Control of hepatitis B infection. The role of surveillance and an isolation hemodialysis center

Najem, G. Reza; Louria, Donald B.; Thind, Inderjit S.; Lavenhar, Marvin A.; Gocke, David J.; Baskin, S; Miller, A M; Frankel, Howard J.; Notkin, J.; Jacobs, Martin; Weiner, Brian C.

doi:10.1001/jama.245.2.153

Cited by 21 publications

(9 citation statements)

References 7 publications

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“…In the renal population, i.e., hemodialysis and kidney-transplant patients, the prevalence of HBV infection is, at least in western Europe and North America, low, and ranges from a few percent to less than 10% (Najem et al, 1981). However, following renal transplantation, it has been clearly demonstrated that chronic immunosuppression is associated in HBV(+)ve patients with a significant increase in liver-related complications, including liver cirrhosis and hepatocarcinoma, particularly in those coinfected with hepatitis C virus (Mathurin et al, 1999).…”

Section: Introductionmentioning

confidence: 99%

Effects of long-term lamivudine therapy in renal-transplant patients

Kamar

Sandres-Sauné²,

Ribes

et al. 2004

Journal of Clinical Virology

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Section: Introductionmentioning

confidence: 99%

Effects of long-term lamivudine therapy in renal-transplant patients

Kamar

Sandres-Sauné²,

Ribes

et al. 2004

Journal of Clinical Virology

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“…Hepatitis B virus (HBV) was previously responsible for most cases of hepatitis in hemodialysis patients [1,2], but during the past 15 years the incidence of hepatitis B has declined [3,4], while the cases of non-A, non-B hepatitis increased [5,6], The recent development of a diagnostic test for hepatitis C antibodies has enabled us to identify hepatitis C virus (HCV) as the major cause of non-A, non-B hepatitis in patients on hemodialysis [7,8].…”

Section: Introductionmentioning

confidence: 99%

Superinfection with Hepatitis C Virus in Hemodialysis Patients with Hepatitis B Surface Antigenemia: Its Prevalence and Clinical Significance in Taiwan

Chen

Lo²,

Liao³

et al. 1996

Nephron

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A survey of hepatitis B surface antigen (HB_sAg) and antibodies against hepatitis C virus (anti-HCV) in 173 patients undergoing hemodialysis in Taiwan revealed that 15 (9%) patients were positive for both HB_sAg and anti-HCV, 106 (61%) were positive for anti-HCV alone, and 14 (8%) were positive for HB_sAg alone. Most HB_sAg positivity was acquired before the onset of hemodialysis. Anti-HCV positivity, however, was mainly acquired via the hemodialysis procedure. Patients with dual markers were younger (43.7 ± 3.3 years old, p = 0.0274), had the longest period on hemodialysis (6.6 ± 1.3 years, p < 0.001), and more severe liver dysfunction. When compared with those who were negative for both markers, patients with both HB_sAg and anti-HCV had an increased incidence of chronicity (5/15 vs. 2/38; p < 0.05), ultrasonographic cirrhosis (5/15 vs. 1/38; p < 0.05), and clinical decompensation (2/15 vs. 0/38; p < 0.05). Their risk for developing ultrasonographic cirrhosis and clinical decompensation was also greater than that of patients with anti-HCV alone (5/15 vs. 8/106 and 2/15 vs. 2/106; p < 0.05 for both). The presence of HB_sAg alone, however, did not increase the incidence of liver dysfunction. The presence of anti-HCV alone was only associated with a greater elevation of serum alanine aminotransferase (44.2 ± 5.5 vs. 19.1 ± 2.5 U/l; p < 0.05) and an increased incidence of chronicity (30/106 vs. 2/38; p < 0.05). Our results indicate that a high prevalence of HCV superinfection impose a significant risk on a large population of HB_sAg-positive hemodialysis patients in Taiwan. As the coexistence of anti-HCV and HB_sAg is associated with more severe liver dysfunction, it is urgent to devise effective methods to prevent HCV circulation in a hemodialysis environment – especially in a hepatitis B virus endemic area such as Taiwan.

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“…[97][98][99] The success of isolation practices in preventing transmission of HBV infection is linked to other infection control practices, including routine serologic surveillance and routine cleaning and disinfection. Frequent serologic testing for HBsAg detects patients recently infected with HBV quickly so isolation procedures can be implemented before crosscontamination can occur.…”

Section: Epidemiologymentioning

confidence: 99%

“…These tests are not FDA-approved and are most commonly used for patients being managed with antiviral therapy. 97,98,104,105 The presence of HBsAg is indicative of ongoing HBV infection and potential infectiousness. In newly infected persons, HBsAg is present in serum 30 to 60 days after exposure to HBV and persists for variable periods.…”

Section: Screening and Diagnostic Testsmentioning

confidence: 99%