Hepatitis B in Moscow Hemodialysis Centers: clinical and epidemiological feature

Between 1996 and 2001 669 patients with end stage of renal disease, treated in four Moscow Hemodialysis Units were observed. Markers of in past or current infection, caused by hepatitis В virus (HBV) were revealed in 411 patients (61%). In 16 patients (2%) the signs of acute hepatitis В (AHB) were found. 80 patients (12%) proved to be carriers of HBsAg, and in 21 of them (3%) there was a combination with HCV-infection. Among the patients with detected specific antibodies to HBV antigens, the isolated HBcoreAb were found most often (in 55%). HBsAb were revealed in 21% of patients, and their combination with HBcoreAb - in 24%. The linkage between the duration of hemodialysis treatment and HBV-infection was confirmed. Most of patients (76%) proved to be infected during the first year of replacement renal therapy. But we did not succeed in establishing a connection between frequency of infection and sex, age of patients, the character of renal disease which caused uremia, and the quantity of hemotransfusions. The course of AHB in hemodialysis patients was characterized by preferentially subclinical manifestations. Some patients, in spite of vaccination, proved to be infected by HBV. In this group AHB was characterized by higher frequency of jaundice. Hepatitis В chronification was established in 37% of patients. In 77% of patients with persistence of HBsAg, the signs of viral replication were found.

гепатит В, гемодиализ, вакцинация, иммунный ответ

1. Акимкин В.Г., Скворцов С.В., Еналеева А.А. и др. Эпидемиологические особенности распространения вирусных гепатитов В и С в отделении гемодиализа // Мир вирусных гепатитов. 2000; 7-8: 5-6.

2. Зубкин М.Л., Селиванов Н.А., Стаханова В.М. и др. Распространенность и особенности инфицирования вирусами гепатитов В и С в условиях лечения гемодиализом // Вопр. вирусол. 2000; 1: 10-14.

3. Ивашкин В.Т., Калинин А.В., Ивлев А.С. и др. // Российский журнал гастроэнтерологии, гепатологии. 1993; 2: 34-38.

4. Майер К.-П. Гепатит и последствия гепатита. - М.: Гэотар Медицина, 1999; 51-54.

5. Савин Е.А. Вирусные гепатиты (частные аспекты проблемы). - СПб.: Наука, 1996; 85-94: 115-120.

6. Соринсон С.Н. Вирусные гепатиты A, B, C, D, E, ни A-E в клинической практике. - СПб.: Теза, 1996: 48-66.

7. Тареев Е.М., Ермоленко В.М., Ананьев В.А. и др. Вирусные гепатиты у больных, находящихся на поддерживающем ГД. Особенности клиники. Вопросы эпидемиологии // Вестник АМН СССР. 1979; 4: 20-26.

8. Doherty C.C., Girndt M., Gerken G., Kohler H. The patient with failing renal function. Hepatitis. In: Oxford Textbook of Clinical Nephrology. (ed. Davison A.M., Cameron J.S., Grunfeld J.-P. et al.). Oxford, New York, Tokyo: Oxford University Press, 1998: 1924-1935.

9. Fairley C.K., Mijch A., Gust I.D. et al. The increased risk of fatal liver disease in renal transplant recipients who are hepatitis Be antigen and/or HBV DNA positive. Transplantation. 1991; 52: 497-500.

10. Harnett J.D., Zeldis J.B., Parfrey P.S. et al. Hepatitis B disease in dialysis and transplant patients. Transplantation. 1987; 44: 369-376.

11. Hess G., Arnold W. The clinical relevance of the antibody to hepatitis B core antigen (anti-HBc): a review. J. Virol. Meth. 1980; 2: 107-117.

12. Hiesse C., Buffet C., Neyrat N. et al. Impact of HBs antigenemia on long-term patient survival and causes of death after renal transplantation. Clin. Transplant. 1992; 46: 461-467.

13. Hoofnagle J.H., Schafer D.F. Serologic markers of hepatitis D virus infection. Semin. Liver Dis. 1986; 6: 1-10.

14. Jibani M.M., Heptonstall J., Walker A.M. et al. Hepatitis B immunization in UK renal units: failure to put policy into practice. Nephrol. Dial. Transplant. 1994; 9: 1765-1768.

15. Kitchen A.D., Harrison T.J., Meacock T.J. et al. Incidence and significance of hepatitis B core antibody in a healthy blood donor population. J. Med. Virol. 1988; 25: 69-75.

16. Маrtinov S., Kugaevskaya A., Kopyrina E. et al. Hepatitis virus infection in haemodialysis patients in Sakha Republic (Yakutia). XXXVI Congress of the European Renal Association European Dialysis and Transplant. Association, Madrid, Spain 1999: 216.

17. McIntyre A., Nimmo G.R., Wood G.M. et al. Isolated hepatitis B core antibody - can response to hepatitis B vaccine help elucidate the cause? Aust. NZ. J. Med. 1992; 22:19-22.

18. Meuer S.C., Hauer M., Kurz P. et al. Selective blockade of the antigen-receptor-mediated pathway of T cell activation in patients with impaired immune responses. J. Clin. Investig. 1987; 80: 743-749.

19. Neilson J.O., Dietrichson O., Elling P., Christofferson P. Incidence and meaning of persistence of Australian antigen in patients with acute viral hepatitis: developement of chronic hepatitis. N. Engl. J. Med. 1971; 285:1157-1159.

20. Neto M.C., Draibe S.A., Silva A.E.B. et al. Incidence of and risk factors for hepatitis B virus and hepatitis C virus infection among hemodialysis and CAPD patients: evidence for environmental transmission. Nephrol. Dial. Transplant. 1995; 10: 240-246.

21. Paparella M., Tarantino A., Ponticelli C. How to manage the dialysis patient with chronic viral hepatitis who is consider for renal transplantation. Nephrol. Dial. Transplant. 1996; 11: 2122-2124.

22. Parfrey P.S., Farge D., Forbes R.D.C. et al. Chronic hepatitis in end-stage renal disease: Comparison of HbsAg-negative and HBsAg-positive patients. Kidney Int. 1985; 28: 959-967.

23. Rao V.K., Ma J. Chronic viral hepatitis enhances the risk of infection but not acute rejection in renal transplant recipients. Transplantation 1996; 62: 1765-1769.

24. Ribot S., Rothstein M., Goldblat M., Grasso M. Duration of hepatitis B surface antigenemia (HBsAg) in hemodialysis patients. Arch. Intern. Med. 1975; 1319: 178-180.

25. Sherlock S., Dooley J. Diseases of the liver and biliary system. Oxford, London, Edinburg, Malden: Blackwell Science Ltd, 1997; 274-335.

26. Slade B.A., Vroon D.H. Anti-HBc to screen for susceptibility to hepatitis B. Lancet 1984: 1246-1247.

27. Tabor E., Hoofnagle J.H., Barker L.F. et al. Antibody to hepatitis B core antigen in blood donors with a history of hepatitis. Transfusion. 1981; 21: 366-371.

28. Teles S.A., Martins R.M., Silva S.A. et al. Hepatitis B virus infection profile in central Brazilian hemodialysis population. Rev. Inst. Med. Trop Sao Paulo. 1998; Sept-Oct; 40 (5): 281-6.

29. Younossi M.Z., Braun E.W., Protiva A.D. at al. Chronic viral hepatitis in renal transplant recipients with allografts functioning for more than 20 years. Transplantation. 1999; 67: 272-275.

30. Wright T.L., Lau J.Y. Clinical aspects of hepatitis B virus infection. Lancet. 1993; 342: 1340-1344.