Hepatitis C Virus Infection in Haemodialysis: The ‘No-Isolation’ Policy Should Not Be Generalized
Department of Nephrology, All-India Institute of Medical Sciences, New Delhi, India. Nephron Clinical Practice
(Impact Factor: 1.4).
02/2009; 111(2):c133-40. DOI: 10.1159/000191208
Hepatitis C virus (HCV) infection is the most common blood-borne viral infection in haemodialysis. It causes significant morbidity and long-term mortality. Practice of universal precautions has been reported to be sufficient to prevent HCV seroconversion in dialysis units. However, the seroconversion rate remains very high in many dialysis units. A previous study from 1995 to 1998 at our own hospital without isolation showed that nosocomial transmission is the major cause of HCV seroconversion. The present study was therefore conducted with the aim to study the impact of isolation on HCV seroconversion. In this prospective cohort study, with non-probability consecutive sampling, patients with HCV infection were dialysed in an isolated room. In addition, standard universal precautions were practiced. HCV seroconversion rate was compared with the previous study. All patients with end-stage kidney disease (ESKD) admitted to our hospital for renal replacement therapy were included in the present study. At the time of admission, HCV screening was done. All anti-HCV-positive patients were dialysed in an isolated room. While on maintenance haemodialysis, all patients were monthly tested for anti-HCV, aspartate aminotransferase and alanine aminotransferase. Any patient who had HCV seroconversion was transferred to an isolated room for maintenance haemodialysis. Patients with HCV infection were managed by further testing for HCV-RNA and liver biopsy. Every patient who ultimately received renal transplantation at our hospital was also tested for HCV just prior to renal transplantation as well as 3 months after renal transplantation. HCV infection was diagnosed by detecting anti-HCV antibodies using an ELISA-based third-generation diagnostic test kit. Serum bilirubin, aspartate aminotransferase and alanine aminotransferase were assayed using standard laboratory techniques. From March 2003 to February 2006, 1,417 patients were admitted for haemodialysis in our unit. Of these 1,077 (76%) had ESKD. Mean age of patients was 42.47 +/- 16.2 (14-94) and 70.39% were males. Patients with ESKD had had more dialysis sessions (10.9 +/- 39.5 vs. 4.4 +/- 5.95, p = 0.009), more blood transfusions and more pre-existing HCV infections (4.72 vs. 1.5%, p = 0.009) than patients with acute renal failure. Of the ESKD patients, 65.7% were discharged, 9.47% died, 1.85% were shifted to chronic ambulatory peritoneal dialysis and 22.46% patients received renal transplantation. Of the patients who received renal transplantation, HCV seroconversion was detected in 2.75%. In the previous study without isolation practices, the HCV seroconversion rate in transplanted patients was 36.2%. The hazard of HCV seroconversion was 0.97 (95% CI 0.93-1.02, p = 0.2) for each additional dialysis and 1.09 (95% CI 0.88-1.36, p = 0.37) for each additional blood transfusion. The study concludes that isolation of HCV-infected patients during haemodialysis significantly decreases the HCV seroconversion rate.
Available from: Yan Yan
- "Many HD centers have improved their adherence to infection-control policies and procedures, and some have even applied the isolation policy of infected HD machines and patients. Some investigators have suggested a decline in HCV prevalence among HD patients in recent years, mostly attributable to strict adherence to universal precautions with observing isolation measures (Agarwal et al., 2009; Barril et al., 2003; Carneiro et al., 2005; Gallego et al., 2006; Harmankaya et al., 2002; Jadoul et al., 2004; Saxena et al., 2003; Saxena et al., 2002; Shamshirsaz et al., 2004; Taskapan et al., 2001; Yang et al., 2003). Detection of anti-HCV antibodies by ELISA allows rare false-negative results in dialysis patients but does not distinguish acute and chronic HCV-infection (Souqiyyeh et al., 1995). "
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ABSTRACT: We aimed to delineate the incidence of hepatitis C virus (HCV) infection and HCV seroconversion (SC) in maintenance hemodialysis (HD) patients and to evaluate the effect of isolation measures on HCV in HD unit. From June 1998 to June 2010, 2465 maintenance HD patients in our HD unit were enrolled in, and the anti-HCV ELISA and HCV nucleic acid testing were consecutively performed every six months. The results showed the prevalence rates of HCV antibody detected consecutively every six months were 54.with isolation measures), respectively. HCV SC occurred in 238 patients during the follow-up period. 1077 patients were followed for 1 to 12 months, of which 49 (4.5%) had SC for HCV. The SC rate increased to 75% in 8 patients followed for 139 to 150 months. Taken together, we conclude that the dialysis environment is responsible for transmission of HCV either due to common usage of the machines or to the fact that the HCV positive patients are not isolated. The application of isolated hemodialysis of anti-HCV positive patients plus strict supervised universal infection control techniques significantly effect on the long-term prevalence of HCV antibody and SC in HD patients.
Available from: Mario Pescatori
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ABSTRACT: Evidence from clinical and experimental studies indicates that hepatitis C virus E2 glycoprotein (HCV/E2) represents a major target antigen involved in the containment and resolution of naturally occurring HCV infection. Antibody phage display allows the molecular cloning of cDNA sequences encoding antibody fragments specific to a wide range of diverse antigens. These antibodies may be produced in bacteria as Fab or converted into full length IgG. The latter have a higher serum half life and display Fc encoded function. Using a library prepared from an HCV-infected individual, we selected a panel of Fab fragments for binding to invariant epitopes of the E2 glycoprotein. This work describes a technique used to convert the selected Fab fragments into full length IgG and to express these antibodies in eukaryotic cells. All the recombinant antibodies retained the binding specificity of the parental Fab showing an increase in apparent relative affinity for E2.
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ABSTRACT: The risk of hepatitis B and C transmission in health care settings has generated considerable attention within the legal system. This article begins with an overview of the relevant sources of law and then explores legal duties and liability arising from two major categories of risk: occupational risks to health care providers and health care-associated risks to patients and other third parties.
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