Decrease in the hepatitis C virus (HCV) prevalence in hemodialysis patients in Spain: effect of time, initiating HCV prevalence studies and adoption of isolation measures.
ABSTRACT The effectiveness of isolation measures to prevent hepatitis C virus (HCV) infection in hemodialysis units is a controversial issue. Strict adherence to the universal infection control precautions has been deemed adequate to prevent nosocomial transmission of HCV. Subsequently, however, select isolation measures, such as the clustering of HCV positive patients in a defined sector of the unit, have been adopted, specially for those units with a high HCV prevalence and when the personnel-patient ratio was such that it could involuntary favor the break of the universal precautions. In this Multicenter Spanish Study on HCV in Dialysis, the importance of both time and isolation measures led to a decrease of HCV prevalence. Time was the most important factor (although interacting with the isolation measures) and was independent of the initial HCV prevalence.
Article: Hepatitis C among Hemodialysis Patients: A Review on Epidemiologic, Diagnostic, and Therapeutic Features[show abstract] [hide abstract]
ABSTRACT: Hepatitis C virus (HCV) is a major public health problem and is the most common liver disease among hemodialysis (HD) patients. The seroprevalence of HCV infection among HD ranged from 1.9% to 80% in reports published since 1999. The main risk factor for HCV acquisition in HD patients seems the length of time on HD. Phylogenetic analysis of HCV viral isolates has suggested nosocomial patient-to-patient transmission of HCV infection among HD patients. Lack of strict adherence to universal precautions by staff and sharing of articles such as multidose drugs might be the main mode of nosocomial HCV spread among HD patients. Currently, there are several dilemmas on the management of these patients: should HCV-RNA testing be included in the routine screening of HD population for HCV infection?; does periodic serum alanine aminotransferase testing have a role in screening HD patients for HCV infection?; can dialysis really 'save' the liver of HCV-infected HD patients?; should HCV-infected subjects be isolated and dialyzed by segregated machines?; is there any difference in treating HD and non-HD HCV-infected subjects? This article gathers the present evidence to address these issues and to demonstrate the current worldwide magnitude of HCV in HD population.Hepatitis Monthly. 01/2007;
Article: Acute hepatitis C virus infection assessment among chronic hemodialysis patients in the Southwest Parana State, Brazil.[show abstract] [hide abstract]
ABSTRACT: Chronic hemodialysis patients are at higher risk for acquiring hepatitis C virus (HCV). The prevalence varies among different countries and hemodialysis centers. Although guidelines for a comprehensive infection control program exist, the nosocomial transmission still accounts for the new cases of infection. The aim of this study was analyze the follow up of newly acquired acute hepatitis C cases, during the period from January 2002 to May 2005, in the Hemodialysis Center, located in the Southwest region of Parana State, Brazil and to analyze the effectiveness of the measures to restrain the appearance of new cases of acute hepatitis C. Patients were analyzed monthly with anti-HCV tests and ALT measurements. Patients with ALT elevations were monitored for possible acute hepatitis C. During this period, 32 new cases were identified with acute hepatitis C virus infection. Blood screening showed variable ALT levels preceding the anti-HCV seroconversion. HCV RNA viremia by PCR analysis was intermittently and even negative in some cases. Ten out of 32 patients received 1 mcg/kg dose of pegylated interferon alfa-2b treatment for 24 weeks. All dialysis personnel were re-trained to strictly follow the regulations and recommendations regarding infection control, proper methods to clean and disinfect equipment were reviewed and HCV-positive patients were isolated. Laboratory tests results showed variable ALT preceding anti-HCV seroconversion and intermittent viremia. The applied recommendations contributed importantly to restrain the appearance of new cases of acute hepatitis C in this center and the last case was diagnosed in May 2004.BMC Public Health 02/2007; 7:50. · 2.00 Impact Factor
Article: Prevalence of Hepatitis B and C Infection in Hemodialysis Patients of Rasht (Center of Guilan Province, Northern Part of Iran)[show abstract] [hide abstract]
ABSTRACT: and Aims: Hepatitis B virus (HBV) and hepatitis C virus (HCV) infections are significant health problems, as they can lead to chronic active hepatitis, liver cirrhosis, and hepatic carcinoma. Factors associated with HBV propagation include blood and derivates transfusion, duration and frequency of hemodialysis, equipment contamination and contact among patients as well as between them and health-care workers. Transmission of HCV through dialysis units has shown a progressive increase worldwide, ranging from 5% in some western countries to 70% in some developing countries. The aim of this study was to determine the prevalence of HBV and HCV infections in hemodialysis patients of Rasht (center of Guilan province, North of Iran).Methods: A cross-sectional analysis was performed on 163 chronic (>6 months) hemodialysis patients. Patients from the hemodialysis unit of Rasht were interviewed. The following data was collected: name, age, gender, occupation, duration of dialysis and cause of End Stage Renal Disease. Blood samples were collected and screened for HBsAg and anti-HCV antibodies by a third-generation enzyme-linked immunosorbent assay (ELISA). Qualitative HCV determination in ELISA positive cases (after two tests) was performed by QIAGEN OneStep RT-PCR kit (assay sensitivity 100 copies/mL).Results: Five patients were HBsAg positive (3.06%) and 30 were anti HCV antibody positive by ELISA (18.40%). HCV positivity was confirmed by PCR in 17(10.42%) patients. All patients had a minimum of two to a maximum of three dialysis sessions per week. Mean age in HBsAg positive cases was 47.3 years and all of them were male. Duration of dialysis was 8-12 years in all five HBsAg positive patients. Mean age in HCV positive patients was 42.3 years. 66% of HCV positive patients were male and 33.33% of them were female. Duration of dialysis was 0-4 years in 33.33 % of HCV positive patients, 4-8 years in 26.66% of cases, 8-12 years in 20% and 12-16 years in 20% of them.Conclusions: This project suggests that hepatitis C infection has a high prevalence in dialysis patients and Anti-HCV Ab test should be performed before scheduling them. Although some references refuse to suggest isolation of dialysis settings for this group of patients, strategies such as closed control of services given to these patients such as blood transfusion and also training the personnel of hemodialysis units for infection prevention seems to be necessary.Hepatitis Monthly. 01/2009;