Retrospective Study
Copyright ©The Author(s) 2016. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Nephrol. Jan 6, 2016; 5(1): 101-107
Published online Jan 6, 2016. doi: 10.5527/wjn.v5.i1.101
Incidence and prevalence of hepatitis B and hepatitis C viruses in hemodialysis patients in Lebanon
Antoine Abou Rached, Lara El Khoury, Talal El Imad, Abdallah S Geara, Josette Jreijiry, Walid Ammar
Antoine Abou Rached, National Hepatitis Program, Ministry of Public Health, Beirut 1106 9800, Lebanon
Antoine Abou Rached, Department of Internal Medicine, Division of Gastroenterology, Lebanese University, Beirut 2903 1308, Lebanon
Lara El Khoury, Talal El Imad, Josette Jreijiry, Faculty of Medical Sciences, Lebanese University, Beirut 2903 1308, Lebanon
Abdallah S Geara, School of Medicine, West Virginia University, Morgantown, WV 26506-9100, United States
Walid Ammar, Ministry of Public Health, Beirut 1106 9800, Lebanon
Author contributions: Abou Rached A was the major investigator who designed the study and contributed to data analysis and paper writing; El Khoury L, El Imad T and Jreijiry J collected the data and contributed to data analysis and paper writing; Geara AS performed the statistical analysis; Ammar W supervised the study and contributed to results analysis.
Institutional review board statement: This study is retrospective, involving anonymous clinical data without affecting the patient’s rights and welfare. These data were obtained directly from the ministry of public health registries in collaboration with its general director. No IRB approval was required.
Informed consent statement: We performed a retrospective study using anonymous patients data collected through the ministry of public health which routinely compiles all HBsAG and HCV serology results from the affiliated HD centers across Lebanon on a monthly basis. Since then, no informed consent was required.
Conflict-of-interest statement: No funding has been received for the conduct of this study. There were no financial or personal interests to be disclosed.
Data sharing statement: All data will be made available alongside the article when published. No additional data are available.
Open-Access: This article is an open-access article which was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/
Correspondence to: Antoine Abou Rached, MD, Department of Internal Medicine, Division of Gastroenterology, Lebanese University, Hadath Campus, PO Box #3, Beirut 2903 1308, Lebanon. abourachedantoine@gmail.com
Telephone: +961-5-451100 Fax: +961-5-455131
Received: April 5, 2015
Peer-review started: April 7, 2015
First decision: July 10, 2015
Revised: September 23, 2015
Accepted: October 23, 2015
Article in press: October 27, 2015
Published online: January 6, 2016
Processing time: 276 Days and 18.6 Hours
Abstract

AIM: To determine the incidence and the prevalence of hepatitis B and C viral infections in patients on hemodialysis (HD) across Lebanon.

METHODS: We reviewed the data registry at the Lebanese Ministry of Public Health where records of monthly hepatitis B surface antigen (HBsAg) and hepatitis C virus (HCV) serology are reported from 60 affiliated HD centers across Lebanon. All patients who were on HD or who started HD between October 2010 and July 2012 were included in the study. Patients from seven HD centers were excluded due to inadequate and incomplete results reporting. During the selected period, HBsAg and HCV serology were available for 3769 patients from 53 HD centers distributed at all Lebanese governorates. The prevalence was calculated by dividing the number of patients with positive HBsAg or HCV serology to the total number of patients. The Incidence was calculated by dividing the number of newly acquired infection to number of patients-years (p-y). Incidence rates at different governorates were compared to each other using two tailed Z test and a P value of < 0.05 was considered significant.

RESULTS: Sixty out of 3769 HD patients were found to have positive HBS Ag and 177 out of 3769 were positive for HCV Antibodies. The prevalence of hepatitis B virus (HBV) and HCV in HD patients across Lebanon was 1.6%, and 4.7%, respectively. The comparison of prevalence according to geographic distribution could not be done accurately due to the frequent shift of patients between dialysis centers at different governorates. The incidence rate was 0.27 per 100 p-y for HBV and 0.37 per 100 p-y for HCV. There was no significant difference concerning the incidence of HBV between HD centers at different governorates (all P values > 0.1), but this difference was highly significant concerning the incidence rates of HCV which occurred predominantly in the southern centers (1.47 per 100 p-y) with a P value of 0.00068 and 0.00374 when compared to Mount Lebanon (0.21 per 100 p-y) and the Northern centers (0.19 per 100 p-y), respectively.

CONCLUSION: The incidence rate of HBV and HCV is very low in the Lebanese HD centers and their prevalence is decreasing over the last two decades.

Keywords: Hemodialysis; Prevalence; Hepatitis C virus; Incidence; Hepatitis B virus; Lebanon

Core tip: This is the largest and most statistically significant study addressing the prevalence and the incidence of hepatitis B virus (HBV) and hepatitis C virus (HCV) in 3769 patients on hemodialysis (HD) through 88% of all HD centers across Lebanon over a period of 22 mo. The prevalence of HBV and HCV in the studied population was 1.6%, and 4.7%, respectively. The incidence rate was 0.27 per 100 p-y for HBV, and 0.37 per 100 p-y for HCV. These values are amongst the lowest rates reported in other countries, which is most probably related to good adherence to infection control standards in the Lebanese HD centers.