Seroconversion of Hepatitis C during dialysis in Major cities of Pakistan

Background: Hepatitis C is highly prevalent in Pakistan. Several studies worldwide have shown that patients undergoing hemodialysis are at a risk for developing Hepatitis C. So this study was carried out to determine the proportion of patients undergoing hemodialysis who seroconverted from HCV negative to HCV positive status in our hospitals.
Methods: This descriptive cross-sectional study was conducted at four tertiary care hospitals of Punjab from January 2016 to March 2016 on patients undergoing hemodialysis currently. With the help of WHO Sample Size Calculator, at confidence level 95%, absolute precision 5% and anticipated population proportion 14%, the minimally required sample size was calculated to be 186 patients but we included 190 patients in our study. Sampling technique was stratified random sampling based on hospital and gender. Our inclusion criterion was all those patients who were Hepatitis C negative (determined by HCV serology, based on the principle of immunochromatography) at the initiation of dialysis and remained negative for the subsequent six months after the initiation of hemodialysis. Our exclusion criteria was all those patients who seroconverted to HCV positive with six months of initiation of hemodialysis (the period corresponding to the incubation period of hepatitis C virus.) and those who were dialyzed on emergency basis. The patients' records were thoroughly checked and information regarding their HCV status at initiation of dialysis and HCV status in later serology tests was recorded. Patients who were HCV negative at baseline but later confirmed to be HCV positive, based on HCV serology were considered seroconverted. All the data was entered and analyzed in Statistical Package of Social Sciences, SPSS (version 22). For All the categorical variables like gender of patient, renal diagnosis, HCV status positive or negative, etc. frequencies along with percentages were calculated. For continuous variables like age of patient, duration since initiation of dialysis (in months) and duration since seroconverted (in months), mode, mean along with standard deviation were calculated.
Results: Out of 190 patients who were HCV negative at the initiation of dialysis, 93 (i.e. 48.9%) patients converted to HCV positive status whereas 97 (i.e. 51.05%) patients remained HCV negative throughout the study. The mean time taken for seroconversion was 18.04 months (SD ± 15.43) months). The median was 12 months, with an inter quartile range of 14 months.
Conclusion: The proportion of HCV seroconversion in our hemodialysis units is very high.