A 1990s perspective of hepatitis C, human immunodeficiency virus, and tuberculosis infections in dialysis patients.
Chronic infections contribute significantly to morbidity and mortality in dialysis patients. These infections are acquired either before or after initiation of dialysis, and the latter may be via nosocomial modes of transmission. Consequently, policies that deal with infection control in dialysis units have assumed increasing importance. The incidence and prevalence of hepatitis C virus (HCV) infection among patients on dialysis is steadily declining. Nonetheless, the 0.4% to 15% incidence of anti-HCV in hemodialysis (HD) units continues to be a cause for concern. Although nosocomial transmission of HCV infection in HD units has been demonstrated, the Centers for Disease Control and Prevention (CDC), Atlanta, GA, does not recommend dedicated machines, patient isolation, or a ban on reuse in HD patients with HCV infection. Conventional cleansing and sterilization procedures for reprocessing the dialyzers appear to be adequate to inactivate the virus. Over the years, there has been a steady increase in the number of human immunodeficiency virus (HIV)-infected patients entering end-stage renal disease (ESRD) programs. Transmission of HIV infection is extremely unlikely in dialysis units that conform to the standard practice guidelines. Dedicated machines or isolation from other patients are not recommended for patients with HIV infection. Risk of acquiring HIV infection after an occupational exposure is approximately 0.32%. Nonetheless, a combination of zidovudine and lamuvidine for most parenteral exposures, and the addition of a protease inhibitor in high-risk exposures, is recommended. The wide range of immunological derangements in chronic renal failure have been postulated to be the cause for the increased susceptibility of dialysis patients to tuberculosis (TB). The high incidence of extrapulmonary disease may be a significant factor in the delay in diagnosis of TB in these patients. In view of their high-risk for exposure to TB, the purified protein derivative (PPD) skin test is recommended on an annual basis in the staff of dialysis units.
Murthy
B V
BV
Tufts University School of Medicine, Boston, MA, USA.
Pereira
B J
BJ
D018562:Disease Transmission, Infectious; D015658:HIV Infections / Q000453:epidemiology / Q000517:prevention & control / Q000635:transmission; D006436:Hemodialysis Units, Hospital; D006526:Hepatitis C / Q000453:epidemiology / Q000517:prevention & control / Q000635:transmission; D006801:Humans; D015994:Incidence; D017053:Infection Control; D007676:Kidney Failure, Chronic / Q000401:mortality / Q000628:therapy*; D015995:Prevalence; D006435:Renal Dialysis / Q000009:adverse effects*; D012307:Risk Factors; D015996:Survival Rate; D014376:Tuberculosis / Q000453:epidemiology / Q000517:prevention & control / Q000635:transmission