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Detection and prevention of hepatitis C in dialysis patients and renal transplant recipients: A long-term follow up (1989–January 1997)
Linköping University, Department of Medicine and Care, Nephrology. Linköping University, Faculty of Health Sciences.
Östergötlands Läns Landsting, Centre for Laboratory Medicine, Department of Transfusion Medicine and Clinical Immunology. Linköping University, Faculty of Health Sciences.
Department of Clinical Virology, University Hospital of Malmö, Sweden.
Linköping University, Department of Medicine and Care, Nephrology. Linköping University, Faculty of Health Sciences.
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2002 (English)In: Journal of Internal Medicine, ISSN 0954-6820, E-ISSN 1365-2796, Vol. 251, no 2, 119-128 p.Article in journal (Refereed) Published
Abstract [en]

Background. Hepatitis C is frequent problem in dialysis wards.

Design.  A long time (1989–97) follow up of hepatitis C virus (HCV) infection in a Swedish nephrology unit was performed with anti-HCV screening, confirmatory antibody tests, viral RNA detection and molecular characterization. Case histories were reviewed with focus, onset of infection, liver morbidity and mortality.

Results.  In October 1991, 10% (19 of 184) of the patients in the unit (haemodialysis-, peritoneal dialysis and transplanted patients) were verified or suspected HCV carriers, whilst the number at the end of 1996 was 8% (13 of 157). Most patients were infected before 1991 but only in one case from a known HCV-infected blood donor. No new HCV infections associated with haemodialysis occurred during the study period. A total of 13 of 24 viremic patients had HCV genotype 2b, a pattern suggesting nosocomial transmission. This was further supported by phylogenetic analysis of HCV viral isolates in seven. HCV viremia was also common in patients with an incomplete anti-HCV antibody pattern as 8 of the 12 indeterminant sera were HCV-RNA positive.

Conclusions.  Awareness, prevention, identification of infected patients and donor testing limited transmission. Indeterminant recombinant immunoblot assays (RIBA)-results should be regarded with caution as a result of the relative immunodeficiency in uremic patients. Our data indicate nosocomial transmission in several patients.

Place, publisher, year, edition, pages
2002. Vol. 251, no 2, 119-128 p.
Keyword [en]
dialysis, hepatitis C virus, polymerase chain reaction, recombinant immunoblot assay, transmission
National Category
Medical and Health Sciences
Identifiers
URN: urn:nbn:se:liu:diva-26424DOI: 10.1046/j.1365-2796.2002.00938.xLocal ID: 10966OAI: oai:DiVA.org:liu-26424DiVA: diva2:246973
Available from: 2009-10-08 Created: 2009-10-08 Last updated: 2017-12-13Bibliographically approved
In thesis
1. Immunoglobulins, immunoglobulin subclass-distributions and serologic markers in some renal and systemic disorders
Open this publication in new window or tab >>Immunoglobulins, immunoglobulin subclass-distributions and serologic markers in some renal and systemic disorders
2000 (English)Doctoral thesis, comprehensive summary (Other academic)
Abstract [en]

In this study we evaluated pathogenetic factors and possible mediators of renal and systemic disorders where immunologic mechanisms might be of importance.

An abberant immunoglobulin and IgG-subclass distribution was detected in 103 patients with primary and secondary glomerulonephritis as well as in 38 patients with the systemic disease primary Sjögren 's syndrome or purpura hypergammaglobulinemica (elevated IgG1 and low IgG2 ).

The drug hydralazine, an anti-hypertensive, was considered to cause renal disease on an immunologic base in 17 patients, with autoantibody production (mainly ANA and antibodies to myeloperoxidase).

Dialysis-patients showed adequate antibody responses to vaccination against pneumococci but low responses against hepatitis B, while the IgG-subclass response of the hepatitis B antibody (anti-HBs) was low, but not shown to be significantly different from that of healthy adults.

A therapeutical removal of igG-antibodies with immunoadsorption or plasmapheresis was considered to have a possible adjuvant effect to medical immunosuppressive treatment alone in 44 patients with rapidly progressive glomerulonephritis.

Hepatitis C virus (HCV) is common in dialysis patients and renal transplant recipients. In 20 anti-HCV positive sera from 1988-91 recombinant immunoblott assay (RIBA) was positive in 8 cases and indeterminate in 7, while HCV RNA was present in 13/20 tested sera. In October 1991 17% of our hemodialysis patients were verified or suspected carriers while 11% were verified or suspected carriers in January 1997. Genotype 2b was found in 13/24 tested cases and in 7 amplifiable 2b sequences a strong phylogenetic relationship occurred. In 8 out of 12 RIBA-3 indeterminate sera HCV-RNA was still positive. Awareness and preventive measures limited transmission between patients.

Indeterminate RlBA-results should, also with modem assays, be regarded with caution due to the relative immunodeficiency of uremic patients.

In conclusion renal and systemic diseases may affect the serum immunoglobulins and immunoglobulin G-subclasses, while a study of the specific antibody subclass distributions (anti-HBs) showed no difference in renal (dialysis) patients and healthy adults. Medication (hydralazine) and infection may be triggering factors of various forms of glomerulonephritis. Uremia affects the antibody responses to hepatitis C in dialysis patients. The extent of renal disease as well as the possibility of therapeutic removal of antibodies is also important for the immunologic responses of such disorders.

Place, publisher, year, edition, pages
Linköping: Linköpings universitet, 2000. 87 p.
Series
Linköping University Medical Dissertations, ISSN 0345-0082 ; 646
Keyword
Immunoglobulins, immunoglobulin-subclass distribution, hydralazine, ANCA, anti-:MPO, primary SjOgren's syndrome, hepatitis B vaccination, anti-HBssubclasses, immunoadsorption, plasmapheresis, antibodies, hepatitis C virus, transmission, recombinant immunoblot assay, hepatitis C genotype
National Category
Medical and Health Sciences
Identifiers
urn:nbn:se:liu:diva-27455 (URN)12108 (Local ID)91-7219-747-1 (ISBN)12108 (Archive number)12108 (OAI)
Public defence
2000-12-15, Berzeliussalen, Universitetssjukhuset, Linköping, 13:00 (Swedish)
Opponent
Available from: 2009-10-08 Created: 2009-10-08 Last updated: 2012-08-15Bibliographically approved

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Almroth, GabrielEkermo, BengtSvensson, Samuel

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