Evaluating hepatitis C viremia and antiviral treatment barriers in hemodialysis patients in the post-HCV elimination era: Experience from Ain Shams University Hospitals.

Egypt historically maintained a high prevalence of hepatitis C virus (HCV) infection, with maintenance hemodialysis (HD) patients facing increased risk due to frequent invasive procedures. Following the 2014 launch of Egypt's National HCV Elimination initiative, overall population prevalence declined substantially. However, contemporary data evaluating active viremia and treatment barriers among prevalent HD patients remain limited. To assess the seroprevalence (anti-HCV antibodies) and active viremia (HCV RNA by PCR) among prevalent HD patients after implementation of the National Eradication Initiative, and to identify the barriers to antiviral treatment despite free therapy. A multicenter cross-sectional study was conducted between November 2023 and April 2024 across three affiliated hemodialysis units at Ain Shams University Hospitals, Cairo, Egypt. A total of 410 adult patients (aged ≥ 18 years) on regular maintenance HD for >6 months were recruited using consecutive sampling. Anti HCV antibodies were determined using enzyme-linked immunosorbent assay (ELISA), and active infection was confirmed via quantitative real-time HCV RNA PCR testing. Sociodemographic features, dialysis vintage, treatment history, and self-reported reasons for non-treatment were evaluated. The mean age of participants was 47.1 ± 18.2 years, with a male predominance (62.4%, n= 256). Anti-HCV antibody positivity was identified in 113 of 410 patients (27.6%). Among anti-HCV-positive patients, active viremia (HCV PCR positive) was confirmed in only 14/113 cases (12.4% of seropositive patients; overall study population prevalence of active viremia: 14/410; 3.4%). Of the 113 anti-HCV-positive patients, 95/113 (84.1%) had received antiviral therapy, with 93/95 (97.8%) achieving viral clearance (sustained virological response, SVR). Un-treated patients were (15.9%, n=18). Treatment barriers included lack of awareness regarding free treatment availability (27.8%), fear of side effects (22.2%), treatment refusal (11.1%), and incomplete paperwork (11.1%). HCV PCR positivity was significantly associated with a lack of prior DAA treatment (85.7% vs 6.1%}, p < 0.001) and longer dialysis vintage (5.08 ± 1.1 vs 2.96 ± 1.13 years, p=0.018). In conclusion, the relatively reduced prevalence of HCV in this study reflects the success of the national eradication initiative. Nevertheless, gaps remain in awareness and accessibility, which may hinder complete eradication in high-risk groups such as hemodialysis patients. Enhanced patient education, strict infection-control measures and targeted patient support is crucial to address residual gaps in high-risk dialysis units.