Archive | 2021
Double Jeopardy: Persistently High Hepatitis C Rates in Haemodialysis Patients in Brazil: A Systematic Review and Meta-Analysis
Abstract
\n Background: We conducted a systematic review and meta-analysis of studies assessing HCV infection rates in haemodialysis patients in Brazil. Methods: A systematic review was carried out, followed by two independent meta-analyses. The 1 st included studies with data on HCV prevalence. The 2 nd included previous studies with a confirmatory PCR (i.e. active infection of hepatitis C). We used both Bayesian and classical statistical concepts and methods. A comprehensive set of different methods and procedures were used, including forest plots and respective statistics, polynomial regression, meta-regression, subgroup, influence, and trim and fill analysis. Results: 11,290 individuals were assessed in the pooled analyses. The average time patients were in haemodialysis varied from 23.5 to 56.3 months. Prevalence of HCV infection was highly heterogeneous, with a pronounced decrease from 1992 to 2001, followed by a plateau and a slight decrease in recent years. The summary measure for HCV prevalence was 34% (95%CI:26%-43%) for studies implemented before 2001. For studies launched after 2001, the corresponding summary measure was 11% (95%CI:8%-15%). Estimates for prevalence of active HCV infection were also highly heterogeneous. There was a marked decline from 1996 to 2001, followed by a plateau and a slight increase after 2010. The summary measure for active HCV infection was 19% (95% CI:15%-25%) in studies launched before 2001, with a high degree of heterogeneity. For studies implemented after 2001, the corresponding summary measure was 9% (95% CI: 6%-13%), again with high heterogeneity. The different analyses helped to identify the underlying sources of heterogeneity. Besides the year each study was conducted, the findings differed markedly between geographic regions and were heavily influenced by the size of the various studies and by publication biases.Conclusions: CKD should be targeted with specific interventions to prevent HCV infection, and if prevention fails, prompt diagnosis and treatment. Although the goal of HCV elimination by 2030 in Brazil appears elusive, it is possible and necessary to adopt measures to achieve micro-elimination and to launch initiatives towards targeted interventions to curb the spread of HCV among people with CKD, among other high-risk groups.