Hepatitis C Transmission in Dialysis

Giuseppe Ippolito, AIDS Unit-RM10, Lazzaro Spallanzani Hospital, via Portuense 292, I-00149 Rome (Italy) Sir, Several studies have shown that about 20-30% of dialysis patients have antibodies against hepatitis C virus (anti-HCV). Patients with a history of multiple blood transfusions, intravenous drug abuse or sero-logic evidence of current or previous HBV infection have been found more likely to be anti-HCV positive, while hemodialysis alone did not seem associated with a higher risk for acquiring HCV infection [1]. Conversely, non-A, non-B hepatitis (NANBH) outbreaks in dialysis centers have been reported before the test for anti-HCV became available [2, 3] with 38% of cases probably due to patient-to-patient transmission [3]. More recently, a high frequency of anti-HCV positivity in dialysis patients, even in those never transfused, resulted significantly associated with the lenght of hemodialysis [4], We report a case of acute hepatitis C in a patient whose only risk factor was to be dia-lyzed in an unit where anti-HCV-positive patients were not separated from the other patients. A 65-year-old man, dialyzed 3 times a week since 1987, in October 1991 developed jaundice, anorexia, nausea, malaise, pruritus. ALT level was 375 U/ml, hemoglobin 11.4 g/ dl and total serum bilirubin was 17.6 mg/dl (direct 11.2). He had been vaccinated in the past against HBV and resulted HBsAg negative, anti-HBs positive and IgM anti-HBc negative. IgM anti-CMV, anti-HSV and anti-EBV were negative. He resulted negative for anti-HCV by a 2nd generation ELISA assay (Ortho), as he had 2 months before. Ecographic and TAC findings did not show any obstructive cause of the jaundice. After 1 week, ALT level rose to 575 U/ml and total bilirubin to 33.2 mg/dl. Two weeks later, ALT level was 163 U/ml and total bilirubin 42.8 mg/dl. On day 20 from hospital admission, the patient seroconverted for anti-HCV (positivity evidenced both by 2nd generation ELISA and RIBA assay, Ortho). He was discharged home 40 days after admission with normal ALT levels and total bilirubin 4.2 mg/dl. Complete biochemical recovery occurred in 2 months. The patient had never been transfused and, on careful epidemiological investigation, he denied any other risk factors for HCV infection.