Routine Serologic Testing for Hepatitis C Virus Infection Should Be Instituted Among Dialysis Patients

Abstract

Since the cloning of hepatitis C virus (HCV), a number of serologic and virologic tests for detecting infections with this virus have been made available for clinical practice. This led to the recognition of HCV as a major health hazard in hemodialysis (HD) centers. Yet the nephrology community has not been offered explicit recommendations about routine serologic testing for HCV of dialysis patients and consequently has remained unclear and divided about the utility of this testing. This review presents evidence in support of instituting routine serologic testing for HCV among dialysis patients. It concludes that because of the peculiar features of HCV infection in HD patients, serologic testing for HCV is the only means for unequivocal diagnosis of hepatitis C and an irreplaceable instrument for monitoring the incidence and the prevalence of the infection in this population. Serologic surveillance for HCV infection is crucial for identifying the association of new cases of HCV infection with potential risk factors for HCV transmission, particularly nosocomial, that can be modified in a way to prevent further dissemination of the virus. Data collected from routine serologic testing for HCV will undoubtedly improve our understanding of the epidemiology of HCV in the dialysis population and will provide a strong foundation for developing preventive measures and infection control strategies that are highly effective in controlling HCV infection. Routine serologic testing for HCV is also of direct benefit to the individual patient since establishing the HCV serologic status of each patient is important for optimizing patient care.

Effect of Hepatitis C Virus on Hemoglobin and Hematocrit Levels in Saudi Hemodialysis Patients

“…methods of control, cleaning, and disinfection of the HD membranes, machines, instruments, environmental surfaces, and also duration of HD interfere with prevalences. [10][11][12][13][14][15] The vague clinical picture and the fluctuating pattern of symptoms in dialysis patients with hepatitis often make the diagnosis of CHC infection difficult or even impossible if based only on clinical conditions. Although liver biochemical tests among dialysis patients were formerly considered a poor indicator of CHC infection, and normal ALT levels cannot exclude viral hepatitis because HD patients have depressed serum ALT at baseline, [17,18,[26][27][28] a relatively increased serum AST and ALT concentration, even under conventional normal limits, was still discovered among majority of chronic HD patients with CHC when compared with hepatitis-free patients, as shown in some recent publications.…”

Incidence of HCV infection in French hemodialysis units: A prospective study

“…The prevalence of HCV antibodies in chronic hemodialysis patients is correlated significantly with the duration of dialysis, and is independent of the number of blood transfusions [Pereira and Levey, 1997;Salama et al, 2000]. The prevalence of HCV infection is also higher in hemodialysis centers than in peritoneal dialysis or in self-care dialysis patients [Natov and Pereira, 2000;Salama et al, 2000]. In addition, the incidence of HCV infection is higher in dialysis units where the prevalence of HCV infection is high [dos Santos et al, 1996;Pujol et al, 1996].…”

“…Therefore, the prevalence of HCV, from less than 5% to over 70% in some countries, is greater than the prevalence of HCV in the general population [Henderson, 2003]. HCV infection also varies from one center to another within a given country [Natov and Pereira, 2000]. Nosocomial transmission of HCV infection has become the main source of infection in chronic hemodialysis patients rather than transmission by blood-derived products.…”

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

“…The rational is based on the following evidence: (a) HCV infection has a silent and subclinical course; (b) liver biochemical tests are poor indicators of HCV infection among HD patients; (c) HCV infection is more prevalent among HD patients than in the general population; (d) nosocomial transmission of HCV is a major problem in HD units, and (e) early identification of HCV-infected patients is essential [94]. The current CDC recommendations for HCV screening in HD patients include testing for anti-HCV and serum alanine aminotransferase (ALT) on admission, ALT every month, and anti-HCV semiannually [92, 93].…”