[Hepatitis C infection among patients receiving hemodialysis]

In France, the prevalence of hepatitis C virus (HCV) infection in chronic hemodialysis patients is high, about 15 to 42%. Although the incidence and the prevalence of HCV infection decreased during the last decade, de novo cases of HCV infection still occur in hemodialysis units. To date the nosocomial transmission is the principal cause of contamination. The strict application of universal precautions and the separation of chronic hemodialysis patients according to their virological status may decrease the incidence of HCV infection in hemodialysis units. The transaminase level and HCV viremia are lower in chronic hemodialysis patients than that in the general population. Liver disease seems also to be less aggressive. Chronic hemodialysis patients presenting acute hepatitis C infection and those waiting for renal transplantation have to be treated by interferon-alpha (IFN-alpha), since the virological response is elevated and sustained. In case of cirrhosis or severe liver disease, a combined liver-kidney transplantation can be proposed after IFN-alpha therapy. Finally, in chronic hemodialysis who are not candidate for renal transplantation IFN-alpha therapy can be discussed according the patients' age and general health status.