Detection and prevention of hepatitis C in dialysis patients and renal transplant recipients. A long-term follow up (1989-January 1997).
BACKGROUND
Hepatitis C is frequent problem in dialysis wards.


METHODS
A long time (1989-97) follow up of hepatitis C virus (HCV) infection in a Swedish nephrology unit was performed with anti-HCV screening, confirmatory antibody tests, viral RNA detection and molecular characterization. Case histories were reviewed with focus, onset of infection, liver morbidity and mortality.


RESULTS
In October 1991, 10% (19 of 184) of the patients in the unit (haemodialysis-, peritoneal dialysis and transplanted patients) were verified or suspected HCV carriers, whilst the number at the end of 1996 was 8%, (13 of 157). Most patients were infected before 1991 but only in one case from a known HCV-infected blood donor. No new HCV infections associated with haemodialysis occurred during the study period. A total of 13 of 24 viremic patients had HCV genotype 2b, a pattern suggesting nosocomial transmission. This was further supported by phylogenetic analysis of HCV viral isolates in seven. HCV viremia was also common in patients with an incomplete anti-HCV antibody pattern as 8 of the 12 indeterminant sera were HCV-RNA positive.


CONCLUSIONS
Awareness, prevention, identification of infected patients and donor testing limited transmission. Indeterminant recombinant immunoblot assays (RIBA)-results should be regarded with caution as a result of the relative immunodeficiency in uremic patients. Our data indicate nosocomial transmission in several patients.
Almroth
G
G
Department of Nephrology, University Hospital of Linköping, Sweden. gabriel.almroth@lio.se
Ekermo
B
B
Månsson
A S
AS
Svensson
G
G
Widell
A
A
D000293:Adolescent; D000328:Adult; D000368:Aged; D003428:Cross Infection / Q000175:diagnosis / Q000401:mortality / Q000517:prevention & control / Q000635:transmission; D004797:Enzyme-Linked Immunosorbent Assay; D005260:Female; D005838:Genotype; D016174:Hepacivirus / Q000235:genetics / Q000276:immunology; D006526:Hepatitis C / Q000175:diagnosis* / Q000401:mortality / Q000517:prevention & control / Q000635:transmission; D018937:Hepatitis C Antibodies / Q000097:blood; D006801:Humans; D008111:Liver Function Tests; D016031:Liver Transplantation; D008297:Male; D008875:Middle Aged; D016133:Polymerase Chain Reaction; D012367:RNA, Viral / Q000097:blood; D006435:Renal Dialysis; D012307:Risk Factors; D015996:Survival Rate; D013548:Sweden
D018937:Hepatitis C Antibodies; D012367:RNA, Viral