Hepatitis B and C in dialysis units in Iran: Changing the epidemiology Seyed Moayed ALAVIAN, 1 Kamran BAGHERI-LANKARANI, 2 Mitra MAHDAVI-MAZDEH, 3,4 Shahram NOUROZI 4 1 Baqiyatallah Research Center for Gastroenterology and Liver Disease, Baqiyatallah University of Medical Sciences, Tehran, Iran; 2 Gastroenterohepatology Research Center, Shiraz University of Medical Sciences; 3 Medical Sciences, Tehran University, Tehran, Iran; 4 Management Center of Transplantation and Special Diseases, Tehran, Iran Abstract Hepatitis B (HBV) and C (HCV) viruses are the most important infections transmitted by the parenteral route in patients receiving maintenance dialysis. The prevalence varies markedly from country to country. The aim of this study is to review the efficacy of the strategies to reduce the incidence of these infections and the trend of results in Iran. As a routine, all hemodialysis patients in Iran have biannual blood samples for assessment of serum HBSAg, HBS Abs, and HCV Abs. The data are col- lected in the Ministry of Health. For statistical analysis, prevalence, and incidence were calculated. There is an increasing prevalence/incidence of end-stage renal disease (ESRD) in Iran, from 238/ 49.9 pmp in 2000 to 357/63.8 pmp in 2006. The prevalence of positive HBSAg and HCV Abs de- creased from 3.8% and 14.4% in 1999 to 2.6% and 4.5% in 2006, respectively. Regarding the geno- type distribution in Iran, no one was found with genotype 2. On the subject of decreasing HBV infection, our next strategy should be mandatory vaccination in dialysis centers and in the pre-ESRD period. Concerning HCV infection prevention, 2 approaches may be recommended: the first is de- crease of duration of the hemodialysis period by possible early transplantation of suitable patients. The next is a strictly enforced isolation policy for HCV-positive patients, which may play a role in limiting HCV transmission in HD units, and universal precaution in dialysis units should be under constant close surveillance. Key words: Hemodialysis, hepatitis C, hepatitis B, Iran, developing world INTRODUCTION Hepatitis B (HBV) and C (HCV) viruses are the most im- portant causes of transmitted infections by the parenteral route in patients on maintenance hemodialysis. 1–3 Hep- atitis C virus (HCV) is also the major cause of their liver disease in both industrialized and developing countries, which may lead to liver failure or hepatocellular carci- noma. 2–4 The prevalence of HCV and HBV infection in hemodi- alysis patients varies markedly from country to country, ranging from negligible for HBV in developed countries to very high regarding HCV in some developing coun- tries. 1,4,5 There are many reports on the subject of the prevalence of HCV and HBV infections in blood donors, deferred blood donors, hemophiliacs, thalassemic pa- tients, intravenous drug users (IVDs), patients on hemo- dialysis, and the general population in Iran. 2,4,6–14 It has been emphasized that better donor selection, improve- ment of sensitivity of tests and rejection of high-risk groups to donate blood are the main causes of reduced Correspondence to: S. M. Alavian, Prof of Internal Medicine, Gastroenterology and Hepatology, Baqiyatallah Research Center for Gastroenterology and Liver Disease, PO Box: 14155-3651, Vanaq Square, Mola Sadra Street, Tehran, Iran. E-mail: Alavian@thc.ir Hemodialysis International 2008; 12:378–382 r 2008 The Authors. Journal compilation r 2008 International Society for Hemodialysis 378