INCIDENCE AND RISK-FACTORS FOR HEPATITIS-C SEROCONVERSION IN HEMODIALYSIS - A PROSPECTIVE-STUDY

Citation
M. Jadoul et al., INCIDENCE AND RISK-FACTORS FOR HEPATITIS-C SEROCONVERSION IN HEMODIALYSIS - A PROSPECTIVE-STUDY, Kidney international, 44(6), 1993, pp. 1322-1326
Citations number
29
Categorie Soggetti
Urology & Nephrology
Journal title
ISSN journal
00852538
Volume
44
Issue
6
Year of publication
1993
Pages
1322 - 1326
Database
ISI
SICI code
0085-2538(1993)44:6<1322:IARFHS>2.0.ZU;2-C
Abstract
To delineate the incidence and risk factors for seroconversion (SC) fo r HCV, from May 1991 to November 1992 we followed all 401 patients (no i.v. drug abusers) dialyzed in 15 Belgian hemodialysis (HD) units, no ne of which isolates anti-HCV (+) patients. The sensitive ELISA II tes t was performed in the same laboratory for all patients. ELISA II (+) sera were considered truly positive if specific antibodies were detect ed by RIBA II against at least one HCV antigen. Blood transfusions giv en from 12 months prior to inclusion in the study, dialyzer reuse and frequency of dialysis monitor sterilization were recorded. In May 1991 , prevalence of truly positive ELISA II tests averaged 13.5% (54/399). During the three consecutive six-month periods, ELISA II became truly positive in 3 of 305 (1%), 4 of 314 (1.3%) and 1 of 313 (0.3%) patien ts, respectively, which was an average yearly incidence of 1.7%. SC wa s preceded (1 to 6 months) in all cases by an unexplained, unprecedent ed increase in the alanine aminotransferase level. The mean monthly ra te of transfusions was significantly higher (P < 0.001) in eight patie nts with SC (0.7 +/- 0.6 U) than in 393 patients without SC (0.1 +/- 0 .01 U). However, three of eight patients with SC had not been transfus ed at all. SC was observed in only 3 of 13 units (1, 3 and 4 cases, re spectively) dialyzing ELISA (+) patients. In the unit with three SC, p atients were always assigned a fixed station: SC was observed only in patients dialyzed next to an ELISA II (+) patient (3 of 8 vs. 0 of 30, P < 0.02). These facts suggest nosocomial transmission. SC was not as sociated with dialyzer reuse or the lack of sterilization of the dialy sis monitor after each session. In conclusion, the yearly incidence of SC (ELISA II) averaged 1.7% in our group of hemodialyzed patients. Co ntamination appeared to be both transfusional and nosocomial. The abse nce of SC in 10 of 13 units dialyzing ELISA (+) patients suggests that isolation of such patients is not yet warranted. Strict adhesion to t he ''universal precautions'' (CDC, Atlanta) is probably sufficient to prevent nosocomial transmission. Further long-term studies are needed to confirm these conclusions.