title: Incidence and prevalence of hepatitis B and hepatitis C viruses in hemodialysis patients in Lebanon.
abstract: OBJECTIVE
  To determine the incidence and the prevalence of hepatitis B and C viral infections in patients on hemodialysis (HD) across Lebanon.
  
  
  METHODS
  We reviewed the data registry at the Lebanese Ministry of Public Health where records of monthly hepatitis B surface antigen (HBsAg) and hepatitis C virus (HCV) serology are reported from 60 affiliated HD centers across Lebanon. All patients who were on HD or who started HD between October 2010 and July 2012 were included in the study. Patients from seven HD centers were excluded due to inadequate and incomplete results reporting. During the selected period, HBsAg and HCV serology were available for 3769 patients from 53 HD centers distributed at all Lebanese governorates. The prevalence was calculated by dividing the number of patients with positive HBsAg or HCV serology to the total number of patients. The Incidence was calculated by dividing the number of newly acquired infection to number of patients-years (p-y). Incidence rates at different governorates were compared to each other using two tailed Z test and a P value of < 0.05 was considered significant.
  
  
  RESULTS
  Sixty out of 3769 HD patients were found to have positive HBS Ag and 177 out of 3769 were positive for HCV Antibodies. The prevalence of hepatitis B virus (HBV) and HCV in HD patients across Lebanon was 1.6%, and 4.7%, respectively. The comparison of prevalence according to geographic distribution could not be done accurately due to the frequent shift of patients between dialysis centers at different governorates. The incidence rate was 0.27 per 100 p-y for HBV and 0.37 per 100 p-y for HCV. There was no significant difference concerning the incidence of HBV between HD centers at different governorates (all P values > 0.1), but this difference was highly significant concerning the incidence rates of HCV which occurred predominantly in the southern centers (1.47 per 100 p-y) with a P value of 0.00068 and 0.00374 when compared to Mount Lebanon (0.21 per 100 p-y) and the Northern centers (0.19 per 100 p-y), respectively.
  
  
  CONCLUSIONS
  The incidence rate of HBV and HCV is very low in the Lebanese HD centers and their prevalence is decreasing over the last two decades.
authors.affiliation: Antoine Abou Rached, National Hepatitis Program, Ministry of Public Health, Beirut 1106 9800, Lebanon.
authors.forename: Antoine
authors.initials: A
authors.lastname: Abou Rached
authors.affiliation: Antoine Abou Rached, National Hepatitis Program, Ministry of Public Health, Beirut 1106 9800, Lebanon.
authors.forename: Lara
authors.initials: L
authors.lastname: El Khoury
authors.affiliation: Antoine Abou Rached, National Hepatitis Program, Ministry of Public Health, Beirut 1106 9800, Lebanon.
authors.forename: Talal
authors.initials: T
authors.lastname: El Imad
authors.affiliation: Antoine Abou Rached, National Hepatitis Program, Ministry of Public Health, Beirut 1106 9800, Lebanon.
authors.forename: Abdallah S
authors.initials: AS
authors.lastname: Geara
authors.affiliation: Antoine Abou Rached, National Hepatitis Program, Ministry of Public Health, Beirut 1106 9800, Lebanon.
authors.forename: Josette
authors.initials: J
authors.lastname: Jreijiry
authors.affiliation: Antoine Abou Rached, National Hepatitis Program, Ministry of Public Health, Beirut 1106 9800, Lebanon.
authors.forename: Walid
authors.initials: W
authors.lastname: Ammar
keywords: Hemodialysis; Hepatitis B virus; Hepatitis C virus; Incidence; Lebanon; Prevalence