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A very high prevalence of hepatitis C virus infection among patients undergoing hemodialysis in Kosovo: a nationwide study

BACKGROUND: Patients on hemodialysis are at high risk for hepatitis C virus (HCV) infection if measures for effective control of HCV infection in the hemodialysis environment are not implemented. Whereas in developed countries isolated small-scale outbreaks of HCV in hemodialysis units are occasiona...

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Autores principales: Jakupi, Xhevat, Mlakar, Jana, Lunar, Maja M., Seme, Katja, Rudhani, Ibrahim, Raka, Lul, Vince, Adriana, Poljak, Mario
Formato: Online Artículo Texto
Lenguaje:English
Publicado: BioMed Central 2018
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6215601/
https://www.ncbi.nlm.nih.gov/pubmed/30390638
http://dx.doi.org/10.1186/s12882-018-1100-5
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author Jakupi, Xhevat
Mlakar, Jana
Lunar, Maja M.
Seme, Katja
Rudhani, Ibrahim
Raka, Lul
Vince, Adriana
Poljak, Mario
author_facet Jakupi, Xhevat
Mlakar, Jana
Lunar, Maja M.
Seme, Katja
Rudhani, Ibrahim
Raka, Lul
Vince, Adriana
Poljak, Mario
author_sort Jakupi, Xhevat
collection PubMed
description BACKGROUND: Patients on hemodialysis are at high risk for hepatitis C virus (HCV) infection if measures for effective control of HCV infection in the hemodialysis environment are not implemented. Whereas in developed countries isolated small-scale outbreaks of HCV in hemodialysis units are occasionally reported, HCV transmission in the hemodialysis environment still represents a substantial problem in low-resource countries. This study systematically assessed the prevalence of HCV infection among all patients at all hemodialysis centers in Kosovo, determined the HCV genotype distribution, and reviewed the main risk factors associated with HCV infection in this group of patients. METHODS: From January to March 2013, blood samples from all patients undergoing hemodialysis at all seven hemodialysis centers in Kosovo were collected. The samples were screened for the presence of anti-HCV antibodies, and seropositive samples were also tested for HCV RNA. Genotyping was performed by sequencing the core region of the HCV genome. Subsequently, face-to-face interviews were conducted with consented patients attending hemodialysis in December 2015 and with the management of all hemodialysis centers in Kosovo. RESULTS: The overall seroprevalence of HCV infection among hemodialysis patients in Kosovo was 53.0% (354/668), ranging from 22.3 to 91.1% at different centers. HCV RNA was detected in 323/354 (91.2%) seropositive patients. The most frequent HCV genotype was genotype 1a (62.2%), followed by genotypes 4d (33.1%), 1b (4.0%), and 2c (0.7%). The duration of hemodialysis and receiving dialysis at more than one center were identified as independent significant predictors of anti-HCV positivity. Shortage of staff, lack of resources, and inconsistent use of hygienic precautions and/or isolation strategies were observed. CONCLUSIONS: The prevalence of HCV infection among hemodialysis patients in Kosovo is extremely high. The relatively low prevalence of HCV infection in the general population, predominance of two otherwise rare HCV genotypes among hemodialysis patients, and longer history of hemodialysis as a predictor of HCV infection all indicate nosocomial transmission due to inappropriate infection control practices as the main transmission route. ELECTRONIC SUPPLEMENTARY MATERIAL: The online version of this article (10.1186/s12882-018-1100-5) contains supplementary material, which is available to authorized users.
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spelling pubmed-62156012018-11-08 A very high prevalence of hepatitis C virus infection among patients undergoing hemodialysis in Kosovo: a nationwide study Jakupi, Xhevat Mlakar, Jana Lunar, Maja M. Seme, Katja Rudhani, Ibrahim Raka, Lul Vince, Adriana Poljak, Mario BMC Nephrol Research Article BACKGROUND: Patients on hemodialysis are at high risk for hepatitis C virus (HCV) infection if measures for effective control of HCV infection in the hemodialysis environment are not implemented. Whereas in developed countries isolated small-scale outbreaks of HCV in hemodialysis units are occasionally reported, HCV transmission in the hemodialysis environment still represents a substantial problem in low-resource countries. This study systematically assessed the prevalence of HCV infection among all patients at all hemodialysis centers in Kosovo, determined the HCV genotype distribution, and reviewed the main risk factors associated with HCV infection in this group of patients. METHODS: From January to March 2013, blood samples from all patients undergoing hemodialysis at all seven hemodialysis centers in Kosovo were collected. The samples were screened for the presence of anti-HCV antibodies, and seropositive samples were also tested for HCV RNA. Genotyping was performed by sequencing the core region of the HCV genome. Subsequently, face-to-face interviews were conducted with consented patients attending hemodialysis in December 2015 and with the management of all hemodialysis centers in Kosovo. RESULTS: The overall seroprevalence of HCV infection among hemodialysis patients in Kosovo was 53.0% (354/668), ranging from 22.3 to 91.1% at different centers. HCV RNA was detected in 323/354 (91.2%) seropositive patients. The most frequent HCV genotype was genotype 1a (62.2%), followed by genotypes 4d (33.1%), 1b (4.0%), and 2c (0.7%). The duration of hemodialysis and receiving dialysis at more than one center were identified as independent significant predictors of anti-HCV positivity. Shortage of staff, lack of resources, and inconsistent use of hygienic precautions and/or isolation strategies were observed. CONCLUSIONS: The prevalence of HCV infection among hemodialysis patients in Kosovo is extremely high. The relatively low prevalence of HCV infection in the general population, predominance of two otherwise rare HCV genotypes among hemodialysis patients, and longer history of hemodialysis as a predictor of HCV infection all indicate nosocomial transmission due to inappropriate infection control practices as the main transmission route. ELECTRONIC SUPPLEMENTARY MATERIAL: The online version of this article (10.1186/s12882-018-1100-5) contains supplementary material, which is available to authorized users. BioMed Central 2018-11-03 /pmc/articles/PMC6215601/ /pubmed/30390638 http://dx.doi.org/10.1186/s12882-018-1100-5 Text en © The Author(s). 2018 Open AccessThis article is distributed under the terms of the Creative Commons Attribution 4.0 International License (http://creativecommons.org/licenses/by/4.0/), which permits unrestricted use, distribution, and reproduction in any medium, provided you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons license, and indicate if changes were made. The Creative Commons Public Domain Dedication waiver (http://creativecommons.org/publicdomain/zero/1.0/) applies to the data made available in this article, unless otherwise stated.
spellingShingle Research Article
Jakupi, Xhevat
Mlakar, Jana
Lunar, Maja M.
Seme, Katja
Rudhani, Ibrahim
Raka, Lul
Vince, Adriana
Poljak, Mario
A very high prevalence of hepatitis C virus infection among patients undergoing hemodialysis in Kosovo: a nationwide study
title A very high prevalence of hepatitis C virus infection among patients undergoing hemodialysis in Kosovo: a nationwide study
title_full A very high prevalence of hepatitis C virus infection among patients undergoing hemodialysis in Kosovo: a nationwide study
title_fullStr A very high prevalence of hepatitis C virus infection among patients undergoing hemodialysis in Kosovo: a nationwide study
title_full_unstemmed A very high prevalence of hepatitis C virus infection among patients undergoing hemodialysis in Kosovo: a nationwide study
title_short A very high prevalence of hepatitis C virus infection among patients undergoing hemodialysis in Kosovo: a nationwide study
title_sort very high prevalence of hepatitis c virus infection among patients undergoing hemodialysis in kosovo: a nationwide study
topic Research Article
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6215601/
https://www.ncbi.nlm.nih.gov/pubmed/30390638
http://dx.doi.org/10.1186/s12882-018-1100-5
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