Should Patients With Hepatitis C Virus Antibodies In Chronic Hemodialysis Be Isolated?

CORRESPONDENCE

SHOULD PATIENTS WITH HEPATITIS C VIRUS ANTIBODIES IN CHRONIC HEMODIALYSIS BE ISOLATED? To the Editor: Since the identification of the hepatitis C virus (HCY)' and the availability of immunoassay tests for its antibodies, 2 it has been found that HCY is common in chronic hemodialysis patients. 3•6 The presence of antibodies (Ab) is related to the number of blood transfusions3.4.6 and time on hemodialysis,5,6 and in these patients the route of transmission is not clear. 6 Since July 1991, we tested (monthly) 133 chronic hemodialysis patients treated in our unit for Ab to HCY (second Generation Enzyme Immunoassay; Abbott Laboratories, North Chicago, IL). In March 1992,27 patients (20%) were anti-HCY Ab positive (HCY +). These patients had a number of transfusions similar to those without Ab (HCY-) (median of I in both groups) and a longer time on dialysis (56.7 ± 37.1 v 32.3 ± 31 months, P = 0.01). Among the HCY+, eight patients (Group I: males, 3; females, 5; mean age, 54.4 ± 14 years) became positive between July 1991 and March 1992. We compared these 8 new HCY+ patients with 48 randomly chosen patients that remained negative throughout the period (Group 2: males, 20; females, 28; mean age, 55.7 ± 15.9 years) for time on dialysis, number of transfusions, and number Table 1. Effect of Time, Number of TransfuSions, and NB Ab Status on Becoming HeV +

Group 1 Group 2

Time HD (months)

No. Transfusions (median)

Patients With HCV+ NBt Patients Without HCV+ NB*

58.5 ± 38.4 45.3 ± 33.6

2.5 (0-22) 1 (0-20)

5/3 10/38

• X2 with Yates correction

422

=

4.13; P

=

0.042

of HCY + neighbors (NB) (assuming that each patient has 2 NB) (see Table I). In our experience, the presence of HCY Ab is related to time on dialysis. Eight patients became HCY + during a period of 8 months, and this was related to the patients having a HCY + NB during dialysis sessions, suggesting virus transmission within the dialysis unit. Sharing machines with HCY + patients was not a risk factor of becoming HCY +. General agreement should be sought for accepted measures towards the limitation of transmission of HCY in dialysis units. Pedro Leao Neves, MD loao Paulo Amorim, MD Servi<;o de Nefrologia Hospital Distrital de Faro Faro, Portugal

REFERENCES I. Choo Q-L, Kuo G, Weiner AJ, et ai: Isolation of a cDNA clone derived from a blood borne non-A, non-B viral hepatitis genome. Science 244:359-362, 1989 2. Kuo G, Choo Q-L, Alter HJ, et al: An assay for circulating antibodies to a major etiologic virus of human non-A, non-B hepatitis. Science 244:362-364, i989 3. Zeldis JB, Depner T A, Kuramoto IK, et al: The prevalence of hepatitis C virus antibodies among hemodialysis patients. Ann Intern Med 112:958-960, 1990 4. Mondelli MY, Smedile Y, Piazza Y, et al: Abnormal alanine aminotransferase activity reflects exposure to hepatitis C virus in hemodialysis patients. Nephrol Dial Transplant 6: 480-483, 1991 5. Lin H-H, Huang C-C, Sheen I-S, et al: Prevalence of antibodies to hepatitis C virus in the hemodialysis unit. Am J Nephrol II: 192-194, 1991 6. Yoshida CFT, Takahashi C, Gaspar AMC, et al: Hepatitis C virus in chronic hemodialysis patients with non-A, non-B hepatitis. Nephron 60:150-153,1992

American Journal of Kidney Diseases, Vol XX, No 4 (October), 1992: p 422