Infections with hepatitis B and C viruses in patients on maintenance dialysis in Romania and in former communist countries: yellow spots on a blank map?

Abstract

We studied prospectively, between 1993 and 1998, the prevalence and incidence of markers against hepatitis B virus (HBV), hepatitis C virus (HCV) and hepatitis D virus (HDV), in 180 patients with chronic renal failure, dialysed in the Nephrological Clinic, Cluj. HBV and HCV markers were common in the patients who were already on haemodialysis in 1993 (antibodies to hepatitis B core antigen [HBcAb]: 57.9-88%; hepatitis B surface antigen [HBsAg]: 8.7-25%; antibodies to HCV [anti-HCV]: 73.7-100%; simultaneous occurrence of HBsAg and anti-HCV antibodies: 4.4-21%). These patients had the longest mean duration of haemodialysis therapy (6.79 +/- 4.82 years). The lowest prevalence was found in 1996, in the groups of patients included in the haemodialysis programme between 1993 and 1996 (HBcAb: 2.2-3.3%; HBsAg: 0-2.2%; anti-HCV antibodies: 0-2.2%; HBsAg and anti-HCV antibodies: 0-2.2%). The patients included since 1996 had, again, a high prevalence of markers (HBsAg: 21.6%; anti-HCV antibodies: 28.6%), despite the short duration of dialysis therapy (1.65 +/- 1.18 years). The incidence of infection was high before 1993, fell markedly between 1993 and 1996 (zero for the HBsAg and 6. 67% year-1 for the anti-HCV antibodies) and rose sharply between 1996 and 1998 (10.2%, respectively 29% year-1). The prevalence of HBV and HCV infections did not correlate with the age of the patients and depended, but only up to 1993, on the quantity of transfused blood. The link between the duration of the haemodialysis and the prevalence of the HBV and/or HCV infection proved nosocomial transmission. The very high prevalence and incidence of HBV and HCV infections, surpassing not only Western countries, but even those of 'developing' countries that are endemic for these infections, is characteristic of some former communist countries. A radical reform of the medical system in these countries is required.

[No Title Available]

“…Regarding HCV infection in hemodialysis patients, studies showed rates ranging from 3.4%, in the Netherlands (Schneeberger et al 2000), to more than 70%, in Eastern Europe (Vladutiu et al 2000). In our country, HCV prevalence rates of 20.3%, 23.8%, 33.4% and 39% were recently found in Santa Catarina (Moraes 2001), Bahia (Santana et al 2001), Minas Gerais (Busek et al 2002), and Goiás (Carneiro et al 2001), respectively.…”

“…Since both viruses are efficiently transmitted by parenteral route, patients undergoing hemodialysis are at high risk of acquiring these bloodborne hepatitis agents (Cañero-Velasco et al 1998, Covic et al 1999, Vladutiu et al 2000. In addition, infected patients have an increased tendency to develop chronic hepatitis and also to be a potential reservoir for its transmission (Goldbloom & Reed 1980, Harnett et al 1988.…”

Hepatitis B virus infection profile in hemodialysis patients in Central Brazil: prevalence, risk factors, and genotypes

“…In some countries, this infection has been controlled in dialysis centers by adherence to hemodialysis-specific infection-control practices and to hepatitis B vaccination (Ambuhl et al 2000, Finelli et al 2005. However, for others, HBV infection is still an important problem to patients (Vladutiu et al 2000, Otedo et al 2003, Kumar et al 2005. Nevertheless, HBV infection outbreaks are still seen when failures in infection control procedures occur (De Castro et al 2000, Lewis-Ximenez et al 2001.…”

“…These data show that HBV infection continues to be an important problem in Brazilian dialysis units. Blood transfusion has been pointed as an important risk factor for hepatitis B in hemodialysis population (Vladutiu et al 2000, Otedo et al 2003. In the present investigation, patients who received blood transfusion before 1993 had a 2.3-fold (95% CI: 1.6.-3.3) greater risk of HBV positivity compared to those that were transfused after.…”

“…Many investigations have demonstrated that duration of hemodialysis treatment is strictly correlated with hepatitis B positivity, suggesting HBV nosocomial transmission (Vladutiu et al 2000, Busek et al 2002, Otedo et al 2003). In fact, our patients under treatment for more than three years had 2.6-fold (95% CI: 1.7-4.0) greater risk of HBV infection compared to subjects who had undergone less than one year.…”