Nephron 1992;61:307-308
P. Dentico 3 A. Volpe3 R. Buongiornoa A. Carlonea M. Carbóneh M. Mannob
Hepatitis C Virus in Hemodialysis Patients
Istituto Policattedra Clínica Medica e Malattie Infettive, Universitá di Barí; b Centro Dialisi Santa Rita, Barí, Italy “
Abstract Anti-HCV prevalence in 284 hemodialysis patients was assessed using the Abbott HCV-EIA test. Anti-HCV positivity was found in 19.4% of patients, was higher in males than in females and progressively increased with age. A correla tion between time of dialysis treatment, transfusions and ALT course was found. These data suggest that HCV infection is a very important risk in dialysis units.
Introduction Viral hepatitis is a serious complication of blood transfu sion and in most cases post-transfusional hepatitis is due to non-A, non-B (NANB) hepatitis viruses [1, 2]. Recently, a blood-borne NANB hepatitis agent, designated as hepatitis C virus (HCV), has been isolated and an immunoassay test developed to detect circulating antibodies to HCV (antiHCV) [3]. The main route of transmission of the HCV infection is well documented as being parenteral, such as via blood transfusion and intravenous drug abuse. Several studies have shown a high anti-HCV prevalence in hemodi alysis patients and suggested that HC'V infection is a very important risk in dialysis units [4,5], The aim of the present study was to evaluate the anti-HCV antibody status in hemodialysis patients and to analyze the HCV infection risk factors.
Patients and Methods Fresh serum samples from 284 hemodialysis patients, aged 18-72 years, who attended a dialysis unit in Bari were tested for anti-HCV using an HCV-EIA Abbott kit. The repeatedly positive specimens were tested using an HCV EIA Neutralization Abbott kit. Only speci
mens neutralized were definitively considered anti-HCV-t-. In order to evaluate the risk factors of HCV infection, a file card was made for each patient. Information collected included age, duration of dialysis, hepatitis exposure, transfusions and course of ALT levels. Statistical analyses w'ere performed using t h e t e s t with Yates" correction.
Results 55 specimens (19.4%) were identified as anti-HCV-Iafter the EIA neutralization test. Anti-HCV prevalence was higher in males (23.9%) than in females (13.2%) with a statistically significant difference (p < 0.0005). In figure 1, anti-HCV + cases, divided into sex and age groups, are reported. In both sexes, anti-HCV was negative in patients under 20 years of age and progressively increased in the subsequent age groups with the highest values observed in patients older than 60 years (50% in females and 70% in males). Table I summarizes the correlation between antiHCV + , time of dialysis treatment, transfusions and course of ALT. The mean duration of treatment was longer in anti-HCV + than in anti-HCV- patients, with a statistically significant difference (p
anti-HCV+ group, 35% of subjects received less than 15 and 65% more than 15 transfusions. In the anti-HCVgroup, the percentages were 73 and 27%, respectively. A statistically significant difference (p 15 units Persistently normal ALT Transiently abnormal ALT Persistently abnormal ALT
19 36 27 4 24
Conclusions
HCV229 cases
71
40 168 61 183 16 30
35% 65% 49% 7% 44%
73% 27% 80% 7% 13%
Our study confirms that hemodialysis patients are at high risk of HCV infection. The prevalence of anti-HCV increased with age, duration of treatment and number of transfusions. The correlation between persistently abnor mal ALT and anti-HCV + suggests treating these patients as potentially infectious and taking the precaution of isolat ing them to prevent the spread of HCV infection in the dialysis units.
Dienstag J: Non-A, non-B hepatitis: Recognition. epidemiology and clinical features. Gastro enterology 1983;85:439-461. Alter H: The dominant role of non-A, non-B in the pathogenesis of post-transfusion hepatitis: A clinical assessment. Clin Gastroenterol 1980; 9:155-170.
308
3
Choo Q. Kuo G, Weiner A, et al: Isolation of a cDNA clone derived from a blood-borne nonA. non-B viral hepatitis genome. Science 1989;244:359-362. 4 Esteban J, Viladomiu L, Gonzales A, cl a l: Hep atitis C virus antibodies among risk groups in Spain. Lancet 1989:ii:294-296.
5 Schlipkoter U, Roggendorf M. Ernst G, et al: Hepatitis C virus antibodies in haemodialysis patients. Lancet 1990:335:1409.
Dentico/Volpe/Buongiorno/Carlone/ Carbone/M anno
HCV in Hemodialysis Patients
Downloaded by: Boston University 128.197.229.194 - 1/12/2019 3:25:10 AM
References
P. Dentico 3 A. Volpe3 R. Buongiornoa A. Carlonea M. Carbóneh M. Mannob
Hepatitis C Virus in Hemodialysis Patients
Istituto Policattedra Clínica Medica e Malattie Infettive, Universitá di Barí; b Centro Dialisi Santa Rita, Barí, Italy “
Abstract Anti-HCV prevalence in 284 hemodialysis patients was assessed using the Abbott HCV-EIA test. Anti-HCV positivity was found in 19.4% of patients, was higher in males than in females and progressively increased with age. A correla tion between time of dialysis treatment, transfusions and ALT course was found. These data suggest that HCV infection is a very important risk in dialysis units.
Introduction Viral hepatitis is a serious complication of blood transfu sion and in most cases post-transfusional hepatitis is due to non-A, non-B (NANB) hepatitis viruses [1, 2]. Recently, a blood-borne NANB hepatitis agent, designated as hepatitis C virus (HCV), has been isolated and an immunoassay test developed to detect circulating antibodies to HCV (antiHCV) [3]. The main route of transmission of the HCV infection is well documented as being parenteral, such as via blood transfusion and intravenous drug abuse. Several studies have shown a high anti-HCV prevalence in hemodi alysis patients and suggested that HC'V infection is a very important risk in dialysis units [4,5], The aim of the present study was to evaluate the anti-HCV antibody status in hemodialysis patients and to analyze the HCV infection risk factors.
Patients and Methods Fresh serum samples from 284 hemodialysis patients, aged 18-72 years, who attended a dialysis unit in Bari were tested for anti-HCV using an HCV-EIA Abbott kit. The repeatedly positive specimens were tested using an HCV EIA Neutralization Abbott kit. Only speci
mens neutralized were definitively considered anti-HCV-t-. In order to evaluate the risk factors of HCV infection, a file card was made for each patient. Information collected included age, duration of dialysis, hepatitis exposure, transfusions and course of ALT levels. Statistical analyses w'ere performed using t h e t e s t with Yates" correction.
Results 55 specimens (19.4%) were identified as anti-HCV-Iafter the EIA neutralization test. Anti-HCV prevalence was higher in males (23.9%) than in females (13.2%) with a statistically significant difference (p < 0.0005). In figure 1, anti-HCV + cases, divided into sex and age groups, are reported. In both sexes, anti-HCV was negative in patients under 20 years of age and progressively increased in the subsequent age groups with the highest values observed in patients older than 60 years (50% in females and 70% in males). Table I summarizes the correlation between antiHCV + , time of dialysis treatment, transfusions and course of ALT. The mean duration of treatment was longer in anti-HCV + than in anti-HCV- patients, with a statistically significant difference (p
anti-HCV+ group, 35% of subjects received less than 15 and 65% more than 15 transfusions. In the anti-HCVgroup, the percentages were 73 and 27%, respectively. A statistically significant difference (p 15 units Persistently normal ALT Transiently abnormal ALT Persistently abnormal ALT
19 36 27 4 24
Conclusions
HCV229 cases
71
40 168 61 183 16 30
35% 65% 49% 7% 44%
73% 27% 80% 7% 13%
Our study confirms that hemodialysis patients are at high risk of HCV infection. The prevalence of anti-HCV increased with age, duration of treatment and number of transfusions. The correlation between persistently abnor mal ALT and anti-HCV + suggests treating these patients as potentially infectious and taking the precaution of isolat ing them to prevent the spread of HCV infection in the dialysis units.
Dienstag J: Non-A, non-B hepatitis: Recognition. epidemiology and clinical features. Gastro enterology 1983;85:439-461. Alter H: The dominant role of non-A, non-B in the pathogenesis of post-transfusion hepatitis: A clinical assessment. Clin Gastroenterol 1980; 9:155-170.
308
3
Choo Q. Kuo G, Weiner A, et al: Isolation of a cDNA clone derived from a blood-borne nonA. non-B viral hepatitis genome. Science 1989;244:359-362. 4 Esteban J, Viladomiu L, Gonzales A, cl a l: Hep atitis C virus antibodies among risk groups in Spain. Lancet 1989:ii:294-296.
5 Schlipkoter U, Roggendorf M. Ernst G, et al: Hepatitis C virus antibodies in haemodialysis patients. Lancet 1990:335:1409.
Dentico/Volpe/Buongiorno/Carlone/ Carbone/M anno
HCV in Hemodialysis Patients
Downloaded by: Boston University 128.197.229.194 - 1/12/2019 3:25:10 AM
References
