Non-A, Non-B Hepatitis and Anti-HCV Antibodies in Dialysis Patients

Abstract

To define the prevalence of non-A, non-B hepatitis, antibodies to HCV were detected in 193 patients on renal replacement therapy (52 transplant and 141 hemodialysis patients) and in 50 staff members of a Nephrology Department. Unequivocal seroconversion was documented in 5 transplant (9.6%) and in 26 dialysis patients (18.4%). In the dialysis population, the prevalence of anti-HCV antibodies was evaluated in patients grouped according to the number of blood transfusions and to the different sections of dialytic treatment. The most striking findings were the marked differences in the prevalence of anti-HCV antibodies among patients treated in different sections (from 0% to 70%), and the presence of a significant increase in alanine-amino-transferase (ALT) concentrations in 14 anti-HCV negative patients. The results suggest that the diffusion of non-A, non-B hepatitis is mainly transfusion-related, with the possibility of significant environmental diffusion related to the violation of infection-control measures. The current immunoassay is probably unable to detect the actual frequency of the infection.

Hepatitis C risk factor for patients submitted to dialysis

“…The risk of acquiring the infection by HCV in dialysis is well known and the higher the dialysis duration, the higher the seropositivity risk for hepatitis C [1,4,5]. In this study performed in Tubarao, Santa Catarina State, we found a direct association between the dialysis duration and the seropositivity for hepatitis C (p < 0,001), what corroborate with the idea that the long-term dialysis treatment involving hospital procedures may contribute with the infection dissemination [22].…”

“…The increase of prevalence varies from an average of 12% of patients under dialytic treatment for less than five years to 37% of patients under treatment for more than five years [3]. The higher the time of dialysis, the more the seropositivity prevalence for the Hepatitis virus [1,4,5].…”

“…On the other hand, the test limitations that identify these patients and the doubts related to the ways of transmission within the dialytic units [5] highlight the importance and need of determination of the risky factors and the characteristics of the infected patients related to this comorbidity.…”

Prevalência e fatores associados à hepatite C em pacientes de hemodiálise

“…Possivelmente, houve um fator de confusão, já que, por algum tempo essa foi a modalidade de trataTabela 3 -Associação não ajustada entre potenciais fatores de risco relacionados às clínicas de hemodiálise e à positividade sorológica para hepatite C. A média de tempo de hemodiálise foi maior nos pacientes reagentes para o anti-VHC, como já constatado por outros estudos. 4,5,10 Parece lógico pensar que um paciente há mais tempo em tratamento dialítico esteja mais sujeito a acidentes com potencial de contaminação e tenha maior chance de ser transfundido. Porém, a associação entre tempo de diá-lise e positividade para anti-VHC pode não depender exclusivamente de transfusões sanguíneas.…”

“…Sabe-se que no País esse procedimento é uma constante nas unidades de diálise. Da mesma forma, o compartilhamento do frasco de heparina já foi sugerido como possível veículo de disseminação de hepatite C. 10 No presente estudo, o preparo prévio de heparina na seringa antes de manusear o paciente mostrou associação com menor prevalência de anti-VHC.…”