The prevalence of HCV antibody among haemodialysis patients in Cairo governorate sector C and its relation to their glucose homeostasis

Abstract

Hepatitis C is a disease with a significant global impact. According to the World Health Organization there are 170 million people infected with the hepatitis C virus (HCV), corresponding to 3% of the world’s total population. There are considerable regional differences. In some countries, e.g., Egypt, the prevalence is as high as 20%.In Africa and the Western Pacific the prevalence is significantly higher than in North America and Europe. (Anonymous, 2004) According to recent statistics, the worldwide prevalence of HCV infection is ~3% and affects around morethan 170 million people globally.(Gaccheet al., 2010) The number of patients actually HCV RNA positive is estimated to be around 80 to 90% of all HCV-antibody positive persons. Certain groups are preferentially affected: The highest risk factor in most instances is injection drug use. But patients undergoing hemodialysis and persons who received blood transfusions before 1991 are at risk also. In Europe and the United States chronic hepatitis C is the most common chronic liver disease. The majority of liver transplants performed in these regions are for chronic HCV. (Mauss et al., 2010) Hepatitis C is transmitted primarily via parenteral routes. Mucosal exposures to blood or serum-derived fluids and environmental sources also play a role in HCV transmission. Currently the predominant risk factor for HCV in the United States is intravenous drug use. Prior to 1990, blood transfusions contributed the majority of cases; however, with the adoption of effective blood donor screening programs and eventually universal serological screening, this method of transmission has been virtually eliminated. (Shettyet al., 2009) A number of risk factors have been identified for HCV infection among dialysis patients. These include blood transfusions, the duration of hemodialysis, the prevalence of HCV infection in the dialysis unit, and the type of dialysis. The risk is higher with in-hospital hemodialysis as opposed to peritoneal dialysis. The best strategy to prevent hemodialysis-associated HCV transmission is subject to debate.(Mauss et al., 2010) Chronic hepatitis C infection mainly affects liver but can be associated with various extrahepatic manifestations including cryoglobulinemia,sialadenitis, glomerulonephritis, and porphyria cutaneatarda. (Fabriziet al., 2013) Severalstudies reported that HCV infection may also contribute to the development of diabetes, and higher prevalence of type 2 diabetes mellitus has been observed in the developed world (2% to 9.4%) in patients with HCV infection than in those with other forms of chronic hepatitis. (Younossiet al., 2013) This study had surveyed 434 haemodialysis patients in four big hospitals in Cairo that was classified as sector C hospitals for evaluation of the present state of hepatitis C as regarding is prevalence and possible risk factors of transmission then in the second stage of the study; 100 hundred patients were randomly selected and distributed according to HCV infection into two groups: Group (I): 50 patients with HCV antibody positive. Group (II): 50 patients with HCV antibody negative. The study was carried on 2 stages; the 1st one was in the form of survey study using a questionnaire form consisted of 15 parameters to investigate the demographic criteria and susceptibility to different possible risk factors accused in HCV transmission, and this stage involved 434 patients. The collected data was analyzed using statistical methods in SPSS 21 program. The second stage of the study was conducted on 100 patients who were selected from the surveyed community and divided into 2 groups; 1. Group I involved 50 haemodialysis patients with HCV antibody positive 2. Group II consisted of 50 haemodialysis patients with HCV antibody negative. Exclusion criteria in the form of: • Patients ≤ 18 years old. • Diabetic patients. • Patients with end stage liver disease -child’s B&C patients. • Patients on regular haemodialysis for ≤ 6 months. • Patients with HBs antigen positive. All the patients in the two groups were subjected to full clinical examination CBC, renal function tests (pre-dialysis), serum calcium and phosphorus, fasting blood glucoses (mg/dl), 2 hours post-prandial blood glucose (mg/dl), Fasting insulin (µU/ml) and HbA1C. Insulin resistance and beta cell function assessed through the calculation of homeostatic model assessment (HOMA). Group I patients were specially subjected to liver function test including ALT, AST, total protein, serum albumin, bilirubin PT, PTT and INR and abdominal ultrasonography.

In conclusions; the present study revealed that: • Hypertension is the most common cause of CKD in the surveyed people and it accounts for 37.6% of cases. • The prevalence of HCV antibody in the screened units was 65.9% • 33.64% of patients had undergone seroconversion from HCV antibody –ve into HCV antibody +ve. • 32.19% of the seroconverted individuals had undergone seroconversion in the 1st year of haemodialysis while 54.79% had experienced seroconversion between 1-5 years of haemodialysis, 9.59% between 5-10 years and only 5% of the seroconverted population got HCV antibody positivity after 10 years experience of haemodialysis. • The calculated seroconversion rate is 6.1% per year. • Only 2.5% of the totally surveyed population have HBs antigen positive. • According to the isolation strategy, 23.5% of patients have an advantage of patient isolation only while 76.5% have an extra advantage of patient and personnel isolation. • Only 6% of the surveyed people have history of schistosomiasis. • There is a significant statistical impact for each of blood transfusion, history of previous surgery, isolation procedures, vascular access and history of schistosomiasis on seroconversion. • The duration of haemodialysis has a statistically significant effect on seroconversion and it is the most important predictor parameter on seroconversion. • Patients with interstitial nephritis and obstructive uropathy have a double risk for seroconversion. • Diabetic patients had an advantage of being less liable to get seroconverted by about 50% less than the others as well as those patients with patients and personnel isolation strategy. • There is a statistically significant difference between group (I) and group (II) patients regarding total leucocytic count, blood urea, serum creatinine, serum calcium, phosphorus and serum albumin. • There is also a statistically significant difference between group (I) and group (II) patients regarding fasting blood sugar, fasting insulin and insulin resistance as calculated by HOMA-IR. • Group I patients showed:  Fasting blood sugar showed a significant –ve correlation with serum uric acid and β-cell sensitivity but +ve correlation with serum calcium, fasting insulin and insulin resistance.  Insulin resistance showed a significant positive correlation with serum calcium, fasting blood sugar, fasting insulin and β-cell sensitivity. • Group II patients showed:  A significant +ve correlation between fasting blood sugar and serum calcium.