Double Jeopardy: Persistently High Hepatitis C Rates in Haemodialysis Patients in Brazil: A Systematic Review and Meta-Analysis

Abstract

Background: We conducted a systematic review and meta-analysis of studies assessing HCV infection rates in haemodialysis patients in Brazil. Methods: A systematic review was carried out, followed by two independent meta-analyses. The 1 st included studies with data on HCV prevalence. The 2 nd included previous studies with a confirmatory PCR (i.e. active infection of hepatitis C). We used both Bayesian and classical statistical concepts and methods. A comprehensive set of different methods and procedures were used, including forest plots and respective statistics, polynomial regression, meta-regression, subgroup, influence, and trim and fill analysis. Results: 11,290 individuals were assessed in the pooled analyses. The average time patients were in haemodialysis varied from 23.5 to 56.3 months. Prevalence of HCV infection was highly heterogeneous, with a pronounced decrease from 1992 to 2001, followed by a plateau and a slight decrease in recent years. The summary measure for HCV prevalence was 34% (95%CI:26%-43%) for studies implemented before 2001. For studies launched after 2001, the corresponding summary measure was 11% (95%CI:8%-15%). Estimates for prevalence of active HCV infection were also highly heterogeneous. There was a marked decline from 1996 to 2001, followed by a plateau and a slight increase after 2010. The summary measure for active HCV infection was 19% (95% CI:15%-25%) in studies launched before 2001, with a high degree of heterogeneity. For studies implemented after 2001, the corresponding summary measure was 9% (95% CI: 6%-13%), again with high heterogeneity. The different analyses helped to identify the underlying sources of heterogeneity. Besides the year each study was conducted, the findings differed markedly between geographic regions and were heavily influenced by the size of the various studies and by publication biases.Conclusions: CKD should be targeted with specific interventions to prevent HCV infection, and if prevention fails, prompt diagnosis and treatment. Although the goal of HCV elimination by 2030 in Brazil appears elusive, it is possible and necessary to adopt measures to achieve micro-elimination and to launch initiatives towards targeted interventions to curb the spread of HCV among people with CKD, among other high-risk groups.

Measures to Contain the Transmission of Hepatitis C in a Chronic Kidney Care Hospital Unit in the Triângulo Mineiro in Brazil: A Case Study

“…Patients with positive anti-HCV antibodies at the start of dialysis should be treated promptly and this would avoid isolation policies for HCV-positive patients as those used in Taiwan [4] and several other countries [2]. Isolation is costly, did not prove to be effective and is not recommended by the CDC or the KDIGO guideline [10,12]. It is important to note that the testing policy at the beginning of HD should not prevent the testing of patients who return to the service after periods of treatment in another location, especially in a country with the highest prevalence [11], as well as in those with risk factors for acquiring HCV outside the dialysis context.…”

“…Discussing initiatives considering the micro-elimination process becomes necessary, especially for low-and middleincome countries [12], such as Brazil. Thus, the expansion of scientific productions that point out paths for the microelimination of HCV in HD units, in different scenarios, is justified.…”

Global epidemiology of hepatitis C virus in dialysis patients: A systematic review and meta-analysis

“…HCV prevalence in different dialysis centres has been the subject of several systematic reviews. A number of these studies have been conducted in nations such as Afghanistan, India, Vietnam, China, Iran, Brazil, and Pakistan [7,[13][14][15][16][17][18][19][20].…”

Feasibility of dried blood spot for hepatitis C diagnosis in vulnerable subjects and people living in remote areas from Brazil

“…PWUD are difficult to reach for HCV testing due to poor conditions and high mobility. HCV prevalences varies from 2.8 to 12.6% among subjects under hemodialysis [20,27,28] and from 1.3% to 4.5% among people who use crack cocaine in Brazil [21,29]. DBS testing for anti-HCV could be an important tool to increase the access to diagnosis in these individuals what could be important to micro elimination programs of HCV infection.…”