الفهرس 
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Abstract
Hepatitis C Hepatitis C virus (HCV) infection is one of the most commonly reported viral infections in both developing and developed countries, causing significant mortality and morbidity and costing billions of dollars annually. The prevalence of HCV infection in hemodialysis patients varies substantially among different geographical regions. Recent studies have shown that the HCV prevalence in hemodialysis patients varies from 1.4%–28.3% in developed countries and 4.7%–41.9% in developing countries (Hofmeister et al., 2019).
Patients on hemodialysis are at a very high risk of HCV infection due to repeated blood transfusions, frequent hospitalization and infected hemodialysis units with HCV (Nguyen et al., 2019).
HCV and its associated complications have a significant impact on the life expectancy of hemodialysis patients. Hemodialysis patients with HCV infection are at a higher risk of death than uninfected hemodialysis patients (Nguyen et al., 2019).
Early detection and treatment of HCV patients is the goal of Egypt’s treatment program starting in 2014, intending HCV prevalence reduction to < 2% in 10 years, in line with global targets (Omran et al., 2018).
In addition, Egypt has aimed to treat 250000 people annually up to 2020 in the first phase of their treatment program aiming at reducing the number of viremic patients, thus limiting the ongoing HCV transmission. Egypt is aiming at elimination HCV and HCV-related morbidity by 2030 (Omran et al., 2018).
Therefore, this study aimed to estimate the prevalence of HCV infection and to determine the seroconversion rate in prevelant hemodilaysis in Kafr Elsheikh governorate after the hepatitis C virus infection National eradication program in Egypt and to identify the demographics leading to then non-compliance to hepatitis C virus medications and missed follow up among the prevalent hemodialysis patients with HCV infection in Kafr EL sheikh governorate, Egypt.
All patients were assessed for eligibility criteria and were included in the study only when they had met the following inclusion criteria: age older than 18 years old, maintained on regular hemodialysis session for more than 3 months. On the other hand, the exclusion criteria encompassed patients with acute kidney injury or any conditions necessitating temporary dialysis or patient age is less than 18 years old.
1162 prevalent hemodialysis patients in kafr el sheikh governorate, Egypt have been enrolled at our cross sectional study (multi-centric study) applying the proposed standards of the inclusion and exclusion criteria of our study design.
Among these 1162 patients, 403 patients (34.68%) had history of positive PCR for HCV infection prior and during the national eradication campaign. Among those patients, 212 patients (52.61%) received HCV infection treatment in the form of oral and parenteral medications, while 191 patients (47.39%) didn’t receive treatment.
Among the patients who didn’t receive the prescribed medications for HCV virus, 107 patients (56.02%) had concerns about drug complications, 22 patients didn’t receive the prescribed medication due to lack of counselling while 20 patients (10.47%) did not receive treatment due to other causes as being mentally retarded, or having advanced medical comorbidities as advanced liver disease or decompensated heart failure while 42 patients (21.99%) refused to receive treatment without giving reasons.
As regard the patients who started to receive the prescribed HCV Medications, 172 patients (81.13%) were compliant to medication protocol (completed the duration of the treatment (3 months). from them, 22 patients (12.79%) developed seroconversion confirmed by HCV PCR after completion of the protocol. This seroconversion is either due to relapse or reinfention.
Among the recruited patients for our study, 37.18% of the patients have positive HCV Ab and 1.46% have hepatitis B surface antigen.
52.3% of the patients with positive HCV Ab were found to have positive HCV RNA PCR after the campaign. Finally, the prevalence of HCV infection at time of the study and after the National eradication program in Kafr EL-Sheikh dialysis units is 19.4%.
The mean age among our study population was 55.66 years old with the female to male distribution among the study population was 35:65%.
70.5% of the study population were living in rural areas, yet 29.5% were living in urban areas which supports that HCV is mostly prevalent among lower socioeconomic sections of the population.
By reviewing the rate of seroconversion of HCV among prevalent hemodialysis patients enrolled at our study, a higher rate of seroconversion was noticed among the patients received interferon as a treatment for HCV infection compared to the patients received oral treatment with statistically significant difference with p-value is less than 0.001.
Finally we recommend the following to enhance the awareness about the burden of hepatitis C virus among prevalent hemodialysis patients:
Enhancing the awareness about the importance of treating hepatitis C viral infection and the awareness about the possible side effects with their probability to occur and the strategy to overcome them among prevalent hemodialysis patients with evidence of HCV infection and their relatives.
Paying attention for safety measures and infection control protocol during receiving hemodialysis sessions.
All patients have to be screened for the virus before initiating hemodialysis sessions and on regular basis according to the local policy of the hemodialysis units.
We recommend to perform this study on larger scale of patients in different Egyptian governorates.