Decreased risk of nosocomial transmission of hepatitis B and C viruses among hemodialysis patients in Southern Bulgaria.

Introduction: Hepatitis B (HBV) and (HCV) virus infections represent a nosocomial risk in hemodialysis (HD) patients. We aimed to evaluate the risk among adult HD patients in southern Bulgaria.

Methodology: A prospective cohort study included 225 patients from three HD centers between January 2020 and June 2022. HBV and HCV infections were characterized by serological and virological markers determined through enzyme-linked immunosorbent assay and polymerase chain reaction.

Results: HBV infection was detected in 13 patients and HCV in 15. Ten of the hepatitis patients died of non-liver-related complications. Sustained virological response (SVR) was confirmed in five HCV-infected patients previously cured with direct-acting antivirals (DAAs). Five patients were viremic. Three of them achieved SVR after DAAs, and two refused treatments. A decrease in HCV viremia prevalence (2.22% versus 0.89%) was recorded (p = 0.15). Virological suppression was confirmed in four HBV-infected patients treated with nucleos(t)ide analogs. Тwo patients were not eligible for antivirals. Decreased HBV viremia prevalence (2.7% versus 0.89%) was recorded (p = 0.15). Among HBV surface antigen (HBsAg)-negative patients, HBV vaccination coverage was 62.74% (133/212) and higher in 2 HD centers (128/137; 93.43%). Nevertheless, one-third of participants (34/112; 30.36%) were susceptible to HBV. Twenty-four vaccinees (24/112; 21.43%) had acquired natural immunity but remained at risk of reactivation in case of immunosuppression. HBV DNA was detected in eight HBsAg-negative patients, resulting in a prevalence of 7.14% (8/112) for occult HBV infection.

Conclusions: The study reveals a downward trend in HBV and HCV viremia prevalence among HD patients. To further reduce the risk of nosocomial transmission, vaccination for hepatitis B requires updating.