title: Decreased prevalence and incidence of HCV markers in haemodialysis units: a multicentric French survey.
abstract: BACKGROUND
  A variety of epidemiological data provide evidence for the nosocomial transmission of hepatitis C virus (HCV) infections to haemodialysis patients. We conducted a multicentric study to determine the prevalence and incidence of HCV infection in French haemodialysis units.
  
  
  METHODS
  Patients undergoing chronic haemodialysis in 56 French units (4718 patients) were systematically screened for anti-HCV antibodies using third-generation tests. The incidence was estimated by detecting HCV RNA in seronegative patients using a standardized real-time PCR assay on pooled samples.
  
  
  RESULTS
  Testing for HCV antibodies identified 361 patients with anti-HCV antibodies, giving a prevalence of 7.7%. Multivariate analysis demonstrated that anti-HCV status was linked to the time on haemodialysis, previous kidney transplantation and the presence of anti-HBc antibodies, whereas erythropoietin therapy and carrying out dialysis in dedicated spaces seem to protect against HCV infection. Only two of the 4357 patients without anti-HCV antibodies tested positive for HCV RNA, giving an estimated incidence of 0.05% new HCV infections/year. Molecular analyses indicated that the two patients probably acquired HCV outside the haemodialysis unit.
  
  
  CONCLUSIONS
  This decreased prevalence and incidence emphasizes the importance of adhering to the recommended universal infection-control precautions. Virological follow-up based on detecting anti-HCV antibodies with sensitive, specific new-generation serological tests could be adequate for dialysis units with few HCV infections. However, new infections in haemodialysis units should be identified by determining the HCV RNA status of seronegative patients. Standardized real-time PCR assays, plus pooling serum samples, make this a promising method for large-scale epidemiological studies.
authors.affiliation: INSERM U563, Centre de Physiopathologie de Toulouse Purpan, Toulouse, France.
authors.forename: Karine
authors.initials: K
authors.lastname: Sauné
authors.forename: Nassim
authors.initials: N
authors.lastname: Kamar
authors.forename: Marcel
authors.initials: M
authors.lastname: Miédougé
authors.forename: Hugo
authors.initials: H
authors.lastname: Weclawiak
authors.forename: Martine
authors.initials: M
authors.lastname: Dubois
authors.forename: Jacques
authors.initials: J
authors.lastname: Izopet
authors.forename: Lionel
authors.initials: L
authors.lastname: Rostaing
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D003428:Cross Infection / Q000175:diagnosis* / Q000453:epidemiology / Q000635:transmission; D005260:Female; D005500:Follow-Up Studies; D005602:France / Q000453:epidemiology; D005919:Glomerular Filtration Rate; D006306:Health Surveys; D006436:Hemodialysis Units, Hospital; D016174:Hepacivirus / Q000145:classification / Q000235:genetics / Q000276:immunology; D006526:Hepatitis C / Q000175:diagnosis* / Q000453:epidemiology / Q000635:transmission; D018937:Hepatitis C Antibodies / Q000097:blood*; D006801:Humans; D015994:Incidence; D017053:Infection Control; D007676:Kidney Failure, Chronic / Q000628:therapy; D007677:Kidney Function Tests; D008297:Male; D008875:Middle Aged; D010802:Phylogeny; D015995:Prevalence; D011379:Prognosis; D011446:Prospective Studies; D012333:RNA, Messenger / Q000235:genetics; D012367:RNA, Viral / Q000235:genetics; D006435:Renal Dialysis; D020133:Reverse Transcriptase Polymerase Chain Reaction; D012307:Risk Factors; D012698:Serologic Tests; D055815:Young Adult
chemical_list: D018937:Hepatitis C Antibodies; D012333:RNA, Messenger; D012367:RNA, Viral