Disease Patients on Maintenance Haemodialysis in Aden, Yemen: A - PowerPoint PPT Presentation

Hepatitis C Virus Infection among End Stage Renal Disease Patients on Maintenance Haemodialysis in Aden, Yemen: A Retrospective Study Presenter: Assistant Professor Khadiga Aman Aden University, Faculty of Medicine and Health Sciences, Internal Medicine Department, Khormaksar, Aden, Yemen Email: Khak-2010@hotmail.com Co-authors: Saba Kassim PhD/ Queen Mary university of London, UK Reema Aman MD/Tayba Haemodialysis centre , Aden, Yemen Aamenah Hawash BSc/ Queen Mary university of London, UK Mustafa Al-Shagga MD/University of Nottingham, Malaysia Sami Al-Dubai PhD/International Medical University / Malaysia

Background  Hepatitis C virus infection (HCV) is a common nosocomial infection among end stage renal disease (ESRD) patients on haemodialysis (HD) 1  Hepatitis C contributes to high mortality and morbidity among this patients 2  The prevalence of contracting HCV during haemodialysis varies from country to country 21,18,22

Continued……  Tight infection control measures in developed countries has minimised the transmission rate in this patients 3  HCV still remains high in the developing world 4,5,6,7  Risk factors for HCV transmission in this patients include : 1. Transfusion of blood 9,10 ; 2. Sharing HD machines 14 ; 3. Performing haemodialysis in multiple centres 16,17 ; 4. Duration of haemodialysis 16,17 ; and 5. Socio-demographic factors 13,18

Aims To assess the prevalence and factors associated with HCV infection among ESRD patients on HD in the three available centres in Aden, Yemen.

Methods  A retrospective study was conducted between May and July 2013 in all the HD centres in Aden city  Records of 243 patients were reviewed and data of 219 patients was extracted and analysed  Exclusion criteria: aged under 18 years, positive for HBs Ag and with dual HCV and HBV infection.

 Clinical and non clinical data extracted included: a. Anti-hepatitis C positive or negative a. Risk factors for HCV transmission (e.g. Duration of haemodialysis, Surgical intervention and Attending more than one of haemodialysis centre) c. Socio-demographical data (e.g. age, gender, occupation and marital state)  Descriptive, bivariate (chi Squared and unpaired T- Test) and multivariate poisson regression modelling were used in data analyses

Results The mean ±SD age of patients was 47.08±13.9 (range18-80) years, 70% males and 17% were unemployed Of 219 patients 40.2% (95 % CI 33.64 %-46.73%) were anti HCV positive 0 0 88(40.2%) Anti HCV+ 131(59.8%) Anti HCV -

In bivariate analysis only duration of HD and attending more than one centre for HD associated significantly (p≤ 0.05) with HCV. Table 1: Chi square tests of factors associated with anti HCV-positive (n=219) variable Anti HCV positive Anti HCV negative P -Value N (%) N (%) Surgery Yes 20 (40.8) 29 (59.2) NS No 68 (40) 102 (60) Blood transfusion Yes 67(41.9) 93 (58.1) NS No 21 (36.2) 38 (63.8) Access Fistula 87(42.4) 118 (57.6) NS Catheter 1 (7.1) 13 (92.9) Attending HD in more than one centre Yes 42 (53.2) 37(46.8) 0.003 No 46 (32.9) 94 (67.1) Travel Yes 23 (43.4) 30 (56.6) NS No 65 (39.3) 101(60.8)

In multivariate analysis (Table 2), after controlling for age, the significant predictors of anti-HCV positive were the duration of HD and attending more than one center for HD, (p=0.0005 and p=0.004, respectively). Table 2: Multivariate analysis of factors associated with anti HCV-positive AOR a , 95%CI b Explanatory variables P -Value 1.01 (99-1.03) Age .119 Duration of HD 1.01 (1.00-1.02) .0005 1.87 (1.22-2.88) Attending more than one centre .0004 a AOR: Adjusted odd ratio; b 95%CI: 95% confidence interval

Discussion The first retrospective study to report the estimated prevalence of HCV and its associated factors in ESRD patients receiving HD in multiple centres in Aden A prevalence of 40.2% of HCV infection was found and was in accord with figures reported in neighbouring countries such as Egypt (42.2%) 21 , Libya (31.1%) 18 , Syria (48.9) 22 The association of duration of HD with HCV lent further support to the current literature 23, 17, 4, 24 and likewise the history of receiving HD at more than one HD centre 29

Conclusions The prevalence of HCV was significant among ESRD patients underwent HD in these centres Attending more than one centre for HD, and HD for longer durations predicting contract of HCV among ESRD patients Enhancing existing infection control measures and allocating more resources to HD centres warrants prioritisation and consideration

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