Incidence and risk factors of hepatitis C virus infection in a haemodialysis unit

Autor: Revert L, José-María Sánchez-Tapias, Patricia Fernández-Llama, Josep Costa, F X López-Labrador, E Olmedo, Joan Rodés, Xavier Forns, Anna Darnell, J López-Pedret, Mònica Pons, Sergi Ampurdanés
Rok vydání: 1997
Předmět:
Zdroj: Nephrology, dialysis, transplantation : official publication of the European Dialysis and Transplant Association - European Renal Association. 12(4)
ISSN: 0931-0509
Popis: Extremely careful observation of preventive measures seems essential to eradicate HCV transmission in Background. Hepatitis viruses have become one of the main infectious problems in patients on maintenance haemodialysis units. haemodialysis. The aim of this study was to prospect- Key words: blood transfusion; genotypes; HCV; ively investigate the incidence of de novo hepatitis C haemodialysis; nosocomial; transmission virus ( HCV ) infection in a haemodialysis unit and to identify factors currently involved in HCV transmission to haemodialysis patients. Methods. One hundred and fourteen anti-HCV nega- Introduction tive and HCV-RNA negative patients who started long-term haemodialysis were followed for a mean After the introduction of measures aimed to control period of 36 months (range 18‐56 ). Liver tests and the spread of hepatitis B virus infection in dialysis anti-HCV were performed at 6-month intervals. units, it became clear that dialysis patients were at Factors that might be implicated in HCV transmission, increased risk of exposure to the etiologic agent of such as blood transfusions, sexual habits, surgery and parenterally transmitted non-A, non-B (C ) hepatitis. other invasive procedures, were recorded. HCV The prevalence of HCV infection in haemodialysis markers were re-examined in transfused blood and the patients varies markedly from country to country and HCV genotype was investigated in seroconverters to from one center to another and ranges between 5% in anti-HCV and in patients with previous HCV infection North European countries and in the US to more than who were treated in the vicinity of those who 20% in the Mediterranean area [1]. The relevance of seroconverted. HCV infection in patients on haemodialysis is related Results. Eight patients (7%) seroconverted to anti- to the development of serious liver disease, particularly HCV and seven of them became HCV-RNA positive. after renal transplantation [2‐4 ]. HCV markers, including HCV-RNA, were negative in Blood transfusion and the length of time on the blood transfused to seroconverters. No differences haemodialysis were the main factors involved in HCV between seroconverters and non-seroconverters were transmission to haemodialysis patients in the past [5 ]. found in other risk factors not directly related to However, despite screening of blood products for HCV haemodialysis. The investigation of HCV genotype and the wide use of erythropoietin, which reduces suggested that HCV transmission was not restricted to blood transfusion requirements, some patients still patients treated in the vicinity of previously HCV become infected by HCV during haemodialysis. Thus, infected patients. Occasional failure to observe strict mechanisms other than blood transfusion do possibly measures of asepsis was detected in the haemodialysis operate in HCV transmission in this setting. unit and this was the only factor that might be The analysis of genomic sequences of HCV isolates incriminating. from around the world has demonstrated that these Conclusions. HCV acquisition in patients on haemodia- sequences can be classified into distinct genotypes [6 ]. lysis is currently not related to blood transfusion, and The existence of several genetic groups of HCV has nosocomial transmission within the haemodialysis unit clinical relevance and the molecular analysis of HCV seems to be the main mechanism of HCV infection. genomes has been extensively used in epidemiological
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