The Prevalence of Hcv Infection among Renal Failure Patients Before Starting Heamodialysis Treatment at Muhimbili National Hospital

HCV infection is common and associated with significant morbidity and mortality among heamodialysis (HD) patients [1]. Heamodialysis is a trusted intermediate procedure for management of chronic kidney disease (CKD) patients. As such CKD is an immunedeficient state, hence blood borne viral infection particularly HCV pose great risk to patients treated by heamodialysis [2]. A high prevalence of HCV infection in heamodialysis patients has been reported in heamodialysis units since the introduction of heamodialysis therapy. Risk factors such as the number of blood transfusions or duration on heamodialysis. The prevalence of HCV infection in patients undergoing dialysis is greater than that in the general population, suggesting that patients on dialysis may be at higher risk of acquiring HCV infection [3].


2/3
Res Med Eng Sci [9]. However, the prevalence of HCV varies widely from country to country and also from center to center, even within the same country. This can be attributed to variations in the implementation of infection control measures in these heamodialysis units [10].
There is a scarce of information about HCV in Tanzania, and no published data on the seroprevalence of HCV among heamodialysis patients. Thus the magnitude of HCV transmission within heamodialysis units is still unclear and therefore general recommendations for prevention have not been developed. Therefore this study aimed to determine the prevalence of HCV infection among patients undertaking HD treatments at Muhimbili National Hospital, in Tanzania.

Materials and Methods
Study sample and data collection 120 patients were randomly selected fromMuhimbili National Hospital. All patients were interviewed for demographic dataand risk factors to HCV infections including history of number of blood transfusion and surgical interventions.

Antibodies screening
All the subjects were screened for anti HCV antibodiesthird generation test according to the manufactureinstructions (The SD-BIO-LINE HCV TEST).

Statistical analysis
Chi-square test were used to accesses the association between HCV positivity and variables. Statistical significance was evaluated at 0.05 levels. A total of 120 patients were recruited from May to July, 2016. Among of these 101 (84.2%) were males and 19 (15.8%) were females. The overall average age was 51.6 (SD 1.2) years and ranged from 22 to 87 years. Majority of the study participant were in the age group of 55-64, constituting 34(28.3%). Majority of patients had chronic renal failure 111 (92.5%) while 9 (7.5) had acute renal failure. Out of 120 patients, 4 tested positive for HCV, giving a seroprevalence of 3.3%. Among 101 (100%) males, 3 (2.9%) were tested positive for HCV, whereas 1 (5.3%) female out of 19 (100%) tested positive. The difference is not statistically significance (Chi-square=0.26; p-value=0.61). There was no association of anti-HCV seroprevalence between age groups and education level with p-value of 0.66 and 0.11 respectively. 24 (20%) patients had history of blood transfusion while 27 (22.5%) had history of surgery. The results also show that there is slightly association of blood transfusion and anti-HCV positive results with Chi-square= 7.76; p-value=0.06, while there is no statistical significance for history of surgery and HCV infection (Chi-square=1.78; p-value=0.18) ( Figure  1) (Table 1-3).

Discussion
HCV infection has a negative impact on the survival of heamodialysis patients, attributed mostly to HCV-related liver disease and its complications. There is also concern about some adverse outcomes after kidney transplantation in HCV-infected patients. Reduced long term patient and graft survival have been observed in HCV-infected kidney recipients. This is the first study to investigate the seroprevalence among renal failure patients before starting heamodialysis treatment at MNH. The seroprevalence (3.3%) was low compared with the study which was done in northwest of Tanzania in the general population; the prevalence of HCV was reported to be 18.8% [5,10] and in other African countries also, for example, 8% in Kenya and 4.5% in Sudan [4,3] strict adherence to universal infection control procedures, combined with other preventative measures and regular screening of patients and staff might explain the low seroprevalence of HCV. Males were more prominent in this study (84.2%) as compared to females, and HCV prevalence sex ratio was 3:1 for males and females. This is consistent with other study conducted [4,2] indicating that the overall seroprevalence among males and females was 66.7% versus 33.3%, respectively and males comprised a greater proportion (67.8%) of all the study participants. There is a significant decrease in GFR with age among men but not among women and therefore the incidence of ESRD seems to be higher in men than women [54], this explains the reason of more men with renal failure than women. The illiterate and age group of 55-64 years were found with the highest prevalence of HCV infection (8.3% and 5.9%, respectively); but, age and education level were not associated with HCV infection in this study. Similar findings were reported in Sudan [4,3] where by illiterate had prevalence of 36.7% and 18.5% was for age group of 50-60 years.
There is high probability that history of surgery and blood transfusion would be the main risk factors for HCV acquisition among renal failure and heamodialysis patients [5,2]. However, in agreement with other studies done [3][4][5][6] there was no association between history of surgery and blood transfusion with HCV infection. It is concluded that results in this study suggest that HCV infection have low prevalence (3.3%) among renal failure patients before starting heamodialysis treatment at MNH. History of surgery and blood transfusion showed no association with HCV seropostivity but they are major factors to decrease the prevalence and further prevent new infection from these patients.