HIV infection in a high prevalence hemodialysis unit

Chirgwin, Keith; Tk, Rao; Sh, Landesman

doi:10.1097/00002030-198911000-00007

Cited by 21 publications

(12 citation statements)

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“…The prevalence of HIV infection in dialysis units in inner city areas varies from 0% to 39%. 99,100 Despite this, there has been only one report of transmission of HIV in a dialysis unit. 101 Nine of 23 (39%) susceptible haemodialysis patients in a Colombian dialysis centre seroconverted for HIV between January 1992 and December 1993.…”

Section: Hivmentioning

confidence: 99%

Blood‐borne virus infections in dialysis units—A review

Wreghitt

1999

Rev. Med. Virol.

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Hepatitis outbreaks in haemodialysis unit patients and staff were reported in the late 1960s. In 1972, the Rosenheim report in the UK established guidelines which included routine tests for hepatitis B surface antigen and isolation facilities for dialysing patients with hepatitis B virus which resulted in a dramatic fall in cases of hepatitis. However, since these guidelines were introduced, other blood-borne viruses, notably HCV and HIV have been discovered, and failures of infection control practices still lead to outbreaks of HBV in haemodialysis units. The prevalence of HCV in dialysis patients varies considerably throughout the world, with reported prevalence ranging from 3·9% to 71%. The number of blood transfusions and the length of time on dialysis have consistently been associated with HCV prevalence. Several reports provide evidence of patient-to-patient HCV transmission with environmental blood contamination the most significant factor in intra-unit transmission. There is no evidence that HCV has been transmitted by re-use of dialysis machines but being dialysed next to an HCV positive patient is associated with a significant risk of HCV acquisition. Several studies have shown that dialysing HCV positive patients in a separate unit or in a defined sector of a dialysis unit significantly reduces nosocomial HCV infection. HGV is prevalent in dialysis units where there is evidence of transmission to patients but no evidence of associated symptoms. HIV is infrequently transmitted in dialysis units and several units treating many HIV-positive patients have shown no evidence of transmission. Careful attention needs to be paid to infection control procedures and regular virological testing.

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Section: Hivmentioning

confidence: 99%

Blood‐borne virus infections in dialysis units—A review

Wreghitt

1999

Rev. Med. Virol.

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“…[2][3][4][5][6] Serologic surveys estimated the prevalence of and risk for HIV infection among different occupational groups. [7][8][9][10] In the 1980s, national surveillance data on the acquired immunodeficiency syndrome (AIDS) were reviewed in an initial attempt to identify potentially unrecognized cases of occupationally acquired HIV infection; on the basis of that review, no specific occupational exposures could be implicated as the source of infection for any of the healthcare workers with AIDS reported at that time. 11 Although occupationally acquired HIV infection was thought to be rare in the United States, it was clear that descriptive information from ongoing case surveillance was needed to understand how occupational HIV exposure and infection occur.…”

mentioning

confidence: 99%

Occupationally Acquired Human Immunodeficiency Virus (HIV) Infection: National Case Surveillance Data During 20 Years of the HIV Epidemic in the United States

Ciesielski

Metler

et al. 2003

Infect. Control Hosp. Epidemiol.

174

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Objective:To characterize occupationally acquired human immunodeficiency virus (HIV) infection detected through case surveillance efforts in the United States.Design:National surveillance systems, based on voluntary case reporting.Setting:Healthcare or laboratory (clinical or research) settings.Patients:Healthcare workers, defined as individuals employed in healthcare or laboratory settings (including students and trainees), who are infected with HIV.Methods:Review of data reported through December 2001 in the HIV/AIDS Reporting System and the National Surveillance for Occupationally Acquired HIV Infection.Results:Of 57 healthcare workers with documented occupationally acquired HIV infection, most (86%) were exposed to blood, and most (88%) had percutaneous injuries. The circumstances varied among 51 percutaneous injuries, with the largest proportion (41%) occurring after a procedure, 35% occurring during a procedure, and 20% occurring during disposal of sharp objects. Unexpected circumstances difficult to anticipate during or after procedures accounted for 20% of all injuries. Of 55 known source patients, most (69%) had acquired immunodeficiency syndrome (AIDS) at the time of occupational exposure, but some (11%) had asymptomatic HIV infection. Eight (14%) of the healthcare workers were infected despite receiving postexposure prophylaxis (PEP).Conclusions:Prevention strategies for occupationally acquired HIV infection should continue to emphasize avoiding blood exposures. Healthcare workers should be educated about both the benefits and the limitations of PEP, which does not always prevent HIV infection following an exposure. Technologic advances (eg, safety-engineered devices) may further enhance safety in the healthcare workplace

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“…In contrast, the prognosis was significantly better in asymptomatic HIV seropositive individuals undergoing maintenance HD, with a mean survival of 488 ± 75 days in the studies by Ortiz et al (33) and 15.7 ± 3.0 months in the experience of Feinfeld et al (35). Chirgwin et al (18) also reported a longer than 1-year survival in their HIV subjects, with only one patient developing clinical AIDS during a 12-month period. In Miami, among 28 asymptomatic HIV carriers beginning maintenance dialysis, 4 progressed to ARC and 3 to AIDS after 276 ± 81 days (median 180 days).…”

Section: Hiv In Esrd Patientsmentioning

confidence: 91%

“…Overall, 28 patients remained asymptomatic for periods lasting 14 ± 2 months. These observations suggest that some HIV-positive patients develop AIDS in about 6-8 months, while some continue to do well and remain asymptomatic despite very low CD4 counts (18). Varying durations of prior HIV infection may account for the differences observed in these patients.…”

Section: Hiv In Esrd Patientsmentioning

confidence: 93%

“…The HIV seroprevalence rate in dialysis units varies widely among different countries and within each country, depending on the geographic location of the unit and the demographics of patients treated. The prevalence of HIV infection in dialysis units ranged from 0 to 39% in early surveys (Table 4) (17)(18)(19)(20)(21)(22)(23)(24)(25)(26)(27)(28)(29)(30).…”

Section: Esrd In Hiv Diseasementioning

confidence: 99%

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Human Immunodeficiency Virus Infection in End‐Stage Renal Disease Patients

Rao

2003

Seminars in Dialysis

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Human immunodeficiency virus (HIV) infection in patients with end-stage renal disease (ESRD) offers many diagnostic and therapeutic challenges to nephrologists. Renal failure may be a direct consequence of viral infection (HIV-associated nephropathy), or intrinsic renal diseases may occur in previously infected individuals. Patients receiving renal replacement therapy (RRT) may acquire HIV infection from blood transfusions, renal allografts, sexual contacts, or needle sharing by drug addicts. In the early 1980s, the overall prognosis of patients with the acquired immunodeficiency syndrome (AIDS) was very poor, and survival of those with ESRD was dismal. Consequently many even questioned the value of providing maintenance dialysis to patients with AIDS. With advances in diagnostic techniques in serologic and viral markers of disease, and deployment of highly effective antiretroviral agents, the prognosis of HIV-infected patients has dramatically improved. Over the past two decades, experiences in the management of HIV patients with ESRD is accumulating. Both peritoneal dialysis and hemodialysis are effective modes of therapy and many centers are now beginning to perform renal transplantation in HIV-infected patients. This article deals with various aspects of HIV infection in patients with ESRD.

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HIV infection in a high prevalence hemodialysis unit

Cited by 21 publications

References 0 publications

Blood‐borne virus infections in dialysis units—A review

Blood‐borne virus infections in dialysis units—A review

Occupationally Acquired Human Immunodeficiency Virus (HIV) Infection: National Case Surveillance Data During 20 Years of the HIV Epidemic in the United States

Human Immunodeficiency Virus Infection in End‐Stage Renal Disease Patients

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