Serological Profile of Hepatitis B, C, and D and Factors Associated With Hepatitis B Exposure and Vaccination Among Hemodialysis Patients in Northeastern Brazil

Abstract

Introduction Hemodialysis patients are at increased risk for viral hepatitis due to treatment‐related exposures and transmission routes, potentially worsening liver and kidney disease. However, updated regional data in Brazil are scarce. This study evaluated the seroprevalence of hepatitis B, C, and D viruses (HBV, HCV, and HDV) and analyzed risk factors associated with HBV infection among patients undergoing hemodialysis in Northeast Brazil. Methods This study corresponds to a cross‐sectional evaluation of 293 patients from two hemodialysis clinics. Serological markers (HBsAg, anti‐HDV, anti‐HBc, anti‐HBs, and anti‐HCV) were analyzed by chemiluminescence, and the quantification of viral load was measured by real‐time PCR. Sociodemographic and risk‐related characteristics were collected via questionnaire. Statistical analyses included chi‐square and Fisher tests (p < 0.05). Results The prevalence of hepatitis B (HBsAg+) and hepatitis C (anti‐HCV+) was 2.4% and 4.1%, respectively. Regarding hepatitis B serological status, 17.2% presented markers of exposure (HBsAg and/or anti‐HBc+), 35.6% were susceptible, and 47.1% had probable vaccine‐induced immunity (isolated anti‐HBs+). Male sex was associated with HBV exposure, whereas female sex was associated with susceptibility (p < 0.001 and p = 0.036, respectively). Younger age (≤ 50 years) was related to vaccination status (p = 0.027). A history of jaundice was associated with HBV exposure (p = 0.030) and lower vaccination rates (p = 0.034), and psychotropic substance use with incomplete vaccination status (p = 0.014). Complete vaccination coverage (anti‐HBs+ and/or ≥ 3 doses on the vaccination card) was low (51.2%), particularly among drug users. No anti‐HDV reactivity was detected among HBsAg‐positive individuals. Conclusion HBV and HCV prevalence was higher than the national average in hemodialysis, with gender disparities between exposed and susceptible and low vaccination coverage, especially in drug users. Although no anti‐HDV reactivity was found, investigating hepatitis D in this population remains relevant to improving understanding of its geographical distribution and clinical impact. It is recommended to reinforce screening, vaccination, and safety protocols in hemodialysis clinics.