Sanaa Khurshid, Sidra Shafiq Cheema, Shafeeq Cheema.
One Year Reinfection Rate of Hepatitis C among patients on Maintenance Hemodialysis After Successful Antiviral Treatment.
Pak J Kidney Dis Jan ;4(3):290-3.

Background: The use of dedicated dialysis machines for HCV-infected patients is not recommended but hemodialysis units should ensure implementation of, and adherence to, strict infection control procedures designed to prevent transmission of blood borne pathogens. Direct acting antiviral therapies (DAA) are an important tool for hepatitis C virus elimination. However, reinfection among high risk population especially hemodialysis patients may hamper the elimination targets. The most important factor implicated in HCV transmission in dialysis unit is cross-contamination from supplies and surfaces as a result of failure to follow infection control procedures. Therefore, we estimated HCV reinfection rates among treated individuals on maintenance hemodialysis (MHD) in our dialysis center at Jinnah hospital. Aim: The primary objective of this study is to determine the rates of HCV reinfection after successful treatment, among patients on MHD. Methods: We analyzed data from Jinnah hospital dialysis center cohort on maintenance hemodialysis who previously took direct acting antiviral therapy (DAA) for treatment of hepatitis C in a prospective randomized interventional trial which included 36 patients. In this trial, group 1(18 patients) received 400 mg daily sofosbuvir/ 60 mg daily daclatasvir; while group 2 (18 patients) received thrice a week 400 mg sofosbuvir/ daily 60 mg daclatasvir for 12 weeks. These patients were followed for one year after sustained virologic response (SVR) was achieved. During this time `universal precautions` to prevent cross-contamination of HCV were implemented. HCV RNA PCR was measured at one year again. Reinfection was defined as a positive HCV RNA measurement at one year after achievement of SVR. Genotype was also assessed for patients who had positive HCV RNAby PCR. Crude reinfection rates per 100 person-years were calculated. As a secondary objective, one year mortality was also calculated in this treated population. Results: Of 32patients who were treated with DAAs, SVR after one year of completion of treatment was 100% in group 1 and 85.8% in group 2. Overall SVR was 86.3%.None of the patients in group 1 had reinfection one year after achieving SVR while 2 out of 14 patients in group 2 were found to have reinfection with same genotype as previous. Overall reinfection rate was 2/32 (6.25%). Crude reinfection rate per 100 person-years was 6.25. One year mortality was 16% and 44% in group 1 and 2 respectively. Conclusion: Reinfection rate is low among successfully treated HCV patients on maintenance hemodialysis when strict implementation and adherence to `universal precautions` is practiced.

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