Hepatitis C Virus Infection at the Start of Hemodialysis and During Early Follow-up: Evidence from Two Dialysis Centers

BACKGROUND: Hepatitis C virus (HCV) remains a concern in patients undergoing maintenance hemodialysis due to repeated blood exposure and prolonged contact with dialysis environments. Although direct-acting antivirals have reduced HCV burden in many settings, uncertainty persists regarding early infection dynamics at dialysis initiation and during initial follow-up. METHODS: This observational study was conducted in two hemodialysis facilities in northern Iran (2022-2023). All adult patients receiving maintenance hemodialysis were included using a census-based approach. HCV status was assessed by anti-HCV antibody testing at dialysis initiation and repeated after three months as part of routine surveillance. Demographic and clinical variables, including dialysis duration and transfusion history, were extracted from medical records. Analyses focused on prevalence and associations with clinical characteristics. RESULTS: Among 470 patients, six (1.28%) were anti-HCV positive at dialysis initiation. After three months, no new cases were identified; overall prevalence remained unchanged. No significant associations were observed between HCV status and demographic variables, transfusion history, or comorbidities. In contrast, dialysis duration showed a clear association with HCV positivity. Patients with more than ten years of dialysis had markedly higher prevalence than those with shorter durations (P < 0.001). CONCLUSIONS: In this cohort, HCV prevalence at the start of dialysis was low and remained stable during short-term follow-up. Longer dialysis duration was the only factor associated with HCV positivity, supporting its role as a cumulative exposure marker. These findings emphasize the importance of sustained infection-control practices and continued surveillance, even in low-prevalence settings.