Transmission routes of HCV infection in dialysis

Nosocomial transmission of hepatitis C virus (HCV) to haemodialysed patients, strongly suspected in epidemiological studies, has recently been unequivocally demonstrated by molecular virology reports. Potential transmission mechanisms include staff hands, dialysis monitors, and equipment items shared between patients. The respective involvement of each of these vectors in HCV transmission has not been determined. There is no conclusive data on the reality of HCV transmission by dialyser re-use. Prevention of HCV transmission relies on the use of erythropoietin, blood donor screening for anti-HCV antibodies and the application of 'Universal Precautions' (Atlanta CDC). In contrast, isolation of anti-HCV-positive dialysed patients does not appear to be warranted by prospective studies, as it might increase the risk of co-infection by different HCV strains, would entail additional costs and be at best partially effective. Recent data have shown that HCV transmission may be prevented by the observance of the 'Universal Precautions' without having to isolate HCV+ patients.