Abstract

Background: Hepatitis C virus infection (HCV) is the major co-morbidity of patients on chronic hemodialysis. There are many scattered and heterogeneous data about this infection in hemodialysis patients living in countries of the Eastern Mediterranean Region Office of WHO (EMRO) and its distribution is unknown in this region. Aims: To provide a more comprehensive tabulation of available data on the epidemiological characteristics and risk factors for HCV infection in hemodialysis patients in Iran and other EMRO countries. Methods: A systematic review was carried out based on the computerized literature databases. In all, 95 confidence intervals of infection rates were calculated using the approximate normal distribution model. Pooled odds ratios and 95 CIs were calculated by random effects models. The heterogeneity was assessed by either Q or χ2 statistics and quantified by I2. Results: We identified 62 studies that fulfilled our inclusion criteria involving 17,846 hemodialysis subjects. A total of 5,704 (32) patients had positive serology for HCV infection. The prevalence ranged from 6-72 across countries. Pooled HCV seroprevalence was 17 (95 CI 13-20), 63 (95 CI 61-64), 48 (95 CI 45-51), 72 (95 CI 68-76), 23 (95 CI 21-24) in Iran, Saudi Arabia, Egypt, Morocco and Tunisia respectively. Hemodialysis duration OR=7.63 (95 CI 4.64-12.53), transfusion OR=2.06 (95 CI 1.47-2.89) and previous transplantation failure OR=2.66 (95 CI 1.46-4.86) were major risk factors of HCV infection. Age, sex and dialysis session/week were not associated with infection rate. Conclusion: Nearly 32 (95 CI 31-33) of hemodialysis patients in the EMRO countries are infected with HCV. Despite evolution of new strategies to confine HCV transmission among hemodialysis patients, nosocomial transmission is still the major route of HCV infection in these patients in this region. © Springer-Verlag 2010.