Hepatitis C in Hemodialysis Patients: Current Global Magnitude, Natural History, Diagnostic Difficulties, and Preventive Measures

Abstract

Hepatitis C virus (HCV) infection is a significant cause of morbidity and mortality in hemodialysis (HD) patients. The reported prevalence of HCV among the HD population has varied greatly from 1.9 to 84.6% in different countries in recent years. The length of time on HD is generally believed to be associated with HCV acquisition in HD subjects. Nevertheless, several recent reports failed to recognize any significant role of blood transfusion. Although there are some considerations about the accuracy of serologic testing in detecting HCV in HD patients, the accumulated data in this review suggest the false-negativity rate to be not more than 1.66% (153/9,220). Therefore, substituting virologic for serologic testing in the routine diagnosis of HCV infection in HD patients seems unreasonable. Several phylogenetic analyzes of viral isolates suggested nosocomial patient-to-patient transmission of HCV among HD patients for which the main potential source is believed to be contaminated hands and articles. However, isolation of HCV-infected HD patients and use of dedicated machines are currently unjustified while strict adherence to universal precautions seems to be enough to control disease spread in HD units. The present article is an update on epidemiological and clinical features of HCV in HD population.

Phylogenetic Analysis of Isolated HCV Strains from Tunisian Hemodialysis Patients

“…Hemodialysis patients are one of the high risk groups for hepatitis, especially HCV infection (30,34,35). In Tunisian dialysis patients, the prevalence of infection varies from 43% before 1995 (17) to 19.07% in 2002 (3), and this infection was correlated with a history of blood transfusions and with a FIG.…”

“…Chronic HCV infection can lead to permanent liver damage, cirrhosis, and eventually hepatocellular carcinoma. Hemodialysis patients are recognized as a group at increased risk of HCV infection (34,35).…”

Management of hepatitis C virus infection in hemodialysis patients

“…Thus, it was highly possible that some of the hemodialysis patients got HCV infection through this way, especially in regions with poor socioeconomic conditions, where the qualified medical staff and equipments available to treat MHD patients were very limited. In the past two decades, the sensitivity and specificity of laboratory tests for detection of HCV have improved greatly, leading to the more stringent screening of blood donors and the marked decline of new HCV infections [6,45,46] . On the other hand, the availability of erythropoietin has reduced the need of blood transfusion in hemodialysis patients.…”

“…On the other hand, the availability of erythropoietin has reduced the need of blood transfusion in hemodialysis patients. Accordingly, the risk of HCV infection through blood transfusion in hemodialysis patients has decreased significantly in many countries [45] . Second, new HCV infections can occur in patients who lack the risk factors of blood transfusion, intravenous drug use, high-risk sexual activity, or exposure to known HCV-positive persons.…”

“…are surely the result of nosocomial patient-to-patient transmission [45,[47][48][49][50] . The infection risk usually increases with the prevalence of HCV, and the number and length of hemodialysis exposure in corresponding hemodialysis units [4,5,31,40] .…”