Detection of hepatitis C virus in patients with terminal renal disease undergoing dialysis in southern Brazil: prevalence, risk factors, genotypes, and viral load dynamics in hemodialysis patients

Abstract

Hepatitis C (HCV) is a serious public health issue, and it is estimated that 3% of the world’s population is infected. Patients in hemodialysis units have an increased risk for contracting HCV, and high prevalence rates have been found in hemodialysis units around the world. This study is aimed at determining the prevalence of HCV in patients with terminal chronic renal disease (tCRD) who have been submitted to hemodialysis and peritoneal dialysis in southern Brazil to characterize the most prevalent genotypes, the viral load, and possible risk factors and to assess the validity between the ELISA and RT-PCR detection methods. Of 320 patients from three dialysis units, 318 participated in this study. According to the medical records, 55 patients were reactive to HCV, as determined via ELISA. All 318 samples were submitted to RT-PCR and genotyped using an Abbott Realtime® m2000 system. Data obtained through a questionnaire and chemical variables were associated with the HCV. Results: The prevalence of HCV was 18.24% (58), and the concordance between the HCV serology and the RT-PCR was 94%. Three patients were diagnosed to be negative for HCV using the ELISA assay but positive when using RT-PCR. Genotype 1 was the most prevalent (46.7%) genotype, within which subtype 1a was the most frequent (74.1%). One of the risk factors associated with HCV infection was the length of time that the patient had been undergoing hemodialysis treatments (p < 0.001). Additionally, the viral load was found to vary when tested before and after hemodialysis (p < 0.001). Conclusion: The prevalence of HCV in dialysis units continues to remain high, indicating nosocomial contamination. RT-PCR detected the presence of the hepatitis C virus in patients with a non-reactive serology, which highlights the importance of performing molecular tests on dialysis patients. The variation in the viral load in patients submitted to hemodialysis indicates a possible destruction or gripping of viral particles to the dialyzer membrane.Electronic supplementary materialThe online version of this article (doi:10.1186/s12985-015-0238-z) contains supplementary material, which is available to authorized users.

Diagnostic and Epidemiologic Features of Hepatitis C among Hemodialysis Patients Living in Yazd Province of Iran

“…We evaluated the HCV infection risk factors such as intra venous drug injection, history of blood transfusion, kidney transplantation, duration of dialysis, and tattoo. Our study showed significant relation between positive HCV markers with hemodialysis duration (p<0.001) similar to Somi et (7,20). The high prevalence of HCV among dialysis patients can be related to several risk factors including the number of blood transfusions, dialysis duration and type of dialysis (lower HCV prevalence among peritoneal dialysis patients).…”

“…Anti HCV in hemodialysis patients is reported 11.6% in the United States to 91% in some developing countries (4,5). The worldwide prevalence of HCV infection in hemodialysis patients approved with reverse transcriptase polymerase chain reaction (RT-PCR) is 5-24% (6,7). Risk factors are known for HCV in hemodialysis patients, including intravenous drug injection, past blood transfusion, kidney transplantation, long duration of dialysis, and tattoo (7,8).…”

“…The worldwide prevalence of HCV infection in hemodialysis patients approved with reverse transcriptase polymerase chain reaction (RT-PCR) is 5-24% (6,7). Risk factors are known for HCV in hemodialysis patients, including intravenous drug injection, past blood transfusion, kidney transplantation, long duration of dialysis, and tattoo (7,8). The routine tests for HCV detection in patients are enzyme-linked immunosorbent assay (ELISA) and RT-PCR.…”

Incidence of hepatitis C in Brazil

“…Despite the major advances in techniques for the detection and prevention of hepatitis C, the number of patients undergoing dialysis treatments who are infected by this virus in Brazil has increased in recent years (4) . There are estimates indicating that 34,366 individuals begin hemodialysis treatment in Brazil annually, including 5,963 new cases per year in the South.…”

“…This is 5 times the rate of infection with human immunodefi ciency virus (HIV) (3) . In Brazil, it is estimated between 2.5% and 4.9% of the population is infected with hepatitis C virus (4) .…”