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Reuters Health Information (2004-11-11): Standard tests for hepatitis B often miss infection in dialysis patients Epidemiology
Standard tests for hepatitis B often miss infection in dialysis patients
Last Updated: 2004-11-11 12:37:31 -0400 (Reuters Health)
NEW YORK (Reuters Health) - Monoclonal antibody testing
for hepatitis B virus (HBV) surface antigen (HbsAg) underestimates the
true prevalence of the infection among patients attending hemodialysis
clinics, results of a Canadian study suggest.
Dr. Gerald Y. Minuk, at the University of Manitoba in Winnipeg, and
colleagues tested patients for occult HBV (serum HbsAg negative but HBV
DNA positive) in the summer of 2003. The 241 patients were attending
two main hemodialysis units in Winnipeg. HBV vaccination had been
administered to 211, of whom 202 had completed four vaccinations.
As the authors report in the November issue of Hepatology, only two
patients were positive for HbsAg. However, nine of the remaining
patients were HBV DNA positive, according to screening by real-time
polymerase chain reaction testing with two independent sets of primers.
Viral loads were low, the authors note, ranging from 650 to 25,000
viral copies/mL. Liver enzyme and function tests were normal. Those
positive for occult HBV did not differ from their counterparts in terms
of demographics, biochemistry, or results of serological testing. All
but one had been vaccinated against HBV.
"Until data exist indicating whether nosocomial transmission of
occult HBV can occur in susceptible dialysis patients and/or staff,
screening with sensitive PCR-based assays of all dialysis patients for
HBV DNA regardless of demographic, biochemical, or serological findings
seems prudent," Dr. Minuk and his associates conclude.
Hepatology 2004;40:1072-1077.
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