Prevalence of overt and occult hepatitis B virus infections among 135 haemodialysis patients attending a haemodialysis centre at Al-Nasiriyah city, Iraq
Background and Objectives: The prevalence of Hepatitis B virus (HBV) infection among haemodialysis (HD) patients has been well documented. In addition to overt infection, occult Hepatitis B infection exists in which a patient who is diagnosed seronegative for Hepatitis B surface antigen (HBsAg) shows positive HBV-DNA on using more accurate molecular methods. This study aims to determine the prevalence of overt and occult HBV infection among the HD patients who had attended Al-Nasiriyah dialysis centre during a two-month period.
Materials and Methods: Serological qualitative detection of HBsAg by rapid test (strips), enzyme immunoassay (EIA, HBsAg) and molecular (real-time polymerase chain reaction (real-time PCR)) was conducted for quantitative detection of HBV in HD patients’ serum.
Results: The prevalence of overt HBV infection among HD patients was 3.7%. The viral load of HBV positive patients was ranging from 5.85 × 101 to 2.16 × 106 copies/ml of serum with median (7.4 × 105 copies/ml). Occult Hepatitis B was not detected in any of the seronegative HD patients (0%). Overt infection was found more in males (80%) than females (20%) (P<0.05). Similarly, infection was found to be higher among patients who had blood transfusions (80%) than those who had not (20%) with statistical significant p<0.05. Although not statistically significant, the mean duration of HD was higher among HBV positive HD patients (17.6) than HBV negative HD patients (14.3). A dual infection of HBV and HCV was not detected in this study.
Conclusion: Nosocomial transmissions at HD centres and blood transfusion are important risk factors. Besides serological screening, real-time PCR offers a safeguard against the spread of overt and occult HBV infection and determines the viral load of the positive patients.
2. Edey M, Barraclough K, Johnson DW. Review article: Hepatitis B and dialysis. Nephrology (Carlton) 2010;15: 137-145.
3. Mohd Hanafiah K, Groeger J, Flaxman AD, Wiersma ST. Global epidemiology of hepatitis C virus infection: new estimates of agespecific antibody to HCV seroprevalence. Hepatology 2013;57:1333-1342.
4. 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;12:378-382.
5. Fontenele AMM, Filho NS, Ferreira ASP. Occult hepatitis B in patients on hemodialysis: a review. Ann Hepatol 2013;12:359-363.
6. Kalantari H, Ferdowsi F, Yaran M. Prevalence of occult hepatitis B virus infection in hemodialysis patients in Isfahan, Iran. Adv Biomed Res 2016; 5:151.
7. 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;4:35-47.
8. Ismail H, Soliman M, Ismail N. Occult hepatitis B virus infection in Egyptian hemodialysis patients with or without hepatitis C virus infection. Pathol Lab Med Int 2010:2:113-120.
9. Ayatollahi J, Sharifyazdi M, Shahcheraghi SH, Jahanabadi S, Hemayati R, Vakili M. The prevalence of occult hepatitis B virus in the hemodialysis patients in Yazd, Iran. Acta Med Iran 2016;54:784-787.
10. Saijo T, Joki N, Inishi Y, Muto M, Saijo M, Hase H. Occult hepatitis B virus infection in hemodialysis patients in Japan. Ther Apher Dial 2015;19:125-130.
11. Hollinger FB, Habibollahi P, Daneshmand A, Alavian SM. Occult Hepatitis B infection in chronic hemodialysis patients: current concepts and strategy. Hepat Mon 2010; 10: 199-204.
12. Otedo AEO, Mc’Ligeyo SO, Okoth FA, Kayima JK. Seroprevalence of hepatitis B and C in maintenance dialysis in a public hospital in a developing country. S Afr Med J 2003;93:380-384.
13. Alibakhshikenari M. Prevalence of Hepatitis B and C viruse’s infections among hemodialysis patients in Tehran, Iran. Biomed J Sci & Tech Res 2018;11:8359-8363.
14. Ribot S, Rothstein M, Goldblat M, Grasso M. Duration of Hepatitis B surface antigenemia (HBsAg) in hemodialysis Pateints. Arch Intern Med 1979;139:178-180.
15. Torbenson M, Thomas DL. Occult hepatitis B Michael. Lancet Infect Dis 2002;2:479-486.
16. Raimondo G, Allain JP, Brunetto MR, Buendia MA, Chen DS, Colombo M, et al. Statements from the Taormina expert meeting on occult hepatitis B virus infection. J Hepatol 2008;49:652-657.
17. Aghakhani A, Banifazl M, Velayati AA, Eslamifar A, Ramezani A. Occult Hepatitis B virus infection in hemodialysis patients: A concept for consideration. Ther Apher Dial 2012;16:328-333.
18. Raimondo G, Caccamo G, Filomia R, Pollicino T. Occult HBV infection. Semin Immunol 2013; 35: 39-52.
19. Aghakhani A, Banifazl M, Kalantar E, Eslamifar A, Ahmadi F, Razeghi E, et al. Occult hepatitis B virus infection in hemodialysis patients with isolated hepatitis B core antibody: A multicenter study. Ther Apher Dial 2010;14:349-353.
20. Minuk GY, Dong FS, Greenberg R, Zhang M, Hawkins K, Uhanova J, et al. Occult hepatitis B virus infection in a North American adult hemodialysis patient population. Hepatology 2004;40:1072-1077.
21. Nagakawa O, Miyatomi Y, Shigeta Y, Inayama E, Murakami K, Sakai T, et al. Occult hepatitis B virus infection in Japanese chronic hemodialysis patients. Ther Apher Dial 2013;17:289-292.
22. Abass YA, Khawam R, Kareem AA. Epidemiology of Hepatitis HBV and HCV at Thi-Qar. QMJ 2008;4:160-171.
23. Tarky AA, Akram W, Al-naaimi A, Omer A. Epidemiology of viral hepatitis B and C in Iraq: a national survey 2005-2006. Zanco J Med Sci 2013;17:370-380.
24. Ibrahim NMR, Sidiq Z, Saleem M, Hussein NR. The prevalence of HIV, HCV, and HBV Among hemodialysis patients attending Duhok hemodialysis center. 2017;5 (1); e63246.
25. Shihab SS, Al-Hmudi HA, Al-Edani HS, Mahdi KH. Viral hepatitis infections in Basrah haemodialysis unit: Serological diagnosis and viral loading. Eur J Exp Biol 2014;4:106-112.
26. Assarehzadegan MA, Shakerinejad G, Noroozkohnejad R, Amini A, Rezaee SAR. 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;20:681-684.
27. Alashek WA, McIntyre CW, Taal MW. Hepatitis B and C infection in haemodialysis patients in Libya: prevalence, incidence and risk factors. BMC Infect Dis 2012;12:265.
28. Yoo JH, Hwang SG, Yang DH, Son MS, Kwon C, Ko KH, et al. Prevalence of occult Hepatitis B virus infection in hemodialysis patients Jeong. Korean J Gastroenterol 2013;61:209-214.
29. Al–Hamdani AH, Al-Rawy SK, Khamees HA. Retrospective seroprevalence study of Hepatitis B and C in Iraqi population at Baghdad: A hospital based study. Iraqi J Comm Med 2012;25:186-190.
30. Mahdavimazdeh M, Hosseini-Moghaddam SM, Alavian SM, Yahyazadeh H. Hepatitis B infection in Hemodialysis patients in Tehran province, Iran. Hepat Mon 2009;9:206-210.
31. Zabadi HA, Rahal H, Fuqaha R. Hepatitis B and C prevalence among hemodialysis patients in the West Bank hospitals, Palestine. BMC Infect Dis 2015;16:41.
32. Al Hijazat M, Ajlouni YM. Hepatitis B infection among patients receiving chronic hemo- dialysis at the Royal Medical Services in Jordan. Saudi J Kidney Dis Transpl 2008;19:260-267.
33. Yakaryilmaz F, Gurbuz OA, Guliter S, Mert A, Songur Y, Karakan T, et al. Prevalence of occult hepatitis B and hepatitis C virus infections in Turkish hemodialysis patients. Ren Fail 2006;28:729-735.
34. Burdick RA, Bragg-Gresham JL, Woods JD, Hedderwick SA, Kurokawa K, Combe C, et al. Patterns of hepatitis B prevalence and seroconversion in hemodialysis units from three continents: The DOPPS. Kidney Int 2003;63:2222-2229.
35. Altindiş M, Uslan I, Cetinkaya Z, Yüksel S, Ciftçi IH, Demirtürk N, et al. Investigation of hemodialysis patients in terms of the presence of occult hepatitis B. Mikrobiyol Bul 2007;41:227‑233.
36. Fabrizi F, Messa PG, Lunghi G, Aucella F, Bisegna S, Mangano S, et al. Occult hepatitis B virus infection in dialysis patients: a multicentre survey. Aliment Pharmacol Ther 2005;21:1341-1347.
37. Goral V, Ozkul H, Tekes S, Sit D, Kadiroglu AK. Prevalence of occult HBV infection in hemodialysis patients with chronic HCV. World J Gastroenterol 2006;12:3420-3424.
38. Abu MA, Makarem E, Hamid MA, Aleem AA, Ali A, Shatat M, et al. Prevalence of occult Hepatitis B virus infection in hemodialysis patients from Egypt with or without Hepatitis C virus infection. Hepat Mon 2012;12:253-258.
39. Athbi HA. Prevalence and risk factors for Hepatitis C and B viruses infection among Hemodialysis patients in Holy Karbala, Iraq. KUFA J Nurs Sci 2015;5:1-8.
40. Ferreira RC, Teles SA, Dias MA, Tavares VR, Silva SA, Gomes SA, et al. Hepatitis B virus infection profile in hemodialysis patients in Central Brazil: prevalence, risk factors, and genotypes. Mem Inst Oswaldo Cruz 2006;101:689-692.
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