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HEPATITIS AND AIDS

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HEPATITIS

Hepatitis is a viral infection of the liver, also known as epidemic jaundice. There are seven hepatotropic viruses identified so far: A, B, C, D, E, F, and G. Although each of these viruses exhibits similar clinical symptoms and biochemical test results, the course of the disease, modes of transmission, and diagnostic methods are specific to the viruses.

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Hepatitis A

The incidence of Hepatitis A in dialysis patients is no higher than in the general population. Hepatitis A generally continues its normal course in dialysis patients and does not carry the risk of becoming chronic.

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Hepatitis B

The incidence of Hepatitis B in hemodialysis patients is higher than in the general population. It usually passes without symptoms and patients usually feel weak. The presence of the disease is usually discovered when investigated due to unexplained elevation of liver enzymes. Thanks to the use of erythropoietin hormone and vaccinations, the incidence of Hepatitis B in hemodialysis patients has decreased from 10% in the past to 1% today. Approximately half of the patients are prone to chronicity and therefore hemodialysis patients should be screened regularly every 2-3 months. Hepatitis B virus is the leading cause of acute and chronic hepatitis, cirrhosis and liver cancer worldwide. The virus is transmitted primarily through blood and infected body fluids. The main reason why hemodialysis patients are at high risk is inadequately cleaned hemodialysis machines. Since the hepatitis B virus can survive on environmental surfaces for more than seven days, the risk of indirect transmission increases. The incubation period of HBV infection varies between 45-160 days and acute hepatitis is usually accompanied by jaundice. However, it can also be seen without jaundice, and in this case, the risk of chronic infection increases. In acute hepatitis, an increase in liver enzymes and blood bilirubin levels is observed in patients with jaundice. SGOT levels can usually increase between 1000-1500 IU/L. In laboratory diagnosis, the presence of HBs antigen and anti-HBc in the IgM structure are the most important indicators.

Laboratory Tests:

  1. HBsAg: Indicates the presence of infection. Positivity lasting longer than 6 months indicates chronicity.

  2. AntiHBs: Indicates the body's antibody response.

  3. AntiHBc IgM: Indicates active infection.

  4. AntiHBc IgG: Indicates past infection.

  5. HBeAg: Indicates the contagiousness of the virus.

  6. HBV DNA: Indicates the presence of the virus in the body.

  7. HBsAg positivity for longer than 6 months and high liver enzymes indicate chronic hepatitis.

  8. Definitive diagnosis is made with liver biopsy.

  9. Because chronic active hepatitis B often results in cirrhosis, it is important to control the infection and inflammation in the liver. The most common and effective treatment is interferon therapy.

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Hepatitis C

  • Hepatitis C Virus (HCV) is the most common cause of chronic liver disease in hemodialysis patients and becomes chronic in 60-70% of cases. As the duration of treatment in hemodialysis patients increases, the number of anti-HCV positive patients increases.

  • Hepatitis C virus is an RNA virus.

  • The main transmission routes of the infection include blood transfusion, needlestick infection with blood products, organ transplantation, from mother to fetus during birth and sexual intercourse.

  • All transmission routes of HCV are not known for sure.

  • HCV infection may show different clinical features.

  • Jaundice is usually not seen in acute HCV infection and patients may transmit the infection without realizing it.

  • HCV infection is the most chronic type of viral hepatitis.

  • Anti-HCV test and HCV RNA test are applied for diagnosis.

  • Interferon is used during the treatment process.

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Hepatitis Precautions for Hemodialysis Personnel and Patients

  • HBsAg and Anti-HBs levels of personnel susceptible to infection (those who are not antibody positive) should be monitored every 3-6 months.

  • Anti-HBs positive patients should be checked annually.

  • HBsAg positive patients should be isolated.

  • Personnel caring for these patients should wear protective clothing (gloves, glasses, gowns, etc.).

  • Contaminated materials should be autoclaved or incinerated.

  • Blood stains should be cleaned with 0.5-1.0% sodium hypochlorite solution.

  • Blood collection needles should be disposed of in a suitable container.

  • Disinfection and blood transfusion should be restricted.

  • Protective aprons and disposable gloves should be routinely used in the dialysis unit.

  • Aprons should not be used outside the dialysis unit.

  • Gloves should be used in standard patient care and hands should be washed after contact with the patient. If possible, soap dispensers that can be used without touching should be preferred.

  • Dialysis patients and personnel should be vaccinated against HBV regularly.

  • Contaminated materials should be autoclaved or incinerated.

  • Surfaces that come into contact with blood should be cleaned with 0.5-1.0% sodium hypochlorite.

  • Care should be taken to clean and sterilize non-disposable dialysis materials.

  • Disinfection of machines should be done properly and completely.

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AIDS

  • In people infected with HIV, a wide spectrum is observed, from asymptomatic carriers to multisystemic diseases. In advanced AIDS cases, weakness, emaciation, life-threatening infections and rare cancers occur. The incidence of kidney disease in HIV-infected patients has been reported as 2-10%, and some of these patients may experience end-stage renal failure or acute renal failure. In this case, dialysis treatment is applied. HIV infection can be transmitted to patients with CKD through blood transfusion, renal transplantation, needle sticks or sexual contact. General disinfection rules are sufficient for patients with HIV infection. In severe AIDS patients, isolation should be applied in case of diarrhea or respiratory problems. Hemodialysis personnel should definitely use gloves and sharp objects and needles should be disposed of properly. The hemodialysis machine does not need to be separated, but the outside of the machine should be cleaned with hypochlorite and the inside with formaldehyde. In our country, machines of HIV-positive patients can be separated for social and psychological reasons. In patients who will be dialysed for the first time, HIV screening should be performed before treatment and HIV tests should be performed every 6 months. In addition, educational programs on AIDS should be organized for patients and healthcare personnel. HIV infection is low in contagiousness and easy to disinfect. It is inactivated in 8 minutes at 56°C, 60°C for 6 minutes, and 15-20 seconds with 70% ethanol, isopropanol or chlorine.

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