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Incidence and risk factors for hepatitis C seroconversion in hemodialysis: a prospective study. The UCL Collaborative
M Jadoul1, C Cornu, C van Ypersele de Strihou
1University of Louvain Medical School, Cliniques Universitaires St-Luc, Brussels, Belgium.
Insights
Hepatitis C virus (HCV) seroconversion (SC) occurred at 1.7% annually in hemodialysis patients. Close proximity to HCV-positive patients and blood transfusions were identified as risk factors for HCV transmission.
Area of Science:
- Nephrology
- Infectious Diseases
- Epidemiology
Background:
- Hepatitis C virus (HCV) poses a significant risk in healthcare settings, particularly for immunocompromised patients.
- Hemodialysis (HD) units without patient isolation present a challenge for controlling infectious disease transmission.
- Understanding HCV seroconversion (SC) incidence and risk factors is crucial for patient safety in HD units.
Purpose of the Study:
- To determine the incidence of HCV seroconversion (SC) in hemodialysis (HD) patients.
- To identify risk factors associated with HCV transmission in a non-isolating HD environment.
- To evaluate the role of blood transfusions and patient proximity in HCV spread.
Main Methods:
- Prospective follow-up of 401 non-intravenous drug-abusing HD patients across 15 Belgian units from May 1991 to November 1992.
- Utilized sensitive ELISA II and confirmatory RIBA II tests for HCV antibody detection.
- Recorded blood transfusion history, dialyzer reuse, and dialysis monitor sterilization frequency.
Main Results:
- The average yearly incidence of HCV seroconversion (SC) was 1.7%.
- Patients with SC showed a significantly higher monthly rate of blood transfusions (P < 0.001).
- Proximity to HCV-positive patients in the same dialysis unit was a significant risk factor (P < 0.02).
Conclusions:
- HCV transmission occurs in non-isolating HD units, with an annual incidence of 1.7%.
- Blood transfusions and close contact with infected individuals are significant risk factors for HCV SC.
- Implementing infection control measures, such as patient isolation or strategic station assignment, is vital in HD settings.
Abstract:
To delineate the incidence and risk factors for seroconversion (SC) for HCV, from May 1991 to November 1992 we followed all 401 patients (no i.v. drug abusers) dialyzed in 15 Belgian hemodialysis (HD) units, none of which isolates anti-HCV (+) patients. The sensitive ELISA II test was performed in the same laboratory for all patients. ELISA II (+) sera were considered truly positive if specific antibodies were detected by RIBA II against at least one HCV antigen. Blood transfusions given from 12 months prior to inclusion in the study, dialyzer reuse and frequency of dialysis monitor sterilization were recorded. In May 1991, prevalence of truly positive ELISA II tests averaged 13.5% (54/399). During the three consecutive six-month periods, ELISA II became truly positive in 3 of 305 (1%), 4 of 314 (1.3%) and 1 of 313 (0.3%) patients, respectively, which was an average yearly incidence of 1.7%. SC was preceded (1 to 6 months) in all cases by an unexplained, unprecedented increase in the alanine aminotransferase level. The mean monthly rate of transfusions was significantly higher (P < 0.001) in eight patients with SC (0.7 +/- 0.6 U) than in 393 patients without SC (0.1 +/- 0.01 U). However, three of eight patients with SC had not been transfused at all. SC was observed in only 3 of 13 units (1, 3 and 4 cases, respectively) dialyzing ELISA (+) patients. In the unit with three SC, patients were always assigned a fixed station: SC was observed only in patients dialyzed next to an ELISA II (+) patient (3 of 8 vs. 0 of 30, P < 0.02).(ABSTRACT TRUNCATED AT 250 WORDS)