Epidemiology and risk factors of HCV infection among hemodialysis patients in countries of the Eastern Mediterranean Regional Office of WHO (EMRO): a quantitative review of literature

Abstract

Background Hepatitis C virus infection (HCV) is the major co-morbidity of patients on chronic hemodialysis. There are many scattered and heterogeneous data about this infection in hemodialysis patients living in countries of the Eastern Mediterranean Region Office of WHO (EMRO) and its distribution is unknown in this region. Aims To provide a more comprehensive tabulation of available data on the epidemiological characteristics and risk factors for HCV infection in hemodialysis patients in Iran and other EMRO countries. Methods A systematic review was carried out based on the computerized literature databases. In all, 95% confidence intervals of infection rates were calculated using the approximate normal distribution model. Pooled odds ratios and 95% CIs were calculated by random effects models. The heterogeneity was assessed by either Q or χ 2 statistics and quantified by I 2 .Results We identified 62 studies that fulfilled our inclusion criteria involving 17,846 hemodialysis subjects. A total of 5,704 (32%) patients had positive serology for HCV infection. The prevalence ranged from 6-72% across countries. Pooled HCV seroprevalence was 17% (95% CI 13-20), 63% (95% CI 61-64), 48% (95% CI 45-51), 72% (95% CI 68-76), 23% (95% CI 21-24) in Iran, Saudi Arabia, Egypt, Morocco and Tunisia respectively. Hemodialysis duration OR=7.63 (95% CI 4.64-12.53), transfusion OR=2.06 (95% CI 1.47-2.89) and previous transplantation failure OR=2.66 (95% CI 1.46-4.86) were major risk factors of HCV infection. Age, sex and dialysis session/ week were not associated with infection rate. Conclusion Nearly 32% (95% CI 31-33) of hemodialysis patients in the EMRO countries are infected with HCV. Despite evolution of new strategies to confine HCV transmission among hemodialysis patients, nosocomial transmission is still the major route of HCV infection in these patients in this region.

Prevalence of Hepatitis C Virus Antibodies among Beta-Thalassemia Major Patients in Kurdistan Province, Iran

“…The seroepidemiology of HCV infection among beta-thalassemia patients has been estimated at 18%, 45%, 63%, and 69% in Iran, Pakistan, Saudi Arabia, and Egypt, respectively. Among Iranian beta-thalassemia patients, splenectomy, high frequency of blood transfusion, advanced age, and transfusion before 1996 were risk factors for HCV infection (8).…”

“…Although the prevalence of HCV infection has been decreasing in recent years among Iranian blood donors due to blood supply tests (1), the frequency of HCV subtypes differs among HCV patients in various provinces of Iran and fluctuates with time (7). The prevalence of HCV is much higher among high-risk groups, such as beta-thalassemia patients (8).…”

Molecular Epidemiology of Hepatitis C Virus Genotypes in Patients with Thalassemia Major in Golestan Province, Iran

“…Positive ELISA results were confirmed by the RIBA test in 568 cases, and the highest and lowest prevalence rates were seen in Semnan (32%) and Zanjan (2%), respectively. The rate of HCV infection in thalassemia patients from Pakistan, Saudi Arabia and Egypt was 45, 63 and 69%, respectively [51]. Lower prevalence rate in Iran compared to these countries could be due to the screening systems for blood transfusion in Iran.…”

“…Another study by Oza et al on 193 children with thalassemia major reported the prevalence of HCV infection as 7.8% [50]. In a systematic review by Alavian et al in Iran [51], of 5229 patients with thalassemia, 941 (17.9%) were anti-HCV antibodypositive. Positive ELISA results were confirmed by the RIBA test in 568 cases, and the highest and lowest prevalence rates were seen in Semnan (32%) and Zanjan (2%), respectively.…”

Hepatitis C in prisons

“…Currently, approximately 170 million people are infected with HCV (2,5). Injecting drug use is the most common route of transmission, thus IDUs have the highest prevalence of HCV infection and also constitute a potential reservoir of HCV in the community (6)(7)(8).…”