HBV markers in haemodialysis Brazilian patients: a prospective 12-month follow-up

Abstract

The aim of this study was to determine the prevalence and the incidence of hepatitis B virus (HBV) among haemodialysis (HD) subjects and to evaluate whether testing for serological markers at the time of admission is suitable for HBV screening in this population. One hundred twenty-three patients belonging to two HD centres from SãoPaulo, Brazil, were tested prospectively. HBV DNA was detected by polymerase chain reaction (PCR) and HBsAg was detected in 3.3% of patients. These authors were in agreement that 54% of patients were either positive for HBsAg, HBV DNA or both. The aim of this study was to determine the prevalence and the incidence of HBV among HD patients and to evaluate whether testing for serological markers at the time of admission is suitable for HBV screening in this population.All patients (n = 123) undergoing treatment in two HD centres from March 1997-April 1998 were included in this study. The study protocol was submitted and approved by the Ethical Committee of Adolfo Lutz Institute and an informed consent was obtained from each patient. These facilities were considered to be representative of local (São Paulo, Brazil) standard HD services. Both units were comparable in terms of the budget per subject, presence of an isolated area for HBV and HCV patients, recommendation of HBV vaccination for patients and staff and isolation of HBsAg-positive patients to the last shift of the HBV room. These HD centres had standard conditions as determined by Brazilian competent organs and by the CDC guidelines, including isolation of HBsAg-positive patients in a separate room and assignment of staff members to HBsAg-positive patients, but not to HBV-susceptible patients during the same shift, as well as assignment of a supply tray to each patient (CDC 2001, MS 2004.HD patients had previously received four doses of 40 µg of Engerix™ B, administered intramuscularly at zero, one, two and six months. Once a year, anti-HBs is quantified and one dose of vaccine is administered, if necessary. Patients had 10 mL of blood drawn from arterial-venous fistula just before the HD procedure, at the time of admission and on a monthly basis. Therefore, a total of 1,476 serum samples were obtained and separated into the following three aliquots: serological tests, PCR and reconfirmation, if necessary. Samples were stored at -20°C in a separate freezer.The first and the last samples from each patient were tested for HBV DNA using DNA extraction and nested PCR (core fragment) techniques, as previously described (Kaneko et al. 1989). All 1,476 samples were tested for HBsAg, total anti-HBc and anti-HBs antibodies using commercially available ELISA kits (Hepanostika™ Uni-

Cross-Sectional Study to Determine the Prevalence of Hepatitis B and C Virus Infection in High Risk Groups in the Northeast Region of Brazil

“…The prevalence of both were higher than the prevalence found in the Southeast region (5.5% of HBsAg and 4% of anti-HBc) [ 19 ] and in a multicentre Brazilian study (1.4% of HBV prevalence) [ 26 ], but lower than the HBsAg prevalence in the South (10%) [ 27 ] and Central-West region (46.7%) [ 28 ]. These studies showed variable HBV prevalence rates in CRF population that may have been influenced by differences in organizational structure or the work process at haemodialysis centres, which includes the frequency of hygiene and sterilization of equipment in the dialysis room, reuse of capillaries and distribution of patients according to the number of health professionals [ 8 , 27 , 29 , 30 ].…”

“…HBV and HCV infections are prevalent worldwide, especially in the most vulnerable populations, such as patients infected with human immunodeficiency virus (HIV), patients with chronic renal failure (CRF) that are on haemodialysis and patients with coagulation disorders compared to the general population [ 6 , 7 , 8 , 9 , 10 , 11 , 12 , 13 , 14 ].…”

“…These infections negatively impact the survival of the haemodialysis patients and those undergoing renal transplant. In Brazil, the prevalence of anti-HBc and HBsAg were 34.1% and 15.4%, respectively, while the prevalence of anti-HCV ranged from 12% to 33.9% in CRF patients [ 7 , 8 , 9 , 19 ].…”

Blood‐borne viruses in the haemodialysis‐dependent population attending Top End Northern Territory facilities 2000–2009

“…We have documented a high prevalence of HBV infection in this study population. Other renal units have reported widely diverse rates of surface antigen positivity, for example, Turkey, Brazil, and USA and Europe of 13.3%, 18 2.4–10% 19 and 0.6–6%, 14 respectively. The Asia Pacific review of HBV and HCV infection in haemodialysis and peritoneal dialysis patients contained limited data regarding HBV with a wide range of prevalence estimates between 1.3% and 14% 20 .…”

Emergence of New Epidemiological Hepatitis B and C Profiles in High Risk Groups in Latin America

“…In Brazil, prevalence of HBsAg of 0, 2.4, 7, 10, 34.1% were reported in hemodialysis center in Southeast, Central, Northeast, South and Midwest regions of Brazil [78][79][80][81][82]. HBsAg prevalence of 4.5, 25, 1.4% was found in hemodialysis patients in Peru, Venezuela, Cuba [59,67].…”