H9(W)
BLOOD- BOURNE VIRUS INFECTION IN LIBYA’S DIALYSIS CENTRES:
PREVALENCE AND RISK FACTORS
Alashek, W1, McIntyre, C1,2, Taal, M2.
1
School of Graduate Entry Medicine, University of Nottingham, 2Department of Renal
Medicine, Royal Derby Hospital
INTRODUCTION: Patients receiving maintenance dialysis are at increased risk for
acquiring blood- bourne viral infections. Strict infection control measures are essential to
prevent nosocomial transmission in dialysis units. The prevalence of blood- bourne viral
infections and the risk factors associated with this have not previously been studied among
dialysis population in Libya.
METHODS: A cross sectional study of all adult dialysis patients (n=2417) in Libyan dialysis
centres (n=39) was conducted from June to August 2009. Testing for HIV, HBV and HCV
antibodies is routinely performed at initiation of dialysis and monitoring is done every 3- 6
months thereafter. Sero-positive patients are dialysed in separate rooms in 93% of centres or
on dedicated machines if space does not allow isolation. Researchers visited 26 HD centres
and contacted the remainder by telephone. Data regarding blood- bourne virus infection
status as well as details of dialysis and associated treatments were collected using a structured
data collection form.
RESULTS: Of all dialysis patients, 63.1% were free from blood- bourne viral infection. Only
one case had HIV infection. HBV antibodies were positive in 55 patients (2.3%) whereas
HCV antibodies were positive in 32.7%. Few patients (1.9%) had both HBV and HCV
infections. Thus the overall prevalence rate of HCV infection was 35% (range 0- 38% in
different centres). 4.8% of patients were sero-positive for viral infections before the initiation
of dialysis. Analysis of factors potentially associated with virus infection is shown in table 1.
Table 1, Factors potentially associated with virus infection in Libya's dialysis centres
Factors potentially associated with virus infection
Age in years (mean± SD)
Males
Dialysis vintage in years (mean± SD)
Previous blood transfusion
Number of blood transfusions (mean± SD)
Previous vaccination
Previous renal transplant
Previous dialysis abroad
Previous dialysis in another Libyan centre
Haemoglobin level in g/dl (mean± SD)
Alanine Aminotransferase in IU/L (mean± SD)
Aspartate Aminotransferase in IU/L (mean± SD)
Alkaline Phosphatise in IU/L (mean± SD)
Body mass index in Kg/m2 (mean± SD)
Diabetes
Virus
positive
47.2±14.4
518 (58.7%)
7.4±5.2
537 (80.6%)
2.9±3.8
503 (81.2%)
117 (13%)
250 (36.6%)
313 (35.4%)
10.2±1.9
28.6±21.2
29.2±21.9
142±65
24.1±5.3
200 (22.7%)
Virus
negative
49.4±16.3
870 (57.7%)
2.2±2.6
623 (66%)
1.9±2.9
714 (79.2%)
37 (2.5%)
468 (49.6%)
568 (37.7%)
9.6±1.7
18.3±15.9
20.4±19.4
130±73
24.8±5.7
540 (35.8%)
P- value
˂0.001
0.642
˂0.001
˂0.001
˂0.001
0.334
˂0.001
˂0.001
0.278
0.006
˂0.001
0.001
0.023
0.076
˂0.001
CONCLUSION: Patients on maintenance dialysis in Libya have a high prevalence rate of
HCV infection. A substantial proportion of patients acquire the infection after initiation of
dialysis. Blood transfusions and travel are major risk factors for infection. Improved
management of anaemia with reduced reliance on transfusion as well as education regarding
the risks of travel will be central to strategies for reducing blood- bourne viral infection risk in
this population.