MULTICENTER STUDY OF HEPATITIS-C VIRUS-INFECTION IN CHRONIC-HEMODIALYSIS PATIENTS AND HEMODIALYSIS CENTER STAFF MEMBERS

Between April 1990 and December 1991, 499 (65%) of 767 patients and 142 (59%) of 239 staff members from 11 chronic hemodialysis centers in different geographic regions of the United States participated in a multicenter prospective cohort study that determined the prevalence and incidence of antibody to hepatitis C virus (anti-HCV) and evaluated their risk factors for HCV infection. Serum samples were tested for anti-HCV by enzyme immunoassay and HCV neutralization assay at baseline and 9 and 18 months later. Collected data included patient and staff demographics, number of years a patient had been on dialysis or staff were employed in the dialysis field, history and dates of blood transfusions, history of injecting drugs, and history of non-A, non-B hepatitis. Anti-HCV was detected in 52 (10%) of 499 patients and in two (1%) of 142 staff members. Logistic regression analysis revealed that in patients, an anti-HCV-positive test was associated with length of time on dialysis (3 or more years), history of injecting drugs, and history of non-A, non-B hepatitis. Anti-HCV positivity was not associated with history of blood transfusions, race, gender, or age. In patients, the cumulative incidence of HCV infection over an 18-month period was 4.6%. Throughout the 18-month follow-up period, no staff members became anti-HCV positive. The association between anti-HCV positivity and increasing patient years on dialysis may reflect the cumulative risk of exposure to infectious blood in the dialysis environment. These results underscore the importance of adhering to universal precautions, scrupulous aseptic technique, and cleaning and disinfection of instruments and environmental surfaces used in the dialysis setting. © 1993, National Kidney Foundation. All rights reserved. All rights reserved.