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Remarkable resemblance in the mode of transmission of HCV infection among haemodialysis patients and IVDAs
  1. A K Saxena,
  2. B R Panhotra,
  3. A M Al-Arabi Al-Ghamdi
  1. King Fahad Hospital, Al-Hasa, Saudi Arabia
  1. Correspondence to:
    A K Saxena
    Division of Nephrology, Post-graduate Department of Medicine, King Fahad Hospital and Teritary Care Centre Hofuf, Al-Hasa, Ea 31982, Saudi Arabia; dranil31982yahoo.com

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Hepatitis C virus (HCV) infection is widespread among patients on long term haemodialysis (HD) and among intravenous drug abusers (IVDAs). However, there appear to be striking similarities in the mode of transmission between the two groups as both are at high risk for parenterally transmitted HCV infection.

The indispensable requirement of having a vascular access site possibly adds to the risk of acquiring HCV infection among patients on long term HD through nosocomial transmission, especially in high HCV prevalence units. Preliminary data suggest that among various types of vascular access used for HD, arteriovenous fistula and polytetrafluoroethylene grafts which require extra skilful handling, perhaps play a more significant role in the transmission of HCV than permanent or temporary central venous catheters.1 Sharing of contaminated dialysis equipment, dialyser reuse, and the physical proximity of an infected patient during HD are additional important factors incriminated in the transmission of HCV in the busy HD unit.2 Gilli et al reported an outbreak of HCV in an Italian HD unit due to sharing of multidose heparin vials.3 Another recent study from the USA reported an outbreak of HCV occurring when a multidose saline vial was contaminated with blood from a HCV infected patient in a Florida hospital.4 Breakdown in the implementation of standard infection control safety measures recommended by the CDC is essentially responsible for the rapid rise in HCV infection among HD patients worldwide.

Likewise, sharing of contaminated equipment (needles and syringes) among IVDAs is also the primary concern attributed to the continuous increase in HCV infection. However, in a recent report from Kolkata, India,5 dissemination of HCV accelerated, paradoxically from a baseline prevalence rate of 17% in 1996 to 66% in 2002 and to 80% during the next year, regardless of the supply of fresh needles and syringes on a daily basis, under the supervision of trained field workers, with the equipment being taken away from IVDAs on the next day after use. Most of the IVDAs did not share their syringes or needles; none the less, they shared the multidose vials of the drugs. Indirectly sharing of the drug ampoules suggested contaminated body fluids/blood being the means of transmission of HCV through direct access to the blood circulation. Transmission of virus was also suspected to occur from sharing of a small pot containing water that some IVDAs used to clean the syringes and needles before using them again.

With strict implementation of standard infection control precautions and probably isolation of anti-HCV positive patients, it may be possible to effectively control the spread of HCV infection among patients on long term HD.6 However, promiscuous sexual behaviour, lack of personal and community hygiene, and absolute disregard for life, prevalent among IVDAs, are the major practical problems preventing implementation of interventional measures for the control of the spread of HCV in this high risk group.

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