12 Genotype and Transmission of Hepatitis C Virus in Hemodialysis Units

Objectives  Hepatitis C virus (HCV) infection is spread worldwide with significant geographical differences in the prevalence and genotypes. The aim of this study was to analyse HCV infection in hemodialysis (HD) units in Bosnia and Herzegovina (BH), through genotypes and routes of transmission. Design and Methods  We analysed data from Renal Registry of BH for the years 2002 and 2003 in order to estimate prevalence and incidence of anti-HCV positive patients in 23 HD units in BH (ELISA III). Then we tested 88 anti-HCV positive patients from Tuzla for HCV RNA using reverse transcription polymerase chain reaction (Amplicor Roche diagnostic commercial test) and genotype with method of reverse hibridization of amplified sample material (Innolipa HCV II commercial test). Results  In 2002 we registered a prevalence of 39.1 and an incidence of 3.1% of anti-HCV positive HD patients in 23 HD units, and in 2003 a prevalence of 29.3 and an incidence of 2.04% in 24 HD units. Prevalence of anti-HCV positive patients was significantly different in HD units, from 14.3 to 69.1%. From 88 tested anti-HCV positive HD patients in Tuzla HD unit, we found 76 HCV RNA positive patients (87.36%). The genotype of HCV was analysed in 59 of these patients and we found, unusual for Europe, genotype 4 in 37 (62.7%), genotype 1b in 17 (28.8%) and 1a in five patients (8.5%). A total of 61% of seroconversions happened in 1999, 2000 and 2001. In 2001, we separated dialysis machines for anti-HCV positive and anti-HCV negative patients, and in 2003 we had nine seroconversions (genotype 4 in five patients). These patients had no blood transfusions. Conclusions  Prevalence and incidence of anti-HCV positive hemodialysis patients is still high in BH and origin of genotype 4 HCV is not clear. Nosocomial spreading of HCV plays a significant and probably the most important role in transmission of HCV in HD units.