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

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.