Jadoul Michel, Barril Guillermina
Contrib Nephrol. 2012;176:35-41. doi: 10.1159/000333761. Epub 2012 Jan 30.
Hemodialysis (HD) patients were recognized as a high risk group for hepatitis C virus (HCV) infection almost immediately after the identification of HCV in 1989. Both transfusional and nosocomial transmission of HCV were then relatively frequent in HD. The dramatic reduction in transfusional transmission of HCV in the 1990s soon underlined the strongly suspected nosocomial risk. Multiple molecular virology reports eventually demonstrated patient to patient transmission. The reinforcement of hygienic precautions and/ or isolation strategies was the main subsequent step taken by most HD units. Both incidence and prevalence of HCV then decreased substantially in most western HD units. Currently, incidence is much lower whereas prevalence is largely influenced by the rate of acquisition of HCV prior to starting HD (be it in the remote past). Still, the risk of occasional nosocomial transmission remains. The actual application of basic hygienic precautions remains the cornerstone of the prevention of HCV nosocomial transmission, as reviewed in the recently published KDIGO guidelines on HCV in CKD.
1989年丙型肝炎病毒（HCV）被发现后不久，血液透析（HD）患者就被视为HCV感染的高危人群。当时，HCV的输血传播和医院内传播在HD患者中都相对频繁。20世纪90年代，HCV输血传播的显著减少很快凸显了备受怀疑的医院内感染风险。多项分子病毒学报告最终证实了患者之间的传播。随后，大多数HD单位采取的主要措施是加强卫生预防措施和/或隔离策略。此后，大多数西方HD单位的HCV发病率和患病率都大幅下降。目前，发病率要低得多，而患病率在很大程度上受开始HD治疗之前（无论时间多么久远）HCV感染率的影响。尽管如此，偶尔发生医院内传播的风险仍然存在。正如最近发表的KDIGO慢性肾脏病（CKD）患者HCV感染指南中所综述的那样，实际应用基本卫生预防措施仍然是预防HCV医院内传播的基石。
