence of positive HCV and those with high prevalence regarding risk factors was carried out, and it was found that the major difference between them was the adherence of the staff to universal infection precautions.(ABSTRACT TRUNCATED AT 250 WORDS)

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Patients who are anti-HCV positive before renal transplantation (Tx) have a significantly increased risk of posttransplant liver disease. We conducted a prospective, controlled study to evaluate the posttransplant outcome of renal graft candidates with HCV-associated chronic hepatitis (n = 30). Patients were randomly assigned to either of two groups. All patients on enrollment underwent liver biopsy, which showed mild-to-moderate hepatitis activity (mean 4.1, range 2–6). Half the patients received interferon-alpha (IFN-a) administered at a dosage of 3 million units three times weekly for 1 year. Liver biopsy was repeated for treated patients at the end of IFN-a treatment. Of these, 11 patients received renal transplant (group A). The other half did not receive IFN-a and to date 10 patients have been transplanted (group B). Renal transplant recipients were prospectively followed for a period of 12 months and a follow-up liver biopsy was also done at the end of this period (end of study). Biochemical and virological responses were evaluated and the histologic activity index (HAI) scoring according to Knodell was assessed. The mean pretreatment serum HCV RNA level was 1.14 ± 0.84 and 1.0 ± 0.89 mEq/ml for groups A and B, respectively (bDNA assay sensitivity threshold is <0.2 mEq/ml). HCV RNA became undetectable in 4 patients of group A. At the end of study period the mean quantitative HCV RNA titers were 1.43 ± 4.07 and 15.18 ± 11.08 mEq/ml in groups A and B, respectively (p < 0.0001). In group A, the mean HAI score decreased from 4.27 ± 1.19 to 1.64 ± 0.67 after IFN-a treatment (p < 0.0001). This score was maintained till the end of the study period with a mean of 1.82 ± 0.6. Mean HAI score of group B on enrollment was 3.9 ± 1.2 and at the end of study increased to 5.5 ± 1.35 (p = 0.01). There was statistically significant difference (p value less than 0.0001) between the HAI scores at the end of the study period between the two groups. These results demonstrate that interferon therapy while on dialysis is associated with less viremia and decreased progression of chronic liver disease in renal transplant patients with hepatitis C.