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Control of Hepatitis B and C virus infection in chronic haemodialysis patients
Chronic haemodialysis patients have a high prevalence of Hepatitis B and C virus infections both of which are associated with chronic liver disease and hepatocellular carcinoma Hepatitis B virus (HBV) was identified as a frequent cause of hepatitis during the early years of chronic haemodialysis the...
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| Format: | Thesis |
| Language: | English |
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Department of Medicine
2017
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| _version_ | 1867613254049595392 |
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| access_status_str | Open Access |
| author | Taal, Maarten Willem |
| author2 | Van-Zyl Smit, Richard N |
| author_browse | Taal, Maarten Willem Van-Zyl Smit, Richard N |
| author_facet | Van-Zyl Smit, Richard N Taal, Maarten Willem |
| author_sort | Taal, Maarten Willem |
| collection | Thesis |
| description | Chronic haemodialysis patients have a high prevalence of Hepatitis B and C virus infections both of which are associated with chronic liver disease and hepatocellular carcinoma Hepatitis B virus (HBV) was identified as a frequent cause of hepatitis during the early years of chronic haemodialysis therapy and strict adherence to infection control measures alone proved inadequate to control the transmission of infection between patients. A policy of regular screening of all patients and blood donations for hepatitis B surface antigen together with isolation of positive patients to separate dialysis units resulted in a significant decline in the incidence of new infections. Hepatitis B vaccination provided an important new means of protection. Despite the finding that haemodialysis patients did not respond to the vaccine as well as normal adults, randomized controlled trials showed significant protection in units with a previously high incidence of infection. Studies have identified both monocyte dysfunction and B cell inhibition by elevated levels of parathyroid hormone (PTH) as possible mechanisms for the reduced response in dialysis patients. Other factors which have been associated with this poor response include increased age, male gender, specific human leukocyte antigens, shorter time on a dialysis programme and poor nutritional status. One study has shown an increased response in patients receiving recombinant human erythropoietin and. there is in vitro evidence that nifedipine improves B cell proliferation in dialysis patients with hyperparathyroidism. Hepatitis C virus (HCV) infection in haemodialysis patients has been associated with blood transfusions in many studies. However, evidence exists that transmission between patients also occurs. There is disagreement as to what measures are necessary to prevent possible nosocomial spread. Some authors recommend isolation of HCV -infected patients to separate dialysis machines or units. There is also concern over the potential of dialyzer reuse to transmit the virus. A protocol for surveillance 0f hepatitis B and C infections was established in the dialysis unit at Groote Schuur Hospital while HCV positive patients were not isolated and reuse of dialyzers was continued for all patients. HBV -infected patients are dialyzed in a separate unit and their dialyzers are not reused. A trial of hepatitis B vaccination of all antibody negative patients was undertaken using four doses of a plasma-derived vaccine given intramuscularly at month 0,1 ,2 and 4. |
| format | Thesis |
| id | oai:open.uct.ac.za:11427/25675 |
| institution | University of Cape Town (South Africa) |
| language | eng |
| last_indexed | 2026-06-10T12:33:12.104Z |
| license_str | Not specified — see source repository |
| provenance_str_mv | Harvested via OAI-PMH from UCTD — University of Cape Town Open Access Repository |
| publishDate | 2017 |
| publishDateRange | 2017 |
| publishDateSort | 2017 |
| publisher | Department of Medicine |
| publisherStr | Department of Medicine |
| record_format | dspace |
| source_str | UCTD — University of Cape Town Open Access Repository |
| spelling | oai:open.uct.ac.za:11427/25675 Control of Hepatitis B and C virus infection in chronic haemodialysis patients Taal, Maarten Willem Van-Zyl Smit, Richard N Hemodialysis~Hepatitis B - therapy~Hepatitis C - therapy~Kidney Failure,Chronic - complications Chronic haemodialysis patients have a high prevalence of Hepatitis B and C virus infections both of which are associated with chronic liver disease and hepatocellular carcinoma Hepatitis B virus (HBV) was identified as a frequent cause of hepatitis during the early years of chronic haemodialysis therapy and strict adherence to infection control measures alone proved inadequate to control the transmission of infection between patients. A policy of regular screening of all patients and blood donations for hepatitis B surface antigen together with isolation of positive patients to separate dialysis units resulted in a significant decline in the incidence of new infections. Hepatitis B vaccination provided an important new means of protection. Despite the finding that haemodialysis patients did not respond to the vaccine as well as normal adults, randomized controlled trials showed significant protection in units with a previously high incidence of infection. Studies have identified both monocyte dysfunction and B cell inhibition by elevated levels of parathyroid hormone (PTH) as possible mechanisms for the reduced response in dialysis patients. Other factors which have been associated with this poor response include increased age, male gender, specific human leukocyte antigens, shorter time on a dialysis programme and poor nutritional status. One study has shown an increased response in patients receiving recombinant human erythropoietin and. there is in vitro evidence that nifedipine improves B cell proliferation in dialysis patients with hyperparathyroidism. Hepatitis C virus (HCV) infection in haemodialysis patients has been associated with blood transfusions in many studies. However, evidence exists that transmission between patients also occurs. There is disagreement as to what measures are necessary to prevent possible nosocomial spread. Some authors recommend isolation of HCV -infected patients to separate dialysis machines or units. There is also concern over the potential of dialyzer reuse to transmit the virus. A protocol for surveillance 0f hepatitis B and C infections was established in the dialysis unit at Groote Schuur Hospital while HCV positive patients were not isolated and reuse of dialyzers was continued for all patients. HBV -infected patients are dialyzed in a separate unit and their dialyzers are not reused. A trial of hepatitis B vaccination of all antibody negative patients was undertaken using four doses of a plasma-derived vaccine given intramuscularly at month 0,1 ,2 and 4. 2017-10-13T13:36:41Z 2017-10-13T13:36:41Z 1997 2017-07-14T13:09:45Z Master Thesis Masters MMed http://hdl.handle.net/11427/25675 eng application/pdf Department of Medicine Faculty of Health Sciences University of Cape Town |
| spellingShingle | Hemodialysis~Hepatitis B - therapy~Hepatitis C - therapy~Kidney Failure,Chronic - complications Taal, Maarten Willem Control of Hepatitis B and C virus infection in chronic haemodialysis patients |
| thesis_degree_str | Master's |
| title | Control of Hepatitis B and C virus infection in chronic haemodialysis patients |
| title_full | Control of Hepatitis B and C virus infection in chronic haemodialysis patients |
| title_fullStr | Control of Hepatitis B and C virus infection in chronic haemodialysis patients |
| title_full_unstemmed | Control of Hepatitis B and C virus infection in chronic haemodialysis patients |
| title_short | Control of Hepatitis B and C virus infection in chronic haemodialysis patients |
| title_sort | control of hepatitis b and c virus infection in chronic haemodialysis patients |
| topic | Hemodialysis~Hepatitis B - therapy~Hepatitis C - therapy~Kidney Failure,Chronic - complications |
| url | http://hdl.handle.net/11427/25675 |
| work_keys_str_mv | AT taalmaartenwillem controlofhepatitisbandcvirusinfectioninchronichaemodialysispatients |