Epidemiological aspects of hepatitis C virus infection among renal transplant recipients in Central Brazil

Abstract

An investigation was conducted involving 255 renal transplant recipients in the state of Goiás, Central Brazil, to determine the prevalence of hepatitis C virus (HCV), its risk factors, the genotypes involved, and the level of alanine aminotransferase (ALT) present in the patients. All serum samples were tested for anti-HCV antibodies and HCV RNA. Hepatitis C virus (HCV) is a well-known agent of liver diseases, including chronic hepatitis, cirrhosis, and hepatocellular carcinoma (Chen & Morgan 2006). Patients with chronic kidney disease are at an increased risk for acquiring HCV either because of their frequent exposure to blood from transfusions, or by exposure to HCV by nosocomial transmission, either during hemodialysis or at the time of renal transplantation. HCV infection has been established as a factor in reduced patient and graft survivals following renal transplantation (Meyers et al. 2003, Aroldi et al. 2005, Fabrizi et al. 2005, Pedroso et al. 2006, Einollahi et al. 2007.The determination of alanine aminotransferase (ALT) levels as well as HCV RNA tests have been utilized in both the diagnosis and follow-up of patients with HCV infection. The latter also plays an important role in monitoring the virological response to antiviral treatment in addition to HCV genotype determination, which is a relevant predictive parameter of the response to treatment; it is thus used for selecting therapeutic regimens (Scott & Grech 2007). This virus is classified into six genotypes (1-6), each comprising multiple subtypes (designated a, b, c, etc). These genotypes have distinct geographical distributions. Furthermore, the genotyping of HCV isolates is a useful tool for establishing the source of outbreaks in hemodialysis centers and other nosocomial settings (Zein 2000, Simmonds et al. 2005). The prevalence of HCV infection has been reported to range from 7.2% among renal transplant recipients (RTP) in Switzerland to 63.8% in Saudi Arabia (Mitwalli et al. 2006, Fehr et al. 2003. In Brazil, a continental country, epidemiological data concerning HCV infection in renal transplant patients are still rare (Corrêa et al. 2003, Giordano et al. 2003, and little is known about the genetic diversity of HCV isolates in these patients (Giordano et al. 2003, Perez et al. 2003. In this study, the prevalence of HCV infection among RTP in Central Brazil was estimated and risk factors associated with HCV infection in this population were analyzed. In addition, ALT levels and HCV genotypes were determined in these patients. PATIENTS, MATERIALS AND METHODSPatients -This study was carried out in the Santa Casa de Misericórdia in Goiânia city, the largest renal transplantation unit in the state of Goiás (GO), Central Brazil. A pilot study found a prevalence of 16% for anti-HCV. In this investigation, the sample was calculated according to the size of the population (420 RTP), on the basis of an alpha error of 5%, a power of 80%, an expected HCV prevalence of 16% and a precision of 3%. In accordance with these data, the minimum sample s...

Hepatitis C among former athletes: association with the use of injectable stimulants in the past

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Prevalência, fatores de risco e genótipos da hepatite C entre usuários de drogas

“…This association has been reported especially in blood transfusions before the implementation in Brazil of anti-HCV screening in blood banks in November 1993. 4,6 In fact, in the present study, among 14 anti-HCV positive subjects who had prior blood transfusion, most of them took place prior to this date (data not shown), stressing the importance of anti-HCV screening in blood banks in Brazil.…”

Prevalence of hepatitis C virus infection and genotypes in patient with chronic kidney disease undergoing hemodialysis

“…Kidney transplantation has also been strongly associated with HCV in other studies [Tu et al, ; Yábar and Zevallos, ; Li and Wang, ]. Botelho et al [] observed a significant association between the presence of anti‐HCV antibodies and kidney transplantation performed before 1994. Similarly, the present patients may have acquired HCV by blood transfusion or contamination of the donor kidney.…”