Lampe Elisabeth, Yoshida Clara Fumiko Tachibana, De Oliveira Rosane Vieira, Lauer Georg M, Lewis-Ximenez Lia Laura
Viral Hepatitis Laboratory, Oswaldo Cruz Institute, FIOCRUZ, Rio de Janeiro, Brazil.
Nephrology (Carlton). 2008 Jun;13(3):186-92. doi: 10.1111/j.1440-1797.2008.00931.x.
Haemodialysis (HD) continues to carry the risk of hepatitis C virus (HCV) transmission, with delayed seroconversion and often normal alanine aminotransferase (ALT) values increasing the likelihood of undetected infection and thus uninterrupted spread of HCV. The aim of this study was to identify the characteristic patterns of ALT changes and seroconversion during an outbreak of HCV in a HD unit. We also wanted to establish the relationship between infecting viruses using molecular analysis.
All patients (n = 72) and staff (n = 23) of the HD unit were prospectively followed for 14 months. Serial measurements for ALT, HCV antibody and HCV-RNA were performed besides HCV sequence analysis.
The initial screening for anti-HCV and HCV-RNA confirmed chronic infection in 16/72 (22%) subjects and identified three subjects with recent seroconversion. In addition, five cases were reverse transcription-polymerase chain reaction positive alone for a total of eight recent cases. The interval between the initial observation of ALT changes and seroconversion varied from 1 to 8 months, and in several individuals ALT fluctuations only below the upper limit of normal were detected. However, relating each subject's ALT values to ALT at baseline, ALT levels increased between 1.6- and 4.7-fold. Molecular analysis provided evidence for transmission from two chronically infected source patients, probably because of inappropriate infection control measures.
Our data highlight the importance of well-implemented safety precautions and regular HCV-RNA testing to prevent the further spread of HCV in this population, and suggest the use of ALT baseline values to identify infections that may remain unnoticed otherwise.
血液透析（HD）仍然存在丙型肝炎病毒（HCV）传播的风险，血清转化延迟以及丙氨酸转氨酶（ALT）值通常正常增加了未被检测到的感染可能性，从而导致HCV的持续传播。本研究的目的是确定HD单位中HCV爆发期间ALT变化和血清转化的特征模式。我们还想通过分子分析确定感染病毒之间的关系。
对HD单位的所有患者（n = 72）和工作人员（n = 23）进行了为期14个月的前瞻性随访。除了进行HCV序列分析外，还对ALT、HCV抗体和HCV-RNA进行了系列测量。
抗HCV和HCV-RNA的初始筛查证实16/72（22%）的受试者存在慢性感染，并确定了3名近期血清转化的受试者。此外，有5例单独逆转录-聚合酶链反应呈阳性，近期共有8例。ALT变化的初始观察与血清转化之间的间隔为1至8个月，在一些个体中仅检测到ALT波动低于正常上限。然而，将每个受试者的ALT值与基线时的ALT值相关联，ALT水平增加了1.6至4.7倍。分子分析提供了从两名慢性感染源患者传播的证据，可能是由于感染控制措施不当。
我们的数据强调了实施良好的安全预防措施和定期进行HCV-RNA检测对于防止HCV在该人群中进一步传播以及建议使用ALT基线值来识别否则可能未被注意到的感染的重要性。
