Updated Evidence on the Epidemiology of Hepatitis C Virus in Hemodialysis

Abstract

Prevalence rates of HCV infection are decreasing in hemodialysis units of most developed countries; however, nosocomial transmission of HCV continues to occur in the hemodialysis setting, not only in the emerging world. According to the Dialysis Outcomes and Practice Patterns Study (DOPPS, 2012–2015), the prevalence of HCV among patients on regular hemodialysis was 9.9%; in incident patients, the frequency of HCV was approximately 5%. Outbreaks of HCV have been investigated by epidemiologic and phylogenetic data obtained by sequencing of the HCV genome; no single factor was retrieved as being associated with nosocomial transmission of HCV within hemodialysis units. Transmission of HCV within HD units can be prevented successfully by full compliance with infection control practices; also, antiviral treatment and serologic screening for anti-HCV can be useful in achieving this aim. Infection control practices in hemodialysis units include barrier precautions to prevent exposure to blood-borne pathogens and other procedures specific to the hemodialysis environment. Isolating HCV-infected hemodialysis patients or using dedicated dialysis machines for HCV-infected patients are not currently recommended; reuse of dialyzers of HCV-infected patients should be made, according to recent guidelines. Randomized controlled trials regarding the impact of isolation on the risk of transmission of HCV to hemodialysis patients have not been published to date. At least two studies showed complete elimination of de novo HCV within HD units by implementation of strict infection control practices without isolation practices. De novo HCV within hemodialysis units has been independently associated with facility HCV prevalence, dialysis vintage, and low staff-to-patient ratio. Antiviral treatment of HCV-infected patients on hemodialysis should not replace the implementation of barrier precautions and other routine hemodialysis unit procedures.

Are We on the Right Track for HCV Micro-Elimination? HCV Management Practices in Dialysis Centers in Poland—A National Cross-Sectional Survey

“…However, with the availability of DAA, the approach does not stand to reason. Furthermore, isolation of HCV viremic patients has not been firmly confirmed as an effective measure to prevent HCV spread, but in certain circumstances, for example, low patient:personnel ratio, it may be justified [ 9 , 24 , 25 ]. Epidemiological investigations have shown that patients dialyzed nearby are at a greater risk of HCV infection than those dialyzed on the same machine as HCV viremic ones [ 9 , 14 ].…”

“…Furthermore, isolation of HCV viremic patients has not been firmly confirmed as an effective measure to prevent HCV spread, but in certain circumstances, for example, low patient:personnel ratio, it may be justified [ 9 , 24 , 25 ]. Epidemiological investigations have shown that patients dialyzed nearby are at a greater risk of HCV infection than those dialyzed on the same machine as HCV viremic ones [ 9 , 14 ]. This may imply that non-adherence to mandatory precautions and not the machine itself is an obstacle to eradicating CHC; this factor requires due consideration rather than mere isolation of patients with CHC.…”

“…CHC is a well-recognized risk factor for increased liver-related morbidity and mortality in patients on renal replacement therapy (RRT), and successful HCV elimination improves clinical outcomes. Additionally, CHC in HD-dependent patients negatively affects overall survival and results in an increased risk of cirrhosis, HCC, and a lower quality of life compared to their HCV-negative counterparts [ 6 , 8 , 9 ]. Therefore, all patients with end-stage renal disease (ESRD) should be considered for AVT [ 1 , 10 , 11 ].…”

Impaired humoral immune response to hepatitis B vaccine in patients on maintenance hemodialysis

“…( Karkar et al, 2006 ) The furthermost recurrent viral infections faced in hemodialysis units due to HBV, HCV and, to a smaller degree, HIV. ( Bernieh, 2015 , Fabrizi et al, 2021 ).…”

Prevalence and Clinico-Biological Characteristics of Viral Hepatitis B and C in Chronic Hemodialysis Patients at the National Hospital Center of Nouakchott-Mauritania

“…Hemodialysis, a commonly used extra-renal purification technique, allows prolonged survival of patients with chronic renal failure who have reached the end stage. However, it induces many complications, mainly infectious, including viral hepatitis B and C [36,37].…”