HIGH SEROPREVALENCE OF BLOODBORNE HEPATITIS IN DIALYSIS UNITS: A STUDY OF HBV/HCV BURDEN AND RISK FACTORS AMONG HEMODIALYSIS PATIENTS IN RAWALPINDI, PAKISTAN

Authors

  • Trabish Saeed Iqra University, Chak Shahzad Campus, Islamabad, Pakistan Author
  • Meh Jabeen Iqra University, Chak Shahzad Campus, Islamabad, Pakistan Author
  • Sufian Ayub Iqra University, Chak Shahzad Campus, Islamabad, Pakistan Author
  • Muhammad Zulqarnain Iqra University, Chak Shahzad Campus, Islamabad, Pakistan Author
  • Safdar Ali Cholistan University of Veterinary and Animal Sciences, Bahawalpur, Pakistan. Author
  • Maimona Sadia Government College University, Faisalabad, Pakistan. Author

DOI:

https://doi.org/10.71000/4h90x234

Keywords:

Hepatitis B, Hepatitis C, Pakistan, Blood Transfusion, Chemiluminescent Immunoassay, Cross-Sectional Studies, Hemodialysis Units

Abstract

Background: Hemodialysis (HD) patients are highly vulnerable to hepatitis B virus (HBV) and hepatitis C virus (HCV) infections due to repeated vascular access, blood transfusions, and extended healthcare exposure. While global initiatives have aimed to reduce these infections, prevalence remains disproportionately high in low- and middle-income countries (LMICs), including Pakistan, where limited epidemiological data are available for dialysis populations. Understanding local burden and risk determinants is crucial to inform targeted prevention strategies.

Objective: To determine the prevalence of HBV and HCV infections and identify associated risk factors among HD patients in Rawalpindi, Pakistan.

Methods: A descriptive cross-sectional study was conducted across five HD centers representing public, private, and charitable healthcare sectors. A total of 100 patients aged ≥18 years, on maintenance HD for at least one month, were recruited using quota sampling. Screening for HBV surface antigen (HBsAg) and anti-HCV antibodies was performed using immunochromatographic tests (ICT), with all reactive cases confirmed via chemiluminescent immunoassay (CLIA). Demographic, clinical, and dialysis-related data were collected through structured questionnaires and verified from medical records. Statistical analysis included descriptive measures and Chi-square tests for associations, with p<0.05 considered significant.

Results: CLIA-confirmed HCV prevalence was 39% (39/100), HBV prevalence was 5% (5/100), and co-infection occurred in 3% (3/100). Thrice-weekly dialysis was associated with higher HCV prevalence (58.1%) compared to twice-weekly (30.4%) (p=0.009). HBV was significantly associated with blood transfusion history (8.8% vs. 0%, p=0.045) and surgical history (10.8% vs. 1.6%, p=0.041). HBV vaccination coverage was 65%, with no significant protective effect (p=0.229).

Conclusion: The substantial burden of HCV and ongoing HBV transmission in HD units indicates persistent infection control gaps. Strengthened sterilization protocols, dedicated equipment for infected patients, improved HBV vaccination strategies, and expanded access to antiviral therapy are urgently required to reduce transmission in resource-limited dialysis settings.

Author Biographies

  • Trabish Saeed, Iqra University, Chak Shahzad Campus, Islamabad, Pakistan

    Department of Allied Health Sciences, Iqra University, Chak Shahzad Campus, Islamabad, Pakistan

  • Meh Jabeen, Iqra University, Chak Shahzad Campus, Islamabad, Pakistan

    Department of Allied Health Sciences, Iqra University, Chak Shahzad Campus, Islamabad, Pakistan

  • Sufian Ayub, Iqra University, Chak Shahzad Campus, Islamabad, Pakistan

    Department of Allied Health Sciences, Iqra University, Chak Shahzad Campus, Islamabad, Pakistan

  • Muhammad Zulqarnain, Iqra University, Chak Shahzad Campus, Islamabad, Pakistan

    Department of Allied Health Sciences, Iqra University, Chak Shahzad Campus, Islamabad, Pakistan

  • Safdar Ali, Cholistan University of Veterinary and Animal Sciences, Bahawalpur, Pakistan.

    Department of Microbiology, Cholistan University of Veterinary and Animal Sciences, Bahawalpur, Pakistan.

  • Maimona Sadia, Government College University, Faisalabad, Pakistan.

    Department of Allied Health Sciences, Iqra University, Chak Shahzad Campus, Islamabad, Pakistan, Department of Microbiology, Government College University, Faisalabad, Pakistan.

References

Abro, A. H., Ustadi, A. M., & Younis, N. J. (2021). Direct-acting antivirals for HCV in hemodialysis patients: A systematic review. Journal of Clinical and Experimental Hepatology, 11(1), 104–112.

Lee HW, Lee H, Kim BK, Chang Y, Jang JY, Kim DY. Cost-effectiveness of chronic hepatitis C screening and treatment. Clin Mol Hepatol. 2022;28(2):164-73.

Kadhim NJ, Al-Huseini LMA, Alzamili F, Al Ameri AM. Epidemiology, treatment and diagnosis of Hepatitis C virus infections. Wiad Lek. 2025;78(2):469-73.

Asif, N., Khokhar, N., & Ilahi, F. (2020). Seroprevalence of HBV and HCV in hemodialysis patients in Rawalpindi, Pakistan. Journal of Virological Methods, 275, 113768

Manns, M. P., & Maasoumy, B. (2022). Breakthroughs in hepatitis C research: From discovery to cure. Nature Reviews Gastroenterology & Hepatology, 19(9), 533–554.

Abdulkadhim Sayah M, Khaled Younis Albahadly W, Subhi Farhan S, Qasem S, Majeed Al-Tamimi S, Al-Shalah SAJ, et al. Investigate the Presence of HBV Surface Antigen in Pregnant Women, Cairo City in Egypt. Arch Razi Inst. 2022;77(5):1909-16.

Hajji M, Barbouch S, Manaa R, Ajimi K, Hamida FBB, Goucha R, et al. National Epidemiological Study about Hepatitis C Virus Infection among Dialysis Patients. Saudi J Kidney Dis Transpl. 2021;32(6):1715-21.

Mahupe P, Molefe-Baikai OJ, Saleshando G, Rwegerera GM. Prevalence and risk factors for hepatitis b and c among end-stage renal disease patients on hemodialysis in Gaborone, Botswana. Niger J Clin Pract. 2021;24(1):81-8.

Khorrami MB, Amali A, Sadeghi M, Riahi-Zanjani B. The prevalence of HBV, HCV, and HIV among hemodialysis patients in a tertiary care hospital in Mashhad, Iran. J Infect Dev Ctries. 2023;17(8):1146-51.

Pisaturo M, Onorato L, Russo A, Coppola N. Prevalence of occult HBV infection in Western countries. J Med Virol. 2020;92(12):2917-29.

Baliashvili D, Averhoff F, Kasradze A, Salyer SJ, Kuchukhidze G, Gamkrelidze A, et al. Risk factors and genotype distribution of hepatitis C virus in Georgia: A nationwide population-based survey. PLoS One. 2022;17(1):e0262935.

Laguna-Meraz S, Jose-Abrego A, Roman S, Leal-Mercado L, Panduro A. Risk Factors Associated with Hepatitis C Subtypes and the Evolutionary History of Subtype 1a in Mexico. Viruses. 2024;16(8).

Goel A, Rewari BB, Sharma M, Konath NM, Aggarwal R. Seroprevalence and burden of hepatitis C virus infection in WHO South-East Asia Region: A systematic review. J Gastroenterol Hepatol. 2022;37(6):964-72.

Altinawe J, Akkawi ME, Kharrat Helu N, Hassan Q, Nattouf AH. Seroprevalence and risk factors of HBV, HCV and HIV among hemodialysis patients: a multicenter cross-sectional study from Damascus Syria. BMC Infect Dis. 2024;24(1):289.

Kolaylı CC, Topbaş M, Özkaya E, Köksal İ, Beyhun NE, Kaklıkkaya N, et al. [Seroprevalence and Risk Factors of Hepatitis B, C and D in Adults in Trabzon, Türkiye]. Mikrobiyol Bul. 2024;58(3):293-308.

Al Shukri I, Al Wahaibi A, Al Kindi H, Al-Maimani Y, Al Maani A, Alqayoudhi A, et al. The Seroprevalence of Hepatitis C Virus (HCV) in Hemodialysis Patients in Oman: A National Cross-Sectional Study. J Epidemiol Glob Health. 2023;13(4):774-81.

Xu M, Liu F, Zhao Q, Zhou Y, Zhuang Y, Ji M. Seroprevalence of hepatitis C virus in Jinan, China, 2008-2020. Eur J Med Res. 2023;28(1):112.

An T, Dean M, Flower R, Tatzenko T, Chan HT, Kiely P, et al. Understanding occult hepatitis C infection. Transfusion. 2020;60(9):2144-52.

Greeviroj P, Lertussavavivat T, Thongsricome T, Takkavatakarn K, Phannajit J, Avihingsanon Y, et al. The world prevalence, associated risk factors and mortality of hepatitis C virus infection in hemodialysis patients: a meta-analysis. J Nephrol. 2022;35(9):2269-82.

Sedeño-Monge V, Laguna-Meraz S, Santos-López G, Panduro A, Sosa-Jurado F, Jose-Abrego A, et al. A comprehensive update of the status of hepatitis C virus (HCV) infection in Mexico-A systematic review and meta-analysis (2008-2019). Ann Hepatol. 2021;20:100292.

Anees M, Sarwar N, Ahmad S, Elahii I, Mateen FE. Factors Associated with Seroconversion of Hepatitis C Virus in End Stage Renal Disease Patients. J Coll Physicians Surg Pak. 2021;31(9):1040-5.

Huang HI, Su CP, Huang WT, Chen WC. Gender differences in risk exposures for acute hepatitis C infection in Taiwan: a nationwide case-control study. BMC Public Health. 2023;23(1):89.

Almezgagi, M., Zhang, Y., & He, Y. (2020). Hepatitis burden in dialysis patients: A global perspective. Hemodialysis International, 24(3), 263–273

Downloads

Published

2025-08-06

Issue

Vol. 3 No. 4 (Health and Allied) (2025): Volume 3 Issue 4 2025

Section

Articles

License

Copyright (c) 2025 Trabish Saeed, Meh Jabeen, Sufian Jabeen, Muhammad Zulqarnain, Safdar Ali, Maimona Sadia (Author)

Creative Commons License

This work is licensed under a Creative Commons Attribution-NonCommercial-NoDerivatives 4.0 International License.

How to Cite

1.
Saeed T, Meh Jabeen, Sufian Ayub, Muhammad Zulqarnain, Safdar Ali, Maimona Sadia. HIGH SEROPREVALENCE OF BLOODBORNE HEPATITIS IN DIALYSIS UNITS: A STUDY OF HBV/HCV BURDEN AND RISK FACTORS AMONG HEMODIALYSIS PATIENTS IN RAWALPINDI, PAKISTAN. IJHR [Internet]. 2025 Aug. 6 [cited 2025 Aug. 29];3(4 (Health and Allied):468-75. Available from: https://insightsjhr.com/index.php/home/article/view/1222