Prevalence of hepatitis C among haemodialysis patients in a tertiary care hospital in south India
-
Anitha Madhavan
,
Arun Sachu
,
Anu Kumar Balakrishnan
,
Anu Vasudevan
,
Sobha Balakrishnan
,
Jayalakshmi Vasudevapanicker
Abstract
Background and Objectives: Hepatitis C is the most common hepatotropic viral infection that affects patients on maintenance hemodialysis. Most of the laboratories in India depend on HCV antibody detection by ELISA. PCR based studies on detection of HCV RNA among haemodialysis patients are very scanty in India. The current study was undertaken to find the prevalence of HCV among haemodialysis patients by ELISA and PCR.
Materials and Methods: This prospective study was conducted from January to May 2018 in a total of 100 samples. Patients more than 18 years of age, who had undergone at least 15 sessions of dialysis were enrolled in the study. All samples were screened for HCV antibody by ELISA and HCV RNA by PCR. Data regarding age and gender of the patients, history of blood transfusion, duration of hemodialysis, total bilirubin levels were collected from medical records.
Results: Among the 100 samples, only one was positive for HCV antibody by ELISA. Eight samples were positive for HCV RNA by PCR. In this study 62.5% of the HCV positives had a previous history of blood transfusion. Duration of dialysis was more among the HCV positive group but there was no statistical significance.
Conclusion: This is the first study from the southern state of Kerala in India showing the prevalence of HCV among hemodialysis patients by PCR. Our study showed an overall HCV prevalence of 8% by PCR. All the PCR positive samples were negative by 3rd generation ELISA which is an alarming finding and further justifies the need for PCR for detecting HCV.
1. Roy P, Patel A, Lole K, Gupta RM, Kumar A, Hazra S. Prevalence and genotyping pattern of hepatitis C virus among patients on maintenance hemodialysis at five centers in Pune, India. Med J Armed Forces India 2019;75:74-80.
2. Alter HJ, Seeff LB. Recovery, persistence, and sequelae in hepatitis C virus infection: a perspective on long-term outcome. Semin Liver Dis 2000;20:17-35.
3. Agarwal SK, Dash SC, Gupta S, Pandey RM. Hepatitis C virus infection in haemodialysis: the 'no-isolation' policy should not be generalized. Nephron Clin Pract 2009;111: c133-c140.
4. Natov SN, Lau JY, Bouthot BA, Murthy BV, Ruthazer R, Schmid CH, et al. Serologic and virologic profiles of hepatitis C infection in renal transplant candidates. New England Organ Bank Hepatitis C Study Group. Am J Kidney Dis 1998; 31: 920-927.
5. Fissell RB, Bragg-Gresham JL, Woods JD, Jadoul M, Gillespie B, Hedderwick SA, et al. Patterns of hepatitis C prevalence and seroconversion in hemodialysis units from three continents: the DOPPS. Kidney Int 2004;65:2335-2342.
6. Lok AS, Chien D, Choo QL, Chan TM, Chiu EK, Cheng IK, et al. Antibody response to core, envelope and nonstructural hepatitis C virus antigens: comparison of immunocompetent and immunosuppressed patients. Hepatology 1993;18:497-502.
7. Centers for Disease Control and Prevention (CDC). Testing for HCV infection: an update of guidance for clinicians and laboratorians. MMWR Morb Mortal Wkly Rep 2013;62:362-365.
8. Gretch DR. Diagnostic tests for hepatitis C. Hepatology 1997;26(3 Suppl 1):43S-47S.
9. Young KK, Archer JJ, Yokosuka O, Omata M, Resnick RM. Detection of hepatitis C virus RNA by a combined reverse transcription PCR assay: comparison with nested amplification and antibody testing. J Clin Microbiol 1995;33:654-657.
10. Saab S, Brezina M, Gitnick G, Martin P, Yee Jr HF. Hepatitis C screening strategies in hemodialysis patients. Am J Kidney Dis 2001;38:91-97.
11. Kondo Y, Sung VM, Machida K, Liu M, Lai MM. Hepatitis C virus infects T cells and affects interferongamma signaling in T cell lines. Virology 2007; 361:161-173.
12. Rahnavardi M, Hosseini Moghaddam SM, Alavian SM. Hepatitis C in hemodialysis patients: Current global magnitude, natural history, diagnostic difficulties, and preventive measures. Am J Nephrol 2008;28:628-640.
13. Goudeau A, Dubois F. Incidence and prevalence of hepatitis B in France. Vaccine 1995;13 Suppl 1:S22-25.
14. Guh JY, Lai YH, Yang CY, Chen SC, Chuang WL, Hsu TC, et al. Impact of decreased serum transaminase levels on the evaluation of viral hepatitis in hemodialysis patients. Nephron 1995;69: 459-465.
15. Muller GY, Zabaleta ME, Arminio A, Colmenares CJ, Capriles FI, Bianco NE, et al. Risk factors for dialysis associated hepatitis C in Venezuela. Kidney Int 1992;41:1055-1058.
16. Jadoul M, Bieber BA, Martin P, Akiba T, Nwankwo C, Arduino JM et al. Prevalence, incidence, and risk factors for hepatitis C virus infection in hemodialysis patients. Kidney Int 2019;95:939-947.
17. Soni PN, Tait DR, Kenoyer DG. Hepatitis C virus antibodies among risk groups in a South African area endemic for hepatitis B virus. J Med Virol 1993;40:65-68.
18. Seck SM, Dahaba M, Gueye S, Ka EF. Trends in hepatitis C infection among hemodialysis patients in Senegal: results of a decade of prevention. Saudi J Kidney Dis Transpl 2014;25:1341-1345.
19. Chadha MS, Arankalle VA, Jha J, Banerjee K. Prevalence of hepatitis B and C virus infections among haemodialysis patients in Pune (western India). Vox Sang 1993;64:127-128.
20. Gosavi MS, Shah SK, Shah SR, Pal RB, Saldanha JA, Banker DD. Prevalence of hepatitis C virus (HCV) infection in Mumbai. Indian J Med Sci 1997;51:378-385.
21. Jasuja S, Gupta AK, Choudhry R. Prevalence and associations of hepatitis C viremia in hemodialysis patients at a tertiary care hospital. Indian J Nephrol 2009;19:62-67.
22. Chandra M, Khaja MN, Hussain MM, Poduri CD, Farees N, Habeeb MA, et al. Prevalence of hepatitis B and hepatitis C viral infections in Indian patients with chronic renal failure. Intervirology 2004;47:374-376.
23. Prakash S, Jain A, Sankhwar SN, Usman K, Prasad N, Saha D, et al. Prevalence of hepatitis B & C viruses among patients on hemodialysis in Lucknow, Uttar Pradesh. Clin Epidemiol Glob Health 2014;2:19-23.
24. Surendra Kumar P, Venu G, Madhusudhana Rao A, Balakrishnan N, SaraVanan T, Sofiarani A. Prevalence and risk factors of hepatitis C among maintenance hemo- dialysis patients at a tertiary care hospital in Coimbatore, India. J Clin Diagnostic Res 2011; 5:725-728.
25. Jamil M, Bhattacharya PK, Yunus M, Lyngdoh CJ, Roy A, Talukdar KK. Prevalence of hepatitis B and hepatitis C in haemodialysis population in a tertiary care centre in north eastern India. Int J Biomed Amp Adv Res 2016;7: 267-269.
26. Subramanian G, Vegad M, Vadsmiya M, Murawala S, Patel F. Seroprevalence of hepatitis C in renal failure patients on maintenance hemodialysis – Study in a tertiary care hospital – Western India. Int J Med Sci Public Health 2016;5:1.
27. Reddy AK, Murthy KV, Lakshmi V. Prevalence of HCV infection in patients on haemodialysis: survey by antibody and core antigen detection. Indian J Med Microbiol 2005;23:106-110.
28. Medhi S, Potukuchi SK, Polipalli SK, Swargiary SS, Deka P, Chaudhary A, et al . Diagnostic utility of hepatitis C virus core antigen in hemodialysis patients. Clin Biochem 2008;41:447-452.
29. Liu CH, Kao JH. Treatment of hepatitis C virus infection in patients with end-stage renal disease. J Gastroenterol Hepatol 2011;26:228-239.
30. Hinrichsen H, Leimenstoll G, Stegen G, Schrader H, Fölsch UR, Schmidt WE, et al. Prevalence and risk factors of hepatitis C virus infection in haemodialysis patients: a multicentre study in 2796 patients. Gut 2002;51:429-433.
31. Bukh J, Wantzin P, Krogsgaard K, Knudsen F, Purcell RH, Miller RH, et al. High prevalence of hepatitis C virus (HCV) RNA in dialysis patients: failure of commercially available antibody tests to identify a significant number of patients with HCV infection. Copenhagen Dialysis HCV Study Group. J Infect Dis 1993;168:1343-1348.
32. Joukar F, Besharati S, Mirpour H, Mansour Ghanaei F. Hepatitis C and hepatitis B seroprevalence and associated risk factors in hemodialysis patients in Guilan province, north of Iran: HCV and HBV seroprevalence in hemodialysis patients. Hepat Mon 2011;11:178-181.
33. Saab S, Martion P, Brezina M, Gitrich G, Yee HF Jr. Serum alanine aminotransferase in hepatitis C screening of the patients on hemodialysis. Am J Kidney Dis 2001; 37: 308-315.
34. Dentico P, Buogiorno R, Volpe A, Carlone A, Carbone M, Manno C, et al. Prevalence and incidence of hepatitis C virus (HCV) in hemodialysis patients: study of risk factors. Clin Nephrol 1992; 38:49-52.
35. Donahue JG, Munoz A, Ness PM, Brown DE Jr, Yawn DH, McAllister HA Jr, et.al. The declining risk of the post transfusion hepatitis C virus infection. N Engl J Med 1992; 327:369-373.
36. Tajbakhsh R. Prevalence of hepatitis C and B virus infectionsamong hemodialysis patients in Karaj, Iran. Saudi J Kidney Dis Transpl 2015; 26: 792-796.
37. Fabrizi F, Messa P, Martin P. Transmission of hepatitis C virus infection in hemodialysis: current concepts. Int J Artif Organs 2008;31:1004-1016.
38. Nguyen DB, Bixler D, Patel PR. Transmission of hepatitis C virus in the dialysis setting and strategies for its prevention. Semin Dial 2019;32:127-134.
39. Bravo Zuniga JI, Loza Munarriz C, Lopez-Alcalde J. Isolation as a strategy for controlling the transmission of hepatitis C virus (HCV) infection in haemodialysis units. Cochrane Database Syst Rev 2016;(8):CD006420.
2. Alter HJ, Seeff LB. Recovery, persistence, and sequelae in hepatitis C virus infection: a perspective on long-term outcome. Semin Liver Dis 2000;20:17-35.
3. Agarwal SK, Dash SC, Gupta S, Pandey RM. Hepatitis C virus infection in haemodialysis: the 'no-isolation' policy should not be generalized. Nephron Clin Pract 2009;111: c133-c140.
4. Natov SN, Lau JY, Bouthot BA, Murthy BV, Ruthazer R, Schmid CH, et al. Serologic and virologic profiles of hepatitis C infection in renal transplant candidates. New England Organ Bank Hepatitis C Study Group. Am J Kidney Dis 1998; 31: 920-927.
5. Fissell RB, Bragg-Gresham JL, Woods JD, Jadoul M, Gillespie B, Hedderwick SA, et al. Patterns of hepatitis C prevalence and seroconversion in hemodialysis units from three continents: the DOPPS. Kidney Int 2004;65:2335-2342.
6. Lok AS, Chien D, Choo QL, Chan TM, Chiu EK, Cheng IK, et al. Antibody response to core, envelope and nonstructural hepatitis C virus antigens: comparison of immunocompetent and immunosuppressed patients. Hepatology 1993;18:497-502.
7. Centers for Disease Control and Prevention (CDC). Testing for HCV infection: an update of guidance for clinicians and laboratorians. MMWR Morb Mortal Wkly Rep 2013;62:362-365.
8. Gretch DR. Diagnostic tests for hepatitis C. Hepatology 1997;26(3 Suppl 1):43S-47S.
9. Young KK, Archer JJ, Yokosuka O, Omata M, Resnick RM. Detection of hepatitis C virus RNA by a combined reverse transcription PCR assay: comparison with nested amplification and antibody testing. J Clin Microbiol 1995;33:654-657.
10. Saab S, Brezina M, Gitnick G, Martin P, Yee Jr HF. Hepatitis C screening strategies in hemodialysis patients. Am J Kidney Dis 2001;38:91-97.
11. Kondo Y, Sung VM, Machida K, Liu M, Lai MM. Hepatitis C virus infects T cells and affects interferongamma signaling in T cell lines. Virology 2007; 361:161-173.
12. Rahnavardi M, Hosseini Moghaddam SM, Alavian SM. Hepatitis C in hemodialysis patients: Current global magnitude, natural history, diagnostic difficulties, and preventive measures. Am J Nephrol 2008;28:628-640.
13. Goudeau A, Dubois F. Incidence and prevalence of hepatitis B in France. Vaccine 1995;13 Suppl 1:S22-25.
14. Guh JY, Lai YH, Yang CY, Chen SC, Chuang WL, Hsu TC, et al. Impact of decreased serum transaminase levels on the evaluation of viral hepatitis in hemodialysis patients. Nephron 1995;69: 459-465.
15. Muller GY, Zabaleta ME, Arminio A, Colmenares CJ, Capriles FI, Bianco NE, et al. Risk factors for dialysis associated hepatitis C in Venezuela. Kidney Int 1992;41:1055-1058.
16. Jadoul M, Bieber BA, Martin P, Akiba T, Nwankwo C, Arduino JM et al. Prevalence, incidence, and risk factors for hepatitis C virus infection in hemodialysis patients. Kidney Int 2019;95:939-947.
17. Soni PN, Tait DR, Kenoyer DG. Hepatitis C virus antibodies among risk groups in a South African area endemic for hepatitis B virus. J Med Virol 1993;40:65-68.
18. Seck SM, Dahaba M, Gueye S, Ka EF. Trends in hepatitis C infection among hemodialysis patients in Senegal: results of a decade of prevention. Saudi J Kidney Dis Transpl 2014;25:1341-1345.
19. Chadha MS, Arankalle VA, Jha J, Banerjee K. Prevalence of hepatitis B and C virus infections among haemodialysis patients in Pune (western India). Vox Sang 1993;64:127-128.
20. Gosavi MS, Shah SK, Shah SR, Pal RB, Saldanha JA, Banker DD. Prevalence of hepatitis C virus (HCV) infection in Mumbai. Indian J Med Sci 1997;51:378-385.
21. Jasuja S, Gupta AK, Choudhry R. Prevalence and associations of hepatitis C viremia in hemodialysis patients at a tertiary care hospital. Indian J Nephrol 2009;19:62-67.
22. Chandra M, Khaja MN, Hussain MM, Poduri CD, Farees N, Habeeb MA, et al. Prevalence of hepatitis B and hepatitis C viral infections in Indian patients with chronic renal failure. Intervirology 2004;47:374-376.
23. Prakash S, Jain A, Sankhwar SN, Usman K, Prasad N, Saha D, et al. Prevalence of hepatitis B & C viruses among patients on hemodialysis in Lucknow, Uttar Pradesh. Clin Epidemiol Glob Health 2014;2:19-23.
24. Surendra Kumar P, Venu G, Madhusudhana Rao A, Balakrishnan N, SaraVanan T, Sofiarani A. Prevalence and risk factors of hepatitis C among maintenance hemo- dialysis patients at a tertiary care hospital in Coimbatore, India. J Clin Diagnostic Res 2011; 5:725-728.
25. Jamil M, Bhattacharya PK, Yunus M, Lyngdoh CJ, Roy A, Talukdar KK. Prevalence of hepatitis B and hepatitis C in haemodialysis population in a tertiary care centre in north eastern India. Int J Biomed Amp Adv Res 2016;7: 267-269.
26. Subramanian G, Vegad M, Vadsmiya M, Murawala S, Patel F. Seroprevalence of hepatitis C in renal failure patients on maintenance hemodialysis – Study in a tertiary care hospital – Western India. Int J Med Sci Public Health 2016;5:1.
27. Reddy AK, Murthy KV, Lakshmi V. Prevalence of HCV infection in patients on haemodialysis: survey by antibody and core antigen detection. Indian J Med Microbiol 2005;23:106-110.
28. Medhi S, Potukuchi SK, Polipalli SK, Swargiary SS, Deka P, Chaudhary A, et al . Diagnostic utility of hepatitis C virus core antigen in hemodialysis patients. Clin Biochem 2008;41:447-452.
29. Liu CH, Kao JH. Treatment of hepatitis C virus infection in patients with end-stage renal disease. J Gastroenterol Hepatol 2011;26:228-239.
30. Hinrichsen H, Leimenstoll G, Stegen G, Schrader H, Fölsch UR, Schmidt WE, et al. Prevalence and risk factors of hepatitis C virus infection in haemodialysis patients: a multicentre study in 2796 patients. Gut 2002;51:429-433.
31. Bukh J, Wantzin P, Krogsgaard K, Knudsen F, Purcell RH, Miller RH, et al. High prevalence of hepatitis C virus (HCV) RNA in dialysis patients: failure of commercially available antibody tests to identify a significant number of patients with HCV infection. Copenhagen Dialysis HCV Study Group. J Infect Dis 1993;168:1343-1348.
32. Joukar F, Besharati S, Mirpour H, Mansour Ghanaei F. Hepatitis C and hepatitis B seroprevalence and associated risk factors in hemodialysis patients in Guilan province, north of Iran: HCV and HBV seroprevalence in hemodialysis patients. Hepat Mon 2011;11:178-181.
33. Saab S, Martion P, Brezina M, Gitrich G, Yee HF Jr. Serum alanine aminotransferase in hepatitis C screening of the patients on hemodialysis. Am J Kidney Dis 2001; 37: 308-315.
34. Dentico P, Buogiorno R, Volpe A, Carlone A, Carbone M, Manno C, et al. Prevalence and incidence of hepatitis C virus (HCV) in hemodialysis patients: study of risk factors. Clin Nephrol 1992; 38:49-52.
35. Donahue JG, Munoz A, Ness PM, Brown DE Jr, Yawn DH, McAllister HA Jr, et.al. The declining risk of the post transfusion hepatitis C virus infection. N Engl J Med 1992; 327:369-373.
36. Tajbakhsh R. Prevalence of hepatitis C and B virus infectionsamong hemodialysis patients in Karaj, Iran. Saudi J Kidney Dis Transpl 2015; 26: 792-796.
37. Fabrizi F, Messa P, Martin P. Transmission of hepatitis C virus infection in hemodialysis: current concepts. Int J Artif Organs 2008;31:1004-1016.
38. Nguyen DB, Bixler D, Patel PR. Transmission of hepatitis C virus in the dialysis setting and strategies for its prevention. Semin Dial 2019;32:127-134.
39. Bravo Zuniga JI, Loza Munarriz C, Lopez-Alcalde J. Isolation as a strategy for controlling the transmission of hepatitis C virus (HCV) infection in haemodialysis units. Cochrane Database Syst Rev 2016;(8):CD006420.
| Files | ||
| Issue | Vol 12 No 6 (2020) | |
| Section | Original Article(s) | |
| DOI | https://doi.org/10.18502/ijm.v12i6.5041 | |
| Keywords | ||
| Hepatitis C; Enzyme linked immunosorbant assay; Polymerase chain reaction; Haemodialysis patients | ||
| Rights and permissions | |
|
This work is licensed under a Creative Commons Attribution-NonCommercial 4.0 International License. |
How to Cite
1.
Madhavan A, Sachu A, Balakrishnan A, Vasudevan A, Balakrishnan S, Vasudevapanicker J. Prevalence of hepatitis C among haemodialysis patients in a tertiary care hospital in south India. Iran J Microbiol. 2020;12(6):644-649.
