Hepatitis C virus infection in chronic haemodialysis patients--relationship to blood transfusions and dialyser re-use.
BACKGROUND
A high prevalence of hepatitis C virus (HCV) infection has been observed in haemodialysis units. Many studies have demonstrated an association with blood transfusions, but other data suggest that nosocomial transmission also occurs. There is disagreement as to what measures are necessary to prevent nosocomial spread.


METHODS
In 1992 we commenced screening of patients for antibodies to HCV (anti-HCV) using a second-generation enzyme-linked immunosorbent assay (ELISA) test. Positive patients were not confined to special machines or units and all dialysers were re-used.


RESULTS
The prevalence of anti-HCV declined from 16.4% in 1992 to 5.3% in 1995 (P = 0.04). At both times, anti-HCV-positive patients, when compared with negative patients, had a longer mean time on haemodialysis (1992: 101.6 (standard deviation (SD) = 57.4) months v. 30.3 (32.4); 1995: 105.5 (23.9) v. 30.2 (32.8) months) and a greater mean number of blood transfusions (1992: 22.6 (18) v. 6.8 (9.4) units; 1995: 14.8 (3.6) v. 4.5 (7.1) units). When the 1992 and 1995 groups were compared there was no difference in time on haemodialysis (mean 42 months v. 34.2 months), but there was a significant reduction in the mean number of blood transfusions (mean 9.4 (12.5) v. 5.0 (7.2), P = 0.03).


CONCLUSIONS
We attribute the decline in prevalence of HCV seropositivity mainly to the introduction of screening of blood donations and a decline in the number of blood transfusions. The reduction in prevalence occurred despite routine re-use of dialysers and lack of isolation of seropositive patients, suggesting that in the setting of low overall prevalence, neither factor contributed significantly to the transmission of HCV. Clearly the possibility of some nosocomial transmission could not be totally excluded.
Taal
M W
MW
Department of Medicine, University of Cape Town.
van Zyl-Smit
R
R
D000328:Adult; D003428:Cross Infection / Q000209:etiology* / Q000517:prevention & control / Q000635:transmission; D004797:Enzyme-Linked Immunosorbent Assay; D005260:Female; D006526:Hepatitis C / Q000209:etiology* / Q000517:prevention & control / Q000635:transmission; D018937:Hepatitis C Antibodies / Q000097:blood; D006801:Humans; D008297:Male; D008875:Middle Aged; D006435:Renal Dialysis / Q000009:adverse effects* / Q000295:instrumentation; D065227:Transfusion Reaction
D018937:Hepatitis C Antibodies