PREVALENCE AND EFFECT OF SEN VIRUS IN HEMODIALYSIS PATIENTS IN ZAGAZIG UNIVERSITY NEPHROLOGY UNIT.

Background: Chronic hemodialysis patients are at higher risk of multiple types of infections than other normal population, especially blood-borne. About 5 % of those patients had a full picture of acute hepatitis without known causative agent for this unknown none A-E hepatitis e.g. TTV, GBV-C and SEN virus (SENV), but after thorough investigations, these viruses were discounted as causes of serious hepatitis. SENV is a single-stranded, non-envelped, circular DNA which was considered as a member of circoviridae family, but it has been recently classified in a ?oating genus named Anellovirus: unclassified Anellovirus which also include Anellovirus PRA1 (felis catus anellovirus PRAI), Anellovirus PRA4 (felis catus anellovirus PRA 4), SEN-V, Small Anellovirus, TTV (transfusion transmitted virus), TTMV (torque teno mini virus) and TTMDV (torque teno midi virus). SENV has nine different genotypes (A to I) with at least 25% divergence in nucleotide sequence. SENV-D and SENV-H genotypes have comparatively higher frequencies in post- transfusion non A-E hepatitis. Additionally SENV-H has been found more frequent in hemodialysis patients. The main route of transmission is parentral via transfusion of blood and its products, however, other routes have been documented such as feco-oral, sexual and vertical transmissions. It can be detected by PCR and has no treatment. Aim of the work: The aim of this study is to screen high risk group i.e. chronic hemodialysis patients and to identify any ability of SENV to induce acute hepatitis or aggravating the already existing chronic hepatitis. Patients and methods: The study included 98 ESRD patients on regular HD screened for SENV and divided in to 2 groups, SENV +ve and SENV –ve groups. The 98 patients were subjected to proper history taking including name, age, sex, occupation, past history of blood transfusion, liver disease and duration of hemodialysis was obtained. Full clinical assessment for relevant clinical signs. Screening for anti-HCV as a marker for HCV and for HBsAg as a marker for HBV as a confirmation for previous virology results recorded in patients’ files, liver function tests and complete blood picture. Screening for SENV-DNA by polymerase chain reaction (PCR) and liver ultrasound. Results: prevalence of SENV infection among patients was only 4.1%. In our study, there were no association between the positivity rates of SENV and the demographic data (age-gender- living area), history of blood transfusion, history of previous surgeries, history of co-morbidities (hypertension, diabetes or both), sera status for anti-HCV antibodies and/or HBs Ag or history of past surgery. SENV alone failed to cause any liver insult in those without any liver illness before and negative for anti-HCV and/or HBsAg. Additionally, it failed to exacerbate or initiate liver insult in our patients with positive sera for anti-HCV antibodies. The effect of SENV on hematopoiesis in our patients has not been clearly established and there has not been any statistically significant effect on WBC, hemoglobin and platelets count. Conclusion: SEN V infection is uncommon (only 4.1%) among HD patients in Zagazig university hospitals nephrology unit. There is no association between age, gender, area of living, history of blood or its products transfusion, history of past surgeries, HCV and/or HBsAg and history of common co-morbidities in ESRD e.g. diabetes and/or hypertension, and the presence of SENV in the sera of chronic hemodialysis patients. SENV has no relation to acute liver insult or to aggravation of pre-existing liver illness.