Risk factors for dialysis-associated hepatitis C in Venezuela

Abstract

Utilizing the first and second generation of enzyme immunoassays which detect antibodies to the C virus we investigated the frequency of anti-HCV antibodies in 315 patients undergoing hemodialysis. Other subpopulations at risk were used as reference groups. One hundred and twenty-three samples (39%) from the hemodialysis group repeatedly showed anti-HCV positive antibodies while only 19% and 1% were positive in the reference groups. The rate of anti-HCV reactive patients correlated with time on hemodialysis (less than 1 year, 17%; 1 to 5 years 43%; greater than 5 years, 64%; r = 0.94, P less than 0.001) and with the number of blood transfusions (1 to 10, 40%; greater than 10, 76%; r = 0.97; P less than 0.001). Length of time on hemodialysis was shown to be the major risk factor in thirty-three anti-HCV positive patients who had no previous record of blood transfusions. Co-infection with HBV was demonstrated in 41% out of 123 anti-HCV reactive patients, and increased alanine aminotransferase (ALT) activity was documented in this co-infected group. Our results further extend the observations on the predisposing factors to HCV spread in hemodialysis units, and suggest that in these renal patients co-infection with C and B viruses is a major cause of rising ALT activity.

Anticorpo contra o vírus C da hepatite em pacientes sob programa de hemodiálise em Salvador, BA, Brasil

“…Destes, 8,6% (6/70) não referiram transfusão. Este fato chama a atenção para outras vias de infecção pelo vírus C. MULLER et al (20) , em estudo semelhante, demonstraram que 33 de 123 (26,8%) pacientes hemodialisados anti-VHC positivos não tinham relato de transfusão. Esses pacientes apresentaram duração de hemodiálise como o principal fator de risco, levando os investigadores a sugerirem a hemodiálise como via de transmissão do vírus C. A observação de que hemodiálise a longo prazo tem importante papel na infecção pelo vírus C é similar a relatos do Japão, Alemanha e Itália (10,18,19,27,30) .…”

“…Os estudos mais recentes, utilizando os testes de segunda geração, mostraram soro-positividade de 10% a 30% (20,22) . Os testes confirmatórios por Immunoblotting (RIBA III) também evoluíram, utilizando proteínas virais diferentes, sejam estruturais ou não-estruturais (15,29) .…”

The Role of α-Glutathione S-Transferase in the Monitoring of Hemodialysis Patients with Hepatitis C Virus Infection Undergoing High-Dose Interferon-α-2b Therapy

“…The lower values of aminotransferases in dialysis patients would also potentially help to explain why some authors have found neither enough sensitivity nor specificity of these enzymes in the diagnosis of HCV disease, as well as the lack of a correlation between the persistence of elevated levels of aminotransferases and the histological patterns of liver damage [12, 13, 14]. The study of Caramelo et al [15]solved this problem by demonstrating that the adaptation of the normal level of aminotransferases to the particular setting of dialysis patients restored sensitivity in using aminotransferases without a major decrease in specificity.…”

Low risk of sexual transmission of hepatitis C virus to spouses of infected hemodialysis patients

“…18,20,21 Nosocomial transmission of HCV in HD patients, strongly suspected in epidemiological studies, has now been unequivocally demonstrated. 19,25,26 Sexual transmission of HCV remains a controversial issue. [4][5][6][7][8][9][10][11][12][13][14][15] In nonuremic patients, this has not been clarified, and questions remain whether this virus has a sexual mode of transmission and, if so, to what extent this mode of spread is responsible for the incidence of hepatitis C infection.…”

“…23 The first and most obvious route of transmission is blood transfusion. Nevertheless, several authors noted a high prevalence of anti-HCV antibodies in HD patients who had never been transfused, [24][25][26] leading them to suspect nosocomial and household transmission. However, the epidemiological relevance of intrafamilial transmission of HCV infection has not been rigorously established.…”