Hepatitis C Virus Infection in Jordanian Haemodialysis Units: Serological Diagnosis and Genotyping

The seroprevalence and genotypes of hepatitis C virus (HCV) were studied in 283 patients attending six haemodialysis units in Jordan. In all, 98 (34.6%) patients were anti-HCV-positive by EIA, 92 (93.9%) of whom were also reactive in an immunoblot assay. The prevalence of anti-HCV was correlated with a history of blood transfusion before the introduction of blood donor screening for HCV and with duration of haemodialysis. HCV RNA was detected in 30 (30.6%) of 98 anti-HCV-positive sera. HCV viraemia was not associated with a particular antibody for the six HCV antigens studied by the immunoblot assay, although reactivity to the core antigens was greater in the HCV RNA-positive sera than in negative sera. Two HCV genotypes (1 and 4) were identified for the first time in Jordan by restriction fragment length polymorphism analysis of HCV 5'-NCR. The predominant genotype was HCV la (12 of 30). Genotypes lb and 4 were detected in 10 and 8 patients, respectively. The antibody response to HCV antigens was genotype-dependent, with a wider range of antibody specificities detected in the immunoblot assay in the 12 patients with genotype 1a infection than in the 8 patients with genotype 4. However, there was no significant difference in the prevalence of antibodies to HCV antigens among patients infected with either genotype 1a or lb. In conclusion, the prevalence of anti-HCV, blood transfusion, duration of dialysis and HCV genotypes suggest possible nosocomial HCV transmission among patients which needs confirmation by phylogenetic analysis of subgenomic HCV regions.