Virological Features of Hepatitis C Virus in Hemodialysis Patients : Northern Districts of Palestine

A total of 71 HD patients were followed up with respect to HCV markers for 18 months. Initial findings showed that 37 (52.11%) were HCV positive and 12 (16.9%) were HBV positive. By the end of the first period (6 months), the prevalence of HCV increased to 65.15 % as 6 new cases became HCV positive. With respect to HBV the prevalence dropped to 10.61 %. ALT levels were monitored on a weekly basis as an indicator for episodes of HCV infection. This marker strongly correlates with HCV infection as all seroconverted HCV new cases showed clear ALT elevation in the acute phase of infection. Fluctuation in ALT levels among HBV positive cases were not as clear as for those with HCV infection, however, HBV positive cases seem to exhibit constantly high levels. Such fluctuations were also observed among some of the initially HCV positive cases, indicating possible HCV re-infection among such cases. Preliminary evidence suggests that a nosocomial infection was behind the observed increase in the prevalence rate of HCV. By the end of this period 5 HCV negative and 1 HCV positive subject died due to various complications. During the second phase of the study, non-of the HCV negative cases (41) were seroconverted to HCV positive and only 1 case was seroconverted to HBV positive. ALT elevation was observed among 2 HCV negative cases, however, non-of these 2 cases entered the acute phase of infection to either HCV or HBV infections. Strict hygienic conditions based on the recommendations of this study is more likely behind the limited number of newly infected cases. By the end of this phase 2 of the HCV positive cases and 7 of the HCV negative died. During the third phase HCV seroconversion was observed in 1 case out of initially 40 HCV negative cases involved. None of the 80 cases involved at the beginning of this phase was seroconverted to HBV positive. Out of the 40 HCV negative cases, 5 died, 1 of which was HBV positive. Out of HCV positive cases involved in this phase (40), 5 patients died and 2 of them were with dual infection (HC V/HB V). All HCV seroconverted cases (7 cases) clearly showed a strong association between high ALT levels and the acute phase of infection. Incubation period ranged between 21-109 days, based upon the findings of high ALT levels in two successive samples and the appearance of either anti-core or anti-NS antibodies. Anti-core antibodies seem to appear in an earlier time compared to anti-NS antibodies as 4 of the seroconverted cases expressed anti-core antibodies as early as 21 days and up to 30 days. The production of an antibody response to the NS antigen occurs relatively late (56109) days. ALT elevation was found to be associated with both antibodies in the acute phase of infection. Subjects expressing anti-NS seem to show much higher ALT levels, that last for longer time. Infection rates increased dramatically with duration of dialysis, thus confirming of the role of dialysis as a risk factor for HCV infection. With increased duration of infection a shift from NS or core to both markers was also observed.