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[The management of dialysis patients seropositive for HBsAg, anti-HCV, or anti-HIV antibodies].
- Source :
-
Giornale italiano di nefrologia : organo ufficiale della Societa italiana di nefrologia [G Ital Nefrol] 2012 Sep-Oct; Vol. 29 Suppl 56, pp. S78-84. - Publication Year :
- 2012
-
Abstract
- Infections by hepatitis B or hepatitis C virus are still common among patients on maintenance dialysis in Western countries. The natural history of HBV and HCV in the dialysis population remains unclear; however, there is good evidence showing an adverse impact of an anti-HCV seropositive status on survival in dialysis patients. A recent meta-analysis of observational studies (n=7, 11,589 unique patients) reported that anti-HCV-positive patients on dialysis had a higher mortality rate than those who were anti-HCV negative (adjusted hazard ratio=1.35, 95% confidence interval, 1.13; 1.59, p<0.001). This was in part attributed to a higher frequency of chronic hepatitis C and its attending complications (cirrhosis and hepatocellular carcinoma). In addition, HCV appeared to have a negative influence on quality of life. Recent clinical guidelines by the KDIGO Study Group have not suggested the isolation of anti-HCV-positive patients on maintenance dialysis. Standard precautions and specific procedures against the transmission of blood-borne agents have been recommended to control HCV infection within dialysis units. Isolation by dialysis machines, staff and rooms has been strongly recommended to control HBV. Vaccination is an important tool against transmission of HBV infection among patients on maintenance dialysis; however, the immune response towards the hepatitis B vaccine in uremic patients remains unsatisfactory. Monotherapy with lamivudine is currently used for dialysis patients with hepatitis B whereas combination antiviral therapy (pegylated interferon plus ribavirin) is the standard of care for hepatitis C in the dialysis population, even if various side effects have been observed.
- Subjects :
- Cross Infection prevention & control
HIV Antibodies blood
HIV Seropositivity blood
Hepatitis B blood
Hepatitis B Surface Antigens blood
Hepatitis C blood
Hepatitis C Antibodies blood
Humans
Practice Guidelines as Topic
Renal Insufficiency, Chronic blood
HIV Seropositivity complications
HIV Seropositivity therapy
Hepatitis B complications
Hepatitis B therapy
Hepatitis C complications
Hepatitis C therapy
Renal Dialysis
Renal Insufficiency, Chronic complications
Renal Insufficiency, Chronic therapy
Subjects
Details
- Language :
- Italian
- ISSN :
- 1724-5990
- Volume :
- 29 Suppl 56
- Database :
- MEDLINE
- Journal :
- Giornale italiano di nefrologia : organo ufficiale della Societa italiana di nefrologia
- Publication Type :
- Academic Journal
- Accession number :
- 23059944