Infecção pelo vírus da hepatite C em pacientes em hemodiálise: prevalência e fatores de risco

Abstract

Rationale: Chronic renal disease patients on hemodialysis (HD) are at increased risk of infection by hepatitis C virus (HCV). High prevalence rates have been reported from dialysis units worldwide. Recent studies have shown an inverse relation between HCV infection and life expectancy of patients on HD and those undergoing renal transplant. Objectives: Assess the prevalence of and risk factors for HCV infection in patients undergoing HD. Patients and methods: A cross-sectional study was undertaken from January to December 2007. During this period, 236 patients were tested for anti-HCV antibodies with third generation ELISA. Those who tested positive further underwent qualitative PCR testing for HCV-RNA. A subject was considered HCV-infected if both tests were positive. Monthly serum ALT and the mean for the 12-month period were obtained from 195 patients. 208 (88.1%) patients answered a standardized questionnaire aiming to identify risk factors for HCV infection. Results: Of the 236 subjects studied, 14.8% (35/236) tested positive for anti-HCV antibodies. Of these, 71.6% (25/35) tested positive for HCV-RNA. HCV infection was thus identified in 10.6% (25/236). Bivariate analysis showed time on HD, number of blood transfusions, previous peritoneal dialysis and previous sexually transmitted diseases (STD) as the main risk factors for HCV infection. Yet multivariate analysis showed just time on HD and previous STD to be significantly associated with HCV infection (p<0.05). Patients on HD for over 10 years were 73.9 (CI 17.5-311.8) times as likely to have acquired HCV, compared with those on HD for less than 5 years. Patients with previous STD had a 4.8 times higher risk of HCV infection compared with those without previous STD. Mean ALT was significantly higher in HCV-infected patients (44.0 +-13.5 U/l versus 33.5 +- 8.0 U/l, p<0.05). Conclusion: HCV infection was highly prevalent in the dialysis unit studied. Hospitalacquired infection seems to be the main form of contamination, once time on HD was the main risk factor observed. HCV-infected patients on HD have higher ALT activity than those without HCV infection.