Infections with hepatitis B and C viruses in patients on maintenance dialysis in Romania and in former communist countries: yellow spots on a blank map?

We studied prospectively, between 1993 and 1998, the prevalence and inciden ce of markers against hepatitis B virus (HBV), hepatitis C virus (HCV) and hepatitis D virus (HDV), in 180 patients with chronic renal failure, dialys ed in the Nephrological Clinic, Cluj. HBV and HCV markers were common in th e patients who were already on haemodialysis in 1993 (antibodies to hepatit is B core antigen [HBcAb]: 57.9-88%; hepatitis B surface antigen [HBsAg]: 8 .7-25%; antibodies to HCV [anti-HCV]: 73.7-100%; simultaneous occurrence of HBsAg and anti-HCV antibodies: 4.4-21%). These patients had the longest me an duration of haemodialysis therapy (6.79 +/- 4.82 years). The lowest prev alence was found in 1996, in the groups of patients included in the haemodi alysis programme between 1993 and 1996 (HBcAb: 2.2-3.3%; HBsAg: 0-2.2%; ant i-HCV antibodies: 0-2.2%; HBsAg and anti-HCV antibodies: 0-2.2%). The patie nts included since 1996 had, again, a high prevalence of markers (HBsAg: 21 .6%; anti-HCV antibodies: 28.6%), despite the short duration of dialysis th erapy (1.65 +/- 1.18 years). The incidence of infection was high before 199 3, fell markedly between 1993 and 1996 (zero for the HBsAg and 6.67% year(- 1) for the anti-HCV antibodies) and rose sharply between 1996 and 1998 (10. 2%, respectively 29% year(-1)). The prevalence of HBV and HCV infections di d not correlate with the age of the patients and depended, but only up to 1 993, on the quantity of transfused blood. The link between the duration of the haemodialysis and the prevalence of the HBV and/or HCV infection proved nosocomial transmission. The very high prevalence and incidence of HBV and HCV infections, surpassing not only Western countries, but even those of ' developing' countries that are endemic for these infections, is characteris tic of some former communist countries. A radical reform of the medical sys tem in these countries is required.