DefinePK

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.