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 Table of Contents  
ORIGINAL ARTICLE
Year : 2020  |  Volume : 22  |  Issue : 1  |  Page : 23-27

Seroprevalence of hepatitis B virus and hepatitis C virus infection in haemodialysis patients at tertiary care hospital in Western Rajasthan, India


1 Department of Microbiology, Dr. S. N. Medical College, Jodhpur, Rajasthan, India
2 Department of Microbiology, ESIC Medical College and Hospital, Faridabad, Haryana, India

Date of Submission26-Dec-2019
Date of Decision04-Mar-2020
Date of Acceptance11-Jun-2020
Date of Web Publication13-Aug-2020

Correspondence Address:
Dr. Vinod Kumar Maurya
Department of Microbiology, ESIC Medical College and Hospital, Faridabad - 121 001, Haryana
India
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Source of Support: None, Conflict of Interest: None


DOI: 10.4103/jacm.jacm_38_19

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  Abstract 


CONTEXT: Viral hepatitis has become the most common viral infections encountered in dialysis patients. Patients undergoing haemodialysis (HD) have a significantly increased risk of exposure to hepatitis B, hepatitis C, HIV and other blood-borne viruses. Hepatitis B virus (HBV) and hepatitis C virus (HCV) infections are the most important causes of morbidity and mortality among HD patients. Patients on routine maintenance HD fail to maintain protective titres against HBV that further poses the risk of developing viral hepatitis. In this study, we are studying the prevalence of HBV and HCV infection among patients undergoing maintenance HD.
SETTING AND DESIGN: This was a cross-sectional study.
METHODS: This study aims to detect and compare the seroprevalence of HBV and HCV infection among chronic HD patients. This study was conducted from July 2015 to January 2017. All patients (n = 150) of various age groups admitted during the study period for maintenance HD at our tertiary care hospital were included. Viral markers were detected using third-generation enzyme-linked immunosorbent assay kits available commercially.
STATISTICAL ANALYSIS USED: Statistical analysis was done with the help of statistical package for SPSS.
RESULTS: Out of 150 patients recruited into the study, 7 (4%) were positive for hepatitis B surface antigen and 29 (19.33%) were positive for HCV. One (0.67%) patient was found positive for both HBV and HCV infections. In this study, the duration of dialysis was significantly correlated with seropositivity for both HCV and HBV (P ≤ 0.0001). The number of blood units transfused was also found to be significantly associated with seropositivity (P ≤ 0.0001).
CONCLUSIONS: The prevalence of HCV is more common compared to HBV infection in HD patients. Seropositivity significantly correlates with duration of dialysis. The number of blood units transfused is also significantly associated with seropositivity.

Keywords: Haemodialysis, hepatitis B, hepatitis C


How to cite this article:
Khullar S, Parihar RS, Khatri PK, Maurya VK. Seroprevalence of hepatitis B virus and hepatitis C virus infection in haemodialysis patients at tertiary care hospital in Western Rajasthan, India. J Acad Clin Microbiol 2020;22:23-7

How to cite this URL:
Khullar S, Parihar RS, Khatri PK, Maurya VK. Seroprevalence of hepatitis B virus and hepatitis C virus infection in haemodialysis patients at tertiary care hospital in Western Rajasthan, India. J Acad Clin Microbiol [serial online] 2020 [cited 2020 Sep 30];22:23-7. Available from: http://www.jacmjournal.org/text.asp?2020/22/1/23/291894




  Introduction Top


Hepatitis B virus (HBV) and hepatitis C virus (HCV) represent a major global health burden. It is estimated that more than 257 million people are infected with HBV worldwide. Among all, 75% of them are from Asia, of which about 50 million people are from India.[1],[2] HCV affecting an estimated 180 million individuals has been reported worldwide.[3] According to the World Health Organization, there were 175 million new cases infected with HCV, corresponding to 3% of the world population.[1] In India, approximately 13 million people are infected with chronic HCV infection.[4] As the infection caused by HCV is of highly asymptomatic nature, most of the cases remain undiagnosed.[5]

Viral hepatitis has become the most common viral infections encountered in dialysis patients. Patients undergoing haemodialysis (HD) have a small but significantly increased risk of exposure to hepatitis B, hepatitis C, HIV and other blood-borne viruses. Prolonged vascular exposure and multiple blood transfusions, contaminated devices, equipment and supplies, environmental surfaces and attending personnel play a crucial role in the nosocomial transmission of these infections. HBV and HCV infections are the most important causes of morbidity and mortality among HD patients.[6],[7] Therefore, patients suffering from chronic kidney disease in whom dialysis is anticipated should be screened for hepatitis B and C, as well as HIV infections. The prevalence of HBV is lesser as compared to HCV due to the availability of efficient vaccine against HBV. The prevalence of HCV infection among HD patients is high and varies from country to country (1%–84.6%) and between dialysis units within a single country.[7],[8],[9],[10] Measures to prevent the infections in dialysis patients include HBV vaccination before starting HD, isolating HBV- or HCV-infected patients, the use of dedicated dialysis machines and regular surveillance for HBV and HCV infection.[8]


  Methods Top


Aims and objectives

The aim of this study was to detect and compare the seroprevalence of HBV and HCV in patients undergoing HD.

In this study, a total of 150 patients of various age groups undergoing chronic HD during July 2015 to January 2017 at our tertiary care hospital were taken into consideration. All patients were screened for HBV, HCV and HIV before going through HD. The dialysis units have a total of 25 dialysis machines including 1 dedicated machine for HD patients positive for HBV, 4 for HCV and 1 for HIV-infected patients.

Written and informed consent was taken before the collection of the blood sample. Patients' medical records were reviewed to obtain detailed information regarding demographic and physical profile details such as age, gender, urban/rural domicile clinical diagnosis and duration of dialysis, history of blood transfusions, alcohol intake, history suggestive of hepatitis in spouse and body piercing/s (tattoos). Further, the results of renal function tests and liver function tests were also recorded for all patients.

Methodology

All the collected and processed sera were tested for serological markers for hepatitis B surface antigen (HBsAg) using third-generation enzyme-linked immunosorbent assay (ELISA) kit Merilisa HBsAg (Meril Diagnostics, India) and hepatitis C antibody using third-generation ELISA kit ErbaLisa HCV (Transasia Biomedical Ltd., India).

Ethical clearance

Ethical clearance was obtained from the Institutional Ethics Committee, Dr. Sampurnanand Medical College, Jodhpur (ref. no. F.1/Acad/MC/JU/15/16565, Date: 22 September 2015). A complete description of the aims of the study and assurance of confidentiality for any information was given to all patients and parents/guardians (in case of children) who were potential study participants.

Statistical analysis

Statistical analysis was done with the help of IBM SPSS Statistics for Windows, Version 20.0. Armonk, NY: IBM Corp.


  Results Top


In this study out of 150 cases, 107 (71.22%) patients were males and 43 (28.66%) patients were females. The age of patients ranged from 16 to 65 years. In our study, majority of the patients were among 41–60 years' age group (44%) [Table 1].
Table 1: Age distribution of haemodialysis patients

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Underlying diseases that led to progression to end-stage renal disease in patients undergoing HD in this study were diabetes mellitus (30.67%), hypertensive nephropathy (24%), chronic glomerulonephritis (21.33%), urologic diseases (19.33%), cystic renal disease patients (3.33%) and patients with unknown aetiology (1.33%) [Table 2].
Table 2: Aetiology of end-stage renal disease in haemodialysis patients in patients under study

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Out of 150 patients recruited into the study, 7 (4%) were positive for HBsAg and 29 (19.33%) were positive for HCV. One (0.67%) patient was found positive for both HBV and HCV infections. In this study out of a total of 150 patients, 40 patients were vaccinated against HBV. Among these 40 patients, seropositivity for HBV and HCV was 2.5% and 12.5% respectively. Among 110 patients, who did not receive HBV vaccination before the start of HD, 24 (21.82%) were seropositive for HCV and 6 (5.45%) patients were seropositive for HBV. One patient (0.67%) who had co-infection of HBV and HCV was non-vaccinated.

In patients with less than or equal to one-year duration of dialysis, 2 (2.27%) were seropositive for HCV and 1 (1.13%) was seropositive for HBV; however, among patients with 1–3-year duration of dialysis, 5 (14.71%) were seropositive for HCV and 2 (5.88%) were seropositive for HBV. In patients who underwent dialysis for more than three-year duration, 22 (78.57%) were seropositive for HCV and 4 (14.29%) were seropositive for HBV. One patient (3.57%) had co-infection of HBV and HCV. In this study, the duration of dialysis was significantly correlated with seropositivity for both HCV and HBV (P ≤ 0.0001) [Table 3] and [Table 4].
Table 3: Distribution of patients according to duration of dialysis for hepatitis B virus

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Table 4: Distribution of patients according to duration of dialysis for hepatitis C virus

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In this study, it was observed that those patients who received 0–1 blood units for transfusion were found negative for HCV or HBV. Among 82 patients who received 2–5 units of blood, the seropositivity for HBV and HCV was 1 (1.22%) and 3 (3.66%), respectively. In 14 patients who received 6–10 units of blood, 2 (14.29%) were positive for HBV and 10 (71.43%) patients were positive for HCV. Among 22 patients who received more than 10 units of whole blood, 4 (18.18%) and 16 (72.73%) were positive for HBV and HCV, respectively, and 1 patient (4.55%) in this group had co-infection. The number of blood units transfused was also found to be significantly associated with seropositivity (P ≤ 0.0001) [Table 5].
Table 5: Distribution of patients based on blood units transfused

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  Discussion Top


In patients undergoing HD, the risk of hepatitis is still a serious problem despite the availability of serological tests and vaccines against HBV infection.[11] Blood donors' positivity for HBV and HCV may further pose risk to infection when infected blood gets transfused in patients on maintenance dialysis. A study from Rajasthan shows the prevalence of hepatitis B to be 1.83% and HCV 0.28%.[12] In our institution, blood bank screens all donated blood by ELISA for HBV, HCV and HIV viral markers.

In our study, majority of the patients were observed in 41–60 years' age group (44%). Like our study, several other studies also show majority of the patients in the age group of 40–60 years.[7],[13],[14],[15]

In our study, we found that 4% of the patients were seropositive for HBV, which was higher as compared to studies conducted by some authors.[8],[13],[16] Seroprevalence observed in some of the studies was consistent with our study [17],[18],[19] but lower in comparison to observations by few authors.[7],[20],[21] Varying prevalences are observed for HCV seropositivity also.[16],[18],[19],[22]

Studies on the seroprevalence of HCV and HBV co-infection in HD patients are rare. In studies conducted worldwide, co-infection rates ranged from 0% to 37.1%.[7],[13],[19],[20] In our study, we found only a single case (0.67%) of dual infection among HD patients.

The incidence of infection was not significant between genders in our study (P = 1.000), whereas Joukar et al. found a significant relationship (P < 0.05) between gender and HCV prevalence.[13] In addition, the prevalence of hepatitis C has been found significant with increasing period of duration of dialysis in our study (P < 0.0001). Similar findings have been reported by some authors.[7],[13] A few studies differ from ours, in that no significant correlation was observed between duration of dialysis and HCV seropositivity.[23],[24]

In our study, a statistically significant correlation was observed in the mean duration of dialysis between HBV-positive (45.71 months) and HBV-negative (17.51 months) and HCV-positive (48.76 months) and HCV-negative (11.61 months) patients (P ≤ 0.001). This correlation of duration of dialysis and seropositivity was consistent with the observations made by many authors worldwide.[24],[25],[26]

When we compared mean number of blood units transfused, we found that mean units of blood transfused were 11.00 in HBV-positive patients and 4.37 in HBV-negative patients. Similarly, the mean number of blood units transfused in HCV-positive patients was 11.79 and HCV-negative patients was 2.97. Hence, we observed in our study that the mean number of blood units transfused was significantly higher in seropositive patients than in seronegative patients for both HBV and HCV infections (P ≤ 0.0001). A similar correlation has been reported by studies around the world.[23],[24],[27]


  Conclusions Top


The above-mentioned findings of the current study indicate that HCV infection is more common than HBV among HD patients. Patients having vaccination against HBV show a lower prevalence of HBV infection. Infection rate correlates with duration of dialysis. The number of blood units transfused is significantly associated with seropositivity.

Financial support and sponsorship

Nil.

Conflicts of interest

There are no conflicts of interest.



 
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  [Table 1], [Table 2], [Table 3], [Table 4], [Table 5]



 

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