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      Hemodialysis of Patients with HCV Infection: Isolation Has a Definite Role


      Nephron Clinical Practice

      S. Karger AG

      HCV, Hepatitis, Infection control, Hemodialysis, Isolation

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          HCV infection in patients on hemodialysis varies from 10 to 60% in various centers. There is controversy regarding the isolation of patients with HCV infection during hemodialysis. Guidelines developed by the Centers for Disease Control and Prevention do not suggest isolation of these patients. In this opposite view, evidence is being given to support the view that there is a definite role of isolation of HCV-infected patients during hemodialysis.

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          Most cited references 15

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          Hepatitis C and renal disease: an update.

          Hepatitis C is both a cause and a complication of chronic renal disease. Chronic infection with hepatitis C virus (HCV) can lead to the immune complex syndromes of cryoglobulinemia and membranoproliferative glomerulonephritis (MPGN). The pathogenetic mechanisms for these conditions have not been defined, although they are clearly caused by the chronic viral infection. Management of HCV-related cryoglobulinemia and MPGN is difficult; antiviral therapy is effective in clearing HCV infection in a proportion of patients, but these conditions can be severe and resistant to antiviral therapy. Hepatitis C also is a complicating factor among patients with end-stage renal disease and renal transplants. The source of HCV infection in these patients can be nosocomial. Screening and careful attention to infection control precautions are mandatory for dialysis units to prevent the spread of hepatitis C. Prevention of spread is particularly important in these patients because HCV infection is associated with significant worsening of survival on dialysis therapy, as well as after kidney transplantation. Furthermore, therapy for hepatitis C is problematic, only partially effective, and associated with significant side effects in this population. There are significant needs in both basic and clinical research in the pathogenesis, natural history, prevention, and therapy for hepatitis C in patients with renal disease.
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            Hepatitis B and C in dialysis units in Iran: changing the epidemiology.

            Hepatitis B (HBV) and C (HCV) viruses are the most important infections transmitted by the parenteral route in patients receiving maintenance dialysis. The prevalence varies markedly from country to country. The aim of this study is to review the efficacy of the strategies to reduce the incidence of these infections and the trend of results in Iran. As a routine, all hemodialysis patients in Iran have biannual blood samples for assessment of serum HBSAg, HBS Abs, and HCV Abs. The data are collected in the Ministry of Health. For statistical analysis, prevalence, and incidence were calculated. There is an increasing prevalence/incidence of end-stage renal disease (ESRD) in Iran, from 238/49.9 pmp in 2000 to 357/63.8 pmp in 2006. The prevalence of positive HBSAg and HCV Abs decreased from 3.8% and 14.4% in 1999 to 2.6% and 4.5% in 2006, respectively. Regarding the genotype distribution in Iran, no one was found with genotype 2. On the subject of decreasing HBV infection, our next strategy should be mandatory vaccination in dialysis centers and in the pre-ESRD period. Concerning HCV infection prevention, 2 approaches may be recommended: the first is decrease of duration of the hemodialysis period by possible early transplantation of suitable patients. The next is a strictly enforced isolation policy for HCV-positive patients, which may play a role in limiting HCV transmission in HD units, and universal precaution in dialysis units should be under constant close surveillance.
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              Decrease in the hepatitis C virus (HCV) prevalence in hemodialysis patients in Spain: effect of time, initiating HCV prevalence studies and adoption of isolation measures.

              The effectiveness of isolation measures to prevent hepatitis C virus (HCV) infection in hemodialysis units is a controversial issue. Strict adherence to the universal infection control precautions has been deemed adequate to prevent nosocomial transmission of HCV. Subsequently, however, select isolation measures, such as the clustering of HCV positive patients in a defined sector of the unit, have been adopted, specially for those units with a high HCV prevalence and when the personnel-patient ratio was such that it could involuntary favor the break of the universal precautions. In this Multicenter Spanish Study on HCV in Dialysis, the importance of both time and isolation measures led to a decrease of HCV prevalence. Time was the most important factor (although interacting with the isolation measures) and was independent of the initial HCV prevalence.

                Author and article information

                Nephron Clin Pract
                Nephron Clinical Practice
                S. Karger AG
                April 2011
                03 November 2010
                : 117
                : 4
                : 328-332
                Department of Nephrology, All India Institute of Medical Sciences, New Delhi, India
                Author notes
                *Prof. Sanjay K. Agarwal, Department of Nephrology, All India Institute of Medical Sciences, New Delhi 110029 (India), Fax +91 112 658 8663, E-Mail skagarwal58@yahoo.co.in
                319984 Nephron Clin Pract 2011;117:c328–c332
                © 2010 S. Karger AG, Basel

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                Page count
                Figures: 1, Tables: 2, References: 23, Pages: 5
                The Opposite View

                Cardiovascular Medicine, Nephrology

                Isolation, Hemodialysis, Infection control, Hepatitis, HCV


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