Infection by the hepatitis C virus in chronic renal failure patients undergoing hemodialysis in Mato Grosso state, central Brazil: a cohort study

BACKGROUND: Hepatitis C virus (HCV) is a significant problem for patients undergoing hemodialysis therapy. This situation has never been studied in Mato Grosso state, central Brazil. This study was conducted aiming to estimate the prevalence of the anti-HCV and the incidence of seroconversion in the main metropolitan region of the state. METHODS: 433 patients from the six hemodialysis units were interviewed and anti-HCV was tested by a third-generation enzyme immunoassay. An open cohort of patients who tested negative for anti-HCV at the entry of the study was created and seroconversions was assessed monthly. The staff responsible for the units were interviewed to assess whether the infection control measures were being followed. Logistic and Cox regression analysis were performed in order to assess risk factor to HCV. RESULTS: The entry on the study took place between January 2002 and June 2005. 73 out of 433 (16.9%, CI95%: 13.3–20.8) was found to be anti-HCV reactive. The multivariate analysis indicated as risk factors associated to anti-HCV the duration of the hemodialysis treatment, the number of transfusions received, and the unit of treatment. An open cohort of 360 patients who tested negative for anti-HCV was created, with a following average of 24 (± 15) months. Forty seroconversions were recorded corresponding to an incidence density of 4.6/1000 patient-months, ranges 0 to 30 among the units. Cox regression indicated the time of hemodialysis (RR = 2.2; CI95%: 1.1–4.6; p < 0.05) and the unit where treatment was performed (RR = 42.4; CI95%: 9.9–180.5; p < 0.05) as risk factors for seroconversion. The three units with highest anti-HCV prevalence and incidence were identified as those that more frequently failed to apply control measures. CONCLUSION: The study demonstrated high prevalence and incidence of anti-HCV in some of the hemodialysis units. Time on hemodialysis therapy was an independent factor associated to HCV. Blood transfusion was associated with anti-HCV in initial survey but was not important in incident cases. Failure of applying control meaures was more evident in units with the highest HCV prevalence and incidence. The results suggest that nosocomial transmission was the main spread factor of HCV in the studied population

The effect of mycophenolate mofetil on primary and secondary treatment of primary glomerulonephritis and lupus nephritis

PubMedID: 18766457Background: Mycophenolate mofetil (MMF) has shown to be a reliable choice in the treatment of glomerulonephritis. We retrospectively reviewed the clinical course and response to MMF therapy in 49 patients with primary glomerulopathy (37 patients) and lupus nephritis [class III (five patients) and IV (seven patients)]. Methods: Patients were treated with MMF for more than 6 months as a primary (18 patients) or an adjunctive treatment (31 patients). Patients were also on methylprednisolone (2-20 mg/day) and angiotensin converting enzyme inhibitor/angiotensin receptor blocker. Results: The mean age ofthe patient cohort was 33.69 ± 12.4 years (range 19-59 years). Twenty-four-hour urinary protein excretion was reduced from 3.50 ± 3.08 g prior to the commencement of MMF drug therapy to 1.21 ± 1.44 and 0.99 ± 1.34 g at the sixth and 12th months of MMF therapy, respectively (P < 0.05 for all). During this same period, significant increases in serum total protein (from 5.92 ± 1.38 to 6.59 ± 0.79 and 6.81 ± 0.77 g/dl) and albumin levels (from 3.23 ± 1.10 to 3.93 ± 0.67 and 4.21 ± 0.50 g/dl) were detected, whereas total cholesterol and low-density lipoprotein levels were found to be significantly decreased (P < 0.05 for all). Serum creatinine levels did not significantly change. The efficacy of MMF in reducing proteinuria was similar in both first line and an adjunctive therapy. The efficacy of MMF therapy began at the third month of treatment and continued through to the 12th month. Conclusion: Mycophenolate mofetil therapy was found to be useful in achieving improvements in proteinuria and nephrotic syndrome and stabilizing renal function. It was also a well-tolerated drug by the majority of the patients. Based on our results, we suggest that MMF may be alternative therapy for resistant/relapsing primary glomerulopathies and lupus nephritis. © Springer Science+Business Media, B.V. 2008