Detection of Hepatitis C Virus in Dialysate and in Blood Ultrafiltrate of HCV-Positive Patients

Sampietro, Maurizio; Graziani, G.; Badalamenti, Salvatore; Salvadori, S.; Caldarelli, Rita; Como, Giovanna; Fiorelli, G.

doi:10.1159/000188234

Cited by 26 publications

(8 citation statements)

References 6 publications

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“…This observation was supported by some authors who failed to detect HCV RNA passage across low-flux (cellulose) or high-flux (polysulfone and polyacrilonitrile) membranes [6, 9]but not by others who found HCV passage through both polysulfone and cuprophan membranes [10, 11]. …”

Section: Discussionmentioning

confidence: 90%

“…Although it largely exceeds the size of the membrane pore, at least two possible conditions might account for this passage: microscopic breaks, increased by succeeding reuses, or passage of viral fragments instead of total virions [10, 15]. The property of adsorption of some membranes, regardless of the size of their pores, is another factor to be taken into account when conditions of viral passage are analyzed [16].…”

Section: Discussionmentioning

confidence: 99%

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Evidence of Hepatitis C Virus Passage Across Dialysis Membrane

Valtuille¹,

Fernández²,

Berridi³

et al. 1998

Nephron

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The passage of hepatitis C virus (HCV) across the dialysis membrane is a controversial issue. We performed a study applying extreme conditions of permeability to the dialysis membrane and avoiding the use of heparin and dialysis bath that might interfere with polymerase chain reaction (PCR) results. We obtained samples from the ultrafiltrate at the beginning of 18 hemodialysis sessions carried out in 6 HCV RNA-positive patients. HCV RNA was detected by PCR in 3 (16.7%) ultrafiltrate samples belonging to 1 of the patients. HCV genotype was the same as that found in positive ultrafiltrate samples and in the serum corresponding to this patient. The viral load of this patient was under the levels detectable by the assay employed. Therefore, contamination of the ultrafiltrate may constitute a potential risk for HCV transmission in hemodialysis units.

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Section: Discussionmentioning

confidence: 90%

Section: Discussionmentioning

confidence: 99%

Evidence of Hepatitis C Virus Passage Across Dialysis Membrane

Valtuille¹,

Fernández²,

Berridi³

et al. 1998

Nephron

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“…Sampietro et al 19 (1994) relataram a existência de um risco potencial de infecção cruzada de VHC por fluídos de diálise; suas conclusões foram baseadas no achado de evidências do subtipo viral desses pacientes em amostras de líquidos de diálise e ultrafiltrados, colhidas durante tratamento dialítico. No presente estudo, promover a desinfecção das máquinas de diálise somente no final do dia associou-se à maior positividade de anti-VHC, sugerindo a necessidade de uma maior atenção nessa etapa dos procedimentos dentro da unidade de diálise.…”

Section: 21unclassified

Prevalência e fatores associados à hepatite C em pacientes de hemodiálise

Medeiros

Lima

et al. 2004

Rev. Saúde Pública

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OBJETIVO: A prevalência da infecção pelo vírus da hepatite C (VHC) é maior em pacientes submetidos à hemodiálise que na população em geral, possivelmente refletindo maior exposição a situações de risco. O estudo realizado teve por objetivo determinar a prevalência de anticorpos anti-VHC em pacientes em hemodiálise e identificar fatores relacionados às clínicas e aos pacientes, associados à transmissão do VHC. MÉTODOS: Realizou-se estudo transversal em 752 pacientes em hemodiálise em todas as 12 clínicas de Fortaleza, Ceará. Eles foram testados com anticorpos anti-VHC por ELISA de terceira geração. Foram entrevistados 663 pacientes quanto a aspectos sociodemográficos, clínicos e epidemiológicos. Fatores nosocomiais foram investigados utilizando-se questionário específico. Para a análise estatística foram aplicados o teste t de Student, o odds ratio e a regressão logística univariada e multivariada. RESULTADOS: A prevalência de anti-VHC foi de 52% (390/746; variando de 6% a 72%). A freqüência de infecção foi maior em pacientes previamente submetidos à diálise peritoneal (OR=1,76; IC 95% 1,12-2,76) e a transfusões de sangue (OR=2,75; IC 95% 1,25-6,03). O tempo de hemodiálise associou-se com positividade do anti-VHC (OR=1,47; IC 95% 1,35-1,61). Procedimentos nas clínicas associados à positividade do anti-VHC foram preparo prévio de heparina (OR=2,92; IC 95% 1,23-6,92), falha no uso ou troca de luvas (OR=5,73; IC 95% 1,75-18,72), desinfecção de máquinas de diálise (OR=2,79; IC 95% 1,57-4,96) e segregação em sala de diálise (OR=0,18; IC 95% 0,05-0,61). CONCLUSÕES: Os resultados mostraram elevada prevalência de anti-VHC em pacientes sob hemodiálise e a associação de fatores de transmissão nosocomial com a infecção pelo VHC.

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“…Vertical transmission of HCV due to 'internal' contamination of HD machines has also been suggested with the overload of transducers, protectors of HD machines [44]. Alterations of pore size and microfractures of the membrane of the dialyzers, occurring during manufacturing or during the course of dialysis sessions, may allow the migration of HCV into the internal circuits of the dialysis machines when there is leakage of blood or blood components through the machines [46]. This may cause 'internal' contamination of dialysis machines and vertical transmission of HCV within HD units.…”

Section: Discussionmentioning

confidence: 99%

Detection of de novo Hepatitis C Virus Infection by Polymerase Chain Reaction in Hemodialysis Patients

Fabrizi

Martin²,

Dixit³

et al. 1999

Am J Nephrol

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Patients on chronic hemodialysis (HD) treatment have been identified by serological testing, including second- and third-generation enzyme-linked immunosorbent assay (ELISA), as a high-risk group for hepatitis C virus (HCV) infection. Previous studies have shown that de novo cases of HCV may occur in HD units in the absence of other parenteral exposures, which suggests the spread of HCV between patients. In addition, the reverse-transcription polymerase chain reaction (RT-PCR), which directly detects HCV virus, has identified HCV infection in chronic HD patients who are seronegative. The aim of this study was to determine the incidence of HCV infection detected by RT-PCR technology in a large cohort of chronic HD patients. One hundred and twenty chronic HD patients, HCV-negative by serological assays (second-generation ELISA) and molecular techniques (branched DNA and RT-PCR), were observed for a mean period of 9.5 months. They were tested monthly for serum alanine aminotransferase levels (ALT) and by second-generation ELISA. At the end of the follow-up period, they were again evaluated by branched DNA and RT-PCR testing. HCV RNA was detected in patients’ sera by RT followed by PCR using two separate primer sets from the 5′-untranslated region of the HCV genome. Southern blot was performed using a digoxigenin-labeled probe. Two patients who had HCV RNA detectable by RT-PCR at the end of the follow-up period remained branched-DNA-negative. Thus, the incidence of de novo acquisition of HCV infection in the current investigation was 2.1% per year. In 1 patient RT-PCR positivity and anti-HCV ELISA seroconversion occurred. The 2nd patient remained anti-HCV ELISA-negative, although viremic. In both patients, the onset of positivity by RT-PCR was associated with a rise of ALT levels into the ‘abnormal range’ in our laboratory. In these 2 patients, de novo acquisition of HCV infection was observed in the absence of obvious parenteral risk factors other than their presence in the HD environment. In conclusion, de novo acquisition of HCV infection may be undetected by ELISA and branched-DNA assays. The need to monitor chronic HD patients by serial ALT testing is emphasized. RT-PCR shoud be incorporated into diagnostic testing for HCV infection in chronic HD patients. RT-PCR technology can identify HCV in HD individuals with raised ALT activity.

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Detection of Hepatitis C Virus in Dialysate and in Blood Ultrafiltrate of HCV-Positive Patients

Cited by 26 publications

References 6 publications

Evidence of Hepatitis C Virus Passage Across Dialysis Membrane

Evidence of Hepatitis C Virus Passage Across Dialysis Membrane

Prevalência e fatores associados à hepatite C em pacientes de hemodiálise

Detection of de novo Hepatitis C Virus Infection by Polymerase Chain Reaction in Hemodialysis Patients

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