Super infection with two genotypes of hepatitis C virus in Syrian hemodialysis patients

الملخص EN

Objective: Hepatitis C virus is a global and major cause of chronic liver disease.

Most of the infected HCV carriers are asymptomatic.

HCV has six major genotypes according to its viral genome, numbered one to six.

HCV is more common among patients with endstage renal disease (ESRD) that require hemodialysis compared to the general population.

ESRD patients with one genotype HCV infection have a high risk of developing infection with another HCV genotype (super infection) from dialysis centers.

Many reasons appear to be involved including: many centers are administered by untrained staff of infection control and a lot of contaminated equipment with HCV in dialysis centers.

The aim of this work was to investigate the super infection with two genotypes of hepatitis C virus (HCV) in patients with end-stage renal disease, who presented to dialysis centers in Syria, and the causes that lead to this super infection.

Methods: During one year (from January 2018 till January 2019), we examined 25 ESRD patients who were under hemodialysis by using Roche MagNA pure (automated extraction).

RNA samples were tested together with negative controls on Roter-Gene machine using Sacace Real Time HCV genotype.

The target population includes patients who underwent hemodialysis in dialysis centers in Syria.

Results: Of the 25 patients enrolled in this study (4 patients) 16% have two genotypes {genotypes 1a-4 found in 3 patients (12%), and genotypes 1b-4 found in one patient (4%)}, from 3 different hemodialysis centers.

Conclusions: There were an increasing infection with HCV among ESRD patients who underwent hemodialysis and the possibility to have infection with more than one genotype of HCV (super infection) during dialysis session.

There are many reasons associated with HCV transmission within a facility that could be avoided by routine monitoring for infection in the facilities, follow CDC recommendations for HCV screening of hemodialysis patients, train the dialysis stuff routinely in a program for preventing infection.

of chronic liver disease.

Current estimates suggest that between 130 and 170 million people worldwide are infected with HCV, and more than 350,000 people die from HCV-related illnesses each year.

Most of the infected HCV carriers are asymptomatic.1 HCV is an enveloped RNA virus with a high degree of genomic variability.

HCV has six major genotypes according to its viral genome,2 numbered one to six.

Most of HCV patients in Syria have infected with genotype 4.3 HCV is a blood-borne pathogen, and transmission modes of the disease are parenteral and to a lesser extent sexual.

Another important ways of transmission include intravenous drug misuses, needle stick injury and sharing tooth brushes/razors.4 Patients in hemodialysis units have an increased risk for contracting HCV, and high prevalence rates found in hemodialysis units around the world.5 HCV is more common among patients with endstage renal disease (ESRD) who require hemodialysis compared to the general population.4-8 The ESRD patients with one genotype HCV infection have a high risk of developing infection with another HCV genotype (super infection) from dialysis centers.9 Many reasons appear to be involved including: many centers are administered by untrained staff of infection control and a lot of contaminated equipment with HCV in dialysis centers.4 There are a few studies in this field and they have insufficient data to determine the exact percentage.10 The aim of this cross-sectional study is to investigate the super infection with two genotypes of HCV in ESRD patients who presented to dialysis centers in Syria, and the causes that lead to this super infection.

There are no previous studies in Syria about this topic.

This research could lead to more efforts to be done to limit the incidence of HCV transmission in this group of patients.