FP722CURRENT STATUS OF HCV INFECTION IN HEMODIALYSIS PATIENTS IN EGYPT

Abstract

Introduction and Aims: Egypt has the highest prevalence of hepatitis C virus (HCV) in the world (14.7 of the population). Egypt also is has the highest prevalence of HCV in HD patients. We aimed to survey HCV in HD patients, assessing its prevalence, seroconversion rate, and risk for seroconversion in Egypt. Methods: The study was implemented by the nephrology department, Ain Shams University) from 2009 to 2012. We retrospectively revised the records in multi-hemodialysis centers that have valid follow-up records. We have enrolled 22,070 patients on regular HD in multi-hemodialysis centers in 20 Egyptian governorates. All patients were evaluated using a questionnaire form for assessment of risk factors for HCV seroconversion such as; age, gender, duration of HD, blood transfusion, etc. Results: 22,070 patients their mean age range 51.52 + 13.52 years, males were (58.9%) and females were (41.1%). main cause of renal failure is HTN in 34.4%, DM in 16.8%, Glomerulonephritis in 7.6 %, obstructive uropathy in 7.8%. chronic pyelonephritis 5.8% APKD in 4.1%, analgesic nephropathy 1.7%, unknown 13.5%, others 8.3%. The mean HD duration 50.15 + 40.08 months. Previous surgical procedure in (37.2%) of patients, blood transfusion in (61.1%) of patients. The isolation procedure is documented in 16491 (74.7%) patients , (75.3 %) were isolated while (24.7%) not isolated. Infection control measures reported in (82.4%) of patients, (14.8 %); (1.5%); 1 (83.7%) were not, partially or totally implement infection control measures respectively]. Switching of HD centers reported in 6364 out of 18221 patients (34.9%). Antibodies to HCV were detected in 8416 patients (38.1%) at the start of dialysis. While antidodies to HBV were positive in 670 patients (3%). Positive family history for HCV and HBV infection were reported in 3531 patients (16 %), 60 patients (0.3%) respectively. History of shistozomiasis were detected in 3249/17394 patients (18.7%). The shistosama mansoni were reported in 1268/15987 patients (7.9%), while shistosoma hematobium in 1851/ 15986 patients (11.6%). The prevalence of HCV by the time of data collection was 11204 patients (50.7%). The number of patients acquired infection after start of HD 2788 patients with a cumulative seroconversion rate (20.4%). The mean timing of seroconversion 4.25 +15.63 months. Incidence Serroconversion per 1000 person year 60.5 (6%) but highest serroconversion rate in 1st year after hemodialysis (8.9 % 1st year). Serroconversion of HCV were highly signifant in older age (t=7.92 p<0.001), longer hemodialysis duration (t=2.67 p<0.001). Univariate analysis of risk factors showed significant high risk with male gender (p<0.007), blood transfusion (p<0.001), surgery (p<0.001), HCV patients isolation , infection control measures (p<0.001), switching between HD units(p<0.001), history of shistozomiasis; global and history of shistosoma Mansoni or Hematobium individually (<0.001). multivariate analysis of risk factors support risk factors of blood transfusion, surgery, switching between HD units, infection control measures and bilharsiasis but not support the age or sex as risk factor for serroconversion. Conclusions: The prevalence of HCV infection in HD patients in Egypt is 50.7%, 38.1% of patients has positive HCV antibodies at start of HD, a cumulative serroconversion rate 20.4%. Incidence Serroconversion per 1000 person year 60.5. The most significant risk factors of serroconversion were blood transfusion, surgery, switching between HD units, infection control measures and shistozomiasis.