SEROLOGICAL AND MOLECULAR PROFILE OF HEPATITIS B AND C VIRUSES AND DETECTION OF OCCULT HBV AMONG HEMODIALYSIS PATIENTS IN DUHOK, IRAQ
Hepatitis Viruses in Hemodialysis Patients
Keywords:
Hemodialysis, Hepatitis B virus, Hepatitis C virus, Occult HBV infection, Anti-HBc antibodies
Abstract
https://doi.org/10.31386/dmj.2026.20.2.7
Background: Hepatitis B and C viral infections are significant global health concern, with hemodialysis patients being more susceptible than the general population.
Objective: The study aimed to assess the prevalence of HBV and HCV infections among hemodialysis patients, detecting occult HBV infection, and perform genotyping.
Methods: The study involved 151 patients with end-stage renal illness, comprising 81 males (53.6%) and 70 females (46.4%) at the Kidney Center's dialysis unit in Duhok-Iraq. All subjects had their blood samples taken prior to hemodialysis. HBsAg, total anti-HBc, anti-HCV and Liver enzyme screening was done. Those who were positive for anti-HBc also had anti-HBs evaluation. HBsAg negative samples were analyzed for occult HBV. HBsAg, Anti HCV positive patients were subjected to PCR. Clinical and demographic information were gathered and examined.
Results: Participants ranged in age from 15 to 96, with a mean age of 55.85±15.50 years. Out of 151 samples, one (0.7%) tested positive for HBsAg, and 3(2.0%) tested positive for anti-HCV antibodies. Anti-HBc testing revealed 37 samples (24.5%) were positive. Among the 39 samples positive for either anti-HBc or occult HBV, 31 (79.5%) were also positive for anti-HBs antibodies. Occult HBV infection was detected in 2 (2.1%) out of 95 samples that tested negative for HBsAg. One sample that tested positive for HBsAg had genotype D. Anti HCV positive samples turned negative by PCR.
Conclusion: Despite the low prevalence of active HBV and HCV infections, the existence of occult HBV underscores the continued hazards of transmission which necessitate serial serological and molecular testing.
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References
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34. Lampertico P, Agarwal K, Berg T, Buti M, Janssen H, Papatheodoridis G. European association for the study of the liver electronic address: easloffice@ easloffice. Eu; European association for the study of the liver. EASL 2017 clinical practice guidelines on the management of hepatitis B virus infection. J. Hepatol. 2017;67(2):370-98. https://doi.org/10.1016/j.jhep.2017.03.021
35. Pascasio-Acevedo JM. Prevención de la infección por el virus de la hepatitis B en el trasplante hepático y renal. Nefrología (English Edition). 2013 Jul 1;4(3):60-6. https://revistanefrologia.com/en-prevencion-infeccion-por-el-virus-articulo-X2013757513003242
36. Mulrooney-Cousins PM, Michalak TI. Asymptomatic hepadnaviral persistence and its consequences in the woodchuck model of occult hepatitis B virus infection. Journal of Clinical and Translational Hepatology. 2015 Sep 15;3(3):211. https://doi.org/10.14218/JCTH.2015.00020
37. Abdulla IM, Goreal AA. Detection of Hepatitis-B virus genotypes among chronic carriers in Duhok-Iraq. Journal of the Faculty of Medicine Baghdad. 2016 Jul 3;58(2):170-5. https://doi.org/10.32007/jfacmedbagdad.582234
38. Lin CL, Kao JH. Hepatitis B virus genotypes and variants. Cold Spring Harbor perspectives in medicine. 2015 May 1;5(5): a021436.
https://doi.org/10.1101/cshperspect.a021436
2. Shawgery HR. Evaluation of serum ferritin level and hepatitis b and hepatitis c viral infection in chronic hemodialysis patients. Cellular and Molecular Biology. 2024 Jul 28;70(7):115-21. http://dx.doi.org/10.14715/cmb/2024.70.7.16
3. Fabrizi F, Messa P. Transmission of hepatitis C virus in dialysis units: a systematic review of reports on outbreaks. The International journal of artificial organs. 2015 Sep;38(9):471-80. https://doi.org/10.5301/ijao.5000437
4. Cai G, Zheng H, Luo L, Wang Z, Jiang Z, Xu S, Lv H, Chen Y, Zhou B, Hu C. Factors correlating to the development of hepatitis c virus infection in hemodialysis patients—findings mainly from asiatic populations: a systematic review and meta-analysis. International journal of environmental research and public health. 2019 Apr;16(8):1453. https://doi.org/10.3390/ijerph16081453
5. Eleftheriadis T, Pissas G, Antoniadi G, Liakopoulos V, Stefanidis I. Factors affecting effectiveness of vaccination against hepatitis B virus in hemodialysis patients. World journal of gastroenterology: WJG. 2014 Sep 14;20(34):12018. https://doi.org/10.3748/wjg.v20.i34.12018
6. Fabrizi F, Dixit V, Messa P. Impact of hepatitis C on survival in dialysis patients: a link with cardiovascular mortality? Journal of viral hepatitis. 2012 Sep;19(9):601-7. https://doi.org/10.1111/j.1365-2893.2012.01633.x
7. Kim HS, Yang JD, El‐Serag HB, Kanwal F. Awareness of chronic viral hepatitis in the United States: an update from the National Health and Nutrition Examination Survey. Journal of viral hepatitis. 2019 May;26(5):596-602. https://doi.org/10.1111/jvh.13060
8. Beykaso G, Mulu A, Giday M, Berhe N, Selamu M, Hailu D, Teklehaymanot T. Occult hepatitis B virus infection and its risks of cryptic transmission in southern Ethiopia. Infection and drug resistance. 2022 Jan 1:619-30. https://doi.org/10.2147/IDR.S344668
9. Kwak MS, Kim YJ. Occult hepatitis B virus infection. World journal of hepatology. 2014 Dec 27;6(12):860. doi: 10.4254/wjh. v6. i12.860
10. Imai E, Horio M, Iseki K, Yamagata K, Watanabe T, Hara S, Ura N, Kiyohara Y, Hirakata H, Moriyama T, Ando Y. Prevalence of chronic kidney disease (CKD) in the Japanese general population predicted by the MDRD equation modified by a Japanese coefficient. Clinical and experimental nephrology. 2007 Jun;11(2):156-63. https://doi.org/10.1007/s10157-007-0463-x
11. Afshar R, Sanavi S, Salimi J. Epidemiology of chronic renal failure in Iran: a four-year single-center experience. Saudi Journal of Kidney Diseases and Transplantation. 2007 Apr 1;18(2):191-4. https://journals.lww.com/sjkd/toc/2007/18020
12. Dhaidan FA. Prevalence of end stage renal disease and associated conditions in hemodialysis Iraqi patients. Int J Res Med Sci. 2018 May;6(5):1515-8. http://dx.doi.org/10.18203/2320-6012.ijrms20181279
13. Jardine MJ, Zuo LI, Gray NA, De Zoysa J, Chan CT, Gallagher MP, Howard K, Hertier S, Cass A, Perkovic V, ACTIVE Dialysis Steering Committee. Design and participant baseline characteristics of ‘AC linical T rial of IntensiVE D ialysis’: The ACTIVE Dialysis Study. Nephrology. 2015 Apr;20(4):257-65. https://doi.org/10.1111/nep.12385
14. López MT, Rodríguez-Rey R, Montesinos F, de Galvis SR, Ágreda-Ladrón MR, Mayo EH. Factors associated with quality of life and its prediction in kidney patients on haemodialysis. Nefrología (English Edition). 2022 May 1;42(3):318-26. https://doi.org/10.1016/j.nefroe.2022.07.007
15. Abubakeer A, Alfaqi R, Alhagig E, Ali M, Alfliow Z. Prevalence of Hepatitis B & C Viruses among Patients in Dialysis Centers in Zintan and Yefren Cities, Libya. AlQalam Journal of Medical and Applied Sciences. 2025 Feb 12:267-70. https://doi.org/10.54361/ajmas.258140
16. Musa MD, Ateya HK. Prevalence of overt and occult hepatitis B virus infections among 135 haemodialysis patients attending a haemodialysis centre at Al-Nasiriyah city, Iraq. Iranian journal of microbiology. 2020 Oct;12(5):475. https://doi.org/10.18502/ijm.v12i5.4610
17. Al Hijazat M, Ajlouni YM. Hepatitis B infection among patients receiving chronic hemodialysis at the Royal Medical Services in Jordan. Saudi Journal of Kidney Diseases and Transplantation. 2008 Mar 1;19(2):260-7. https://journals.lww.com/sjkd/toc/2008/19020
18. Alashek WA, McIntyre CW, Taal MW. Hepatitis B and C infection in haemodialysis patients in Libya: prevalence, incidence and risk factors. BMC infectious diseases. 2012 Oct 20;12(1):265. https://doi.org/10.1186/1471-2334-12-265
19. Saleem ZS, Naqid IA, Hussein NR, Mohammad SJ, Noaman JS, Haji RS, Haji VA, Hussein ZM, Mohammed PH. The prevalence of hepatitis B and C Virus in patients with end-stage kidney disease on regular hemodialysis in Duhok, Iraq: a brief report. Avicenna Journal of Clinical Microbiology and Infection. 2020 Mar 30;7(1):31-3. https://doi.org/10.34172/ajcmi.2020.06
20. Kalantari H, Ferdowsi F, Yaran M. Prevalence of occult hepatitis B virus infection in hemodialysis patients in Isfahan, Iran. Advanced biomedical research. 2016 Jan 1;5(1):151. https://journals.lww.com/adbm/toc/2016/05000
21. Tang Y, Liu X, Lu X, He Q, Li G, Zou Y. Occult hepatitis B virus infection in maintenance hemodialysis patients: prevalence and mutations in “a” determinant. International Journal of Medical Sciences. 2020 Aug 25;17(15):2299. https://doi.org/10.7150/ijms.49540
22. Khullar S, Kothari V, Khatri PK, Lohakare T. Hepatitis C Virus Seroprevalence and Genotypic Distribution Among Hemodialysis Patients at a Teaching and Training Hospital in Western Rajasthan, India. Cureus. 2024 Aug 19;16(8). https://www.cureus.com/articles/284517
23. Çelik N, Çelik O, Sevinç C, Ünal O. Hepatitis C prevalence in hemodialysis patients and the results of new antiviral therapy. Turk J Nephrol. 2019;28(2):103-8. https://turkjnephrol.org/Content/files/sayilar/417/103-108(1).pdf
24. Fabrizi F, Messa P. The epidemiology of HCV infection in patients with advanced CKD/ESRD: A global perspective. InSeminars in dialysis 2019 Mar (Vol. 32, No. 2, pp. 93-98). https://doi.org/10.1111/sdi.12757
25. Taherkhani R, Farshadpour F, Asayesh R. Prevalence and genotypes of hepatitis C infection among hemodialysis patients in Bushehr, Iran. Oman Medical Journal. 2023 Mar 31;38(2): e481. https://doi.org/10.5001/omj.2023.60
26. Ashkani-Esfahani S, Alavian SM, Salehi-Marzijarani M. Prevalence of hepatitis C virus infection among hemodialysis patients in the Middle-East: A systematic review and meta-analysis. World journal of gastroenterology. 2017 Jan 7;23(1):151. https://doi.org/10.3748/wjg.v23.i1.151
27. Ali ZS, Salman AD, Ali IA. Prevalence of Hepatitis B Virus Among Renal Dialysis Patients in Diyala Province, Iraq. South Asian Res J Bio Appl Biosci. 2023;5(04):75-81. https://sarpublication.com/articles/1297/10.36346/sarjbab.2023.v05i04.003
28. Bozaci I, Tosun S. The Relationship of Hepatits B Core Antibody Positivity with Demographic and Laboratory Parameters in Hemodialysis Patients. The Medical Bulletin of Haseki. 2021 Jun 3. https://doi.org/10.4274/haseki.galenos.2021.6883
29. Mohamed MM, Berbesh AE. Occult hepatitis B infection in hemodialysis patients infected with hepatitis C virus. Al-Azhar Medical Journal. 2021 Apr 1;50(2):1553-62. https://doi.org/10.21608/amj.2021.160386
30. Keyvani H, Agah S, Kabir A, Alavian SM. Prevalence and risk factors of isolated anti-HBc antibody and occult hepatitis B infection in hemodialysis patients: a nationwide study. Annals of hepatology. 2015 Jul 27;12(2):213-9. https://doi.org/10.1016/S1665-2681(19)31359-6
31. Ruiz-Calero Cendrero RM, Cancho Castellano B, Martín Hidalgo-Barquero MV, Cid Parra MC, Galán González J, Fernández Solís MA, Sánchez García O. When can it be useful to look for occult HBV in haemodialysis patients? Nefrología (English Edition). 2020 Mar 1;40(2):115-9. https://www.revistanefrologia.com/en-when-can-it-be-useful-articulo-S2013251420300389
32. Malagnino V, Fofana DB, Lacombe K, Gozlan J. Occult hepatitis B virus infection: an old entity with novel clinical involvements. InOpen Forum Infectious Diseases 2018 Oct (Vol. 5, No. 10, p. ofy227). US: Oxford University Press. https://doi.org/10.1093/ofid/ofy227
33. Reddy KR, Beavers KL, Hammond SP, Lim JK, Falck-Ytter YT. American Gastroenterological Association Institute guideline on the prevention and treatment of hepatitis B virus reactivation during immunosuppressive drug therapy. Gastroenterology. 2015 Jan 1;148(1):215-9. https://doi.org/10.1053/j.gastro.2014.10.039
34. Lampertico P, Agarwal K, Berg T, Buti M, Janssen H, Papatheodoridis G. European association for the study of the liver electronic address: easloffice@ easloffice. Eu; European association for the study of the liver. EASL 2017 clinical practice guidelines on the management of hepatitis B virus infection. J. Hepatol. 2017;67(2):370-98. https://doi.org/10.1016/j.jhep.2017.03.021
35. Pascasio-Acevedo JM. Prevención de la infección por el virus de la hepatitis B en el trasplante hepático y renal. Nefrología (English Edition). 2013 Jul 1;4(3):60-6. https://revistanefrologia.com/en-prevencion-infeccion-por-el-virus-articulo-X2013757513003242
36. Mulrooney-Cousins PM, Michalak TI. Asymptomatic hepadnaviral persistence and its consequences in the woodchuck model of occult hepatitis B virus infection. Journal of Clinical and Translational Hepatology. 2015 Sep 15;3(3):211. https://doi.org/10.14218/JCTH.2015.00020
37. Abdulla IM, Goreal AA. Detection of Hepatitis-B virus genotypes among chronic carriers in Duhok-Iraq. Journal of the Faculty of Medicine Baghdad. 2016 Jul 3;58(2):170-5. https://doi.org/10.32007/jfacmedbagdad.582234
38. Lin CL, Kao JH. Hepatitis B virus genotypes and variants. Cold Spring Harbor perspectives in medicine. 2015 May 1;5(5): a021436.
https://doi.org/10.1101/cshperspect.a021436
Published
2026-07-20
How to Cite
1.
Abdalla Goreal A, MAHMOOD ISMAEL K. SEROLOGICAL AND MOLECULAR PROFILE OF HEPATITIS B AND C VIRUSES AND DETECTION OF OCCULT HBV AMONG HEMODIALYSIS PATIENTS IN DUHOK, IRAQ. Duhok Medical Journal [Internet]. 20Jul.2026 [cited 23Jul.2026];20(2):75-6. Available from: https://dmj.uod.ac/index.php/dmj/article/view/366
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College of Medicine, University of Duhok
Duhok, Iraq
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