Main Article Content
Background: Hepatitis b virus infection (HBV) was recognized as an important hazard for patients and staff in Hemodialysis Units (HDU), and this issue was first recognized in the 1960s with a set of guidelines for the control of HBV in HDU. HCV is a blood-borne infection and is the most significant cause of viral hepatitis which is mainly transmitted by blood transfusion. Thus, it is reasonable to perform initial screening for HCV in HD patients. Patients admitted or re-admitted to an HD unit are recommended to be tested for HBsAg, HCV, and HIV antibodies and to be followed up monthly or at least every three months after admission to HDU.
We aim to present this case of spontaneous clearance of HBV and HCV positive after being positive for more than twelve years on HD.
Case Presentation: A 66 years old Egyptian male patient with Chronic Kidney Disease (CKD) from Alexandria had started HD 14 years ago while he tested positive for HCV-Ab and HBs Ag positive, although fared well with normal liver function, while the source of infection was not known. HCV-Ab turned into seronegativity after twelve years on HD. Astonishingly, after 13 years on HD; the test of HBs Ag became negative and hepatitis B surface antibody appears by Elisa testing. This was noticed or observed following the implementation of quality enhancement of the HD parameters in most of the HD services provided units according to the regulations of Ministry of Health (MOH), and this was accompanied by better anemia and more frequent utilization of high flux dialysis with a consequent reduction to the need for blood transfusion in the last four years. Previous publications advocated hypothetical mechanisms of HCV clearance during the process of HD: namely, filtration of the virus particles through the pores of the dialysis membrane and or their adsorption to the HD membrane. These welcome spontaneous clearances of the HBV and HCV in this patient could be attributable to the improvement of anemia state and use of high flux dialysis that might have improved the immunity of this patient.
Conclusion: Spontaneous clearance of HBV and HCV could potentially possible and could benefit from the improvement of both patients and HD states that could enhance the immune system or mechanical entrapment of the virus particles. Suggestions need further studies for confirmation.
Fabrizi F, Poordad FF, Martin P. Hepatitis C infection and the patient with end-stage renal disease. Hepatology. 2002;36:3-10.
Urbánek P. Viral hepatitis infections in chronic kidney disease patients and renal transplant recipients. Kidney Blood Press Res. 2012;35(6):454-67.
Knight AH, Fox RA, Baillod RA, et al. Hepatitis-associated antigen and antibody in haemodialysis patients and staff. Br Med J. 1970;3:603-6.
Bernieh B. Viral hepatitis in hemodialysis: An update. J Transl Int Med. 2015;3(3):93-105.
Covic A, Abramowicz D, Bruchfeld A, et al Endorsement of the kidney disease improving global outcomes (KDIGO) hepatitis C guidelines: A European renal best practice (ERBP) position statement. Nephrol Dial Transplant. 2009;24: 719-727.
Liu CH, Kao JH. Treatment of hepatitis C virus infection in patients with end-stage renal disease. J Gastroenterol Hepatol. 2011;26:228-239.
Hinrichsen H, Leimenstoll G, Stegen G, et al. Prevalence and risk factors of hepatitis C virus infection in haemodialysis patients: A multicentre study in 2796 patients. Gut. 2002;51:429-433.
Gane E, Pilmore H. Management of chronic viral hepatitis before and after renal transplantation. Transplantation. 2002;74:427–437.
Nakayama E, Akiba T, Marumo F, et al. Prognosis ofanti-hepatitis C virus antibody-positive patients on regular hemodialysis therapy. J Am Soc Nephrol. 2000;11: 1896–1902.
Furusyo N, Hayashi J, Ariyama I, et al Maintenance hemodialysis decreases serum hepatitis C virus (HCV) RNA levels in hemodialysis patients with chronic HCV infection. Am J Gastroenterol. 2000;95: 490-496.
Badalamenti S, Catania A, Lunghi G, et al. Changes in viremia and circulating interferon-alpha during hemodialysis in hepatitis C virus-positive patients: only coincidental phenomena? Am J Kidney Dis. 2003;42:143-150.
Mizuno M, Higuchi T, Yanai M, et al. Dialysis-membrane-dependent reduction and adsorption of circulating hepatitis C virus during hemodialysis. Nephron. 2002;91:235-242.
Caramelo C, Navas S, Alberola ML, et al Evidence against transmission of hepatitis C virus through hemodialysis ultrafiltrate and peritoneal fluid. Nephron. 1994;66: 470-473.
Hubmann R, Zazgornik J, Gabriel C, et al. Hepatitis C virus--does it penetrate the hemodialysis membrane? PCR analysis of hemodialysis ultra-filtrate and whole blood. Nephrol Dial Transplant. 1995;10:541-542.
Noiri E, Nakao A, Oya A, et al. Hepatitis C virus in blood and dialysate in hemodialysis. Am J Kidney Dis. 2001;37: 38-42.
Hayashi H, Okuda K, Yokosuka O, et al. Adsorption of hepatitis C virus particles onto the dialyzer membrane. Artif Organs. 1997;21:1056-1059.
Angelini C, Badalamenti S, Lunghi G, et al Evidence against hepatitis C virus trapping in dialysis membranes. Nephrol Dial Transplant. 2002;17:317-318.
Xing L. Effect of different dialysis methods on cellular immunity function of maintenance hemodialysis patients. West Indian Med J. 2015;64(5):499–505.
Hassuna NA, Mansour M, Ahmed TI, et al. Chronic hepatitis C infection has no effect on peripheral CD4+CD25+ tregulatory cells in patients with end-stage renal disease. Journal Immunological Investigations A Journal of Molecular and Cellular Immunology. 2020;49:477-488.
Jeon JM, Ha JK. Spontaneous clearance of hepatitis B surface antigenemia in a hemodialysis patient. Korean J Med. 2014;87:747-749.
Patel C. Spontaneous Clearance of hepatitis B surface antigenemia after long‐term hemodialysis chinmay patel division of nephrology, department of medicine, Hofstra North Shore LIJ school of medicine, NSLIJ Health System, Great Neck, New York. 2014;27(1).
Blankestijn PJ, Vos PF, Rabelink TJ, et al. High-flux dialysis membranes improve lipid profile in chronic hemodialysis patients. J Am Soc Nephrol. 1995;5:1703-1708.
Koda Y, Nishi S, Miyazaki S, et al. Switch from conventional to high‐flux membrane reduces the risk of carpal tunnel syndrome and mortality of hemodialysis patients. Kidney Int. 1997;52:1096-1101.
Wiesholzer M, Harm F, Hauser AC, et al. Inappropriately high plasma leptin levels in obese hemodialysis patients can be reduced by high flux hemodialysis and hemodiafiltration. Clin Sci (Lond). 1998;94: 431-435.
Trevizoli JE, Menezes RP, Velasco LFR, et al. Hepatitis C is less aggressive in hemodialysis patients than in nonuremic patients. Clin J Am Soc Nephrol. 2008;3:1385-1390.
Barril G. Hepatitis C virus-induced liver disease in dialysis patients. Nephrol Dial Transplant. 2000;15(Suppl 8):42–45.
Sterling RK, Sanyal AJ, Luketic VA, et al. Chronic hepatitis C infection in patients with end stage renal disease: Characterization of liver histology and viral load in patients awaiting renal transplantation. Am J Gastroenterol. 1999; 94:3576-3582.
Cotler SJ, Diaz G, Gundlapalli S, et al. Characteristics of hepatitis C in renal transplant candidates. J Clin Gastroenterol. 2002;35:191-195.
Luzar B, Ferlan-Marolt V, Brinovec V, et al. Does end-stage kidney failure influence hepatitis C progression in hemodialysis patients? Hepatogastroenterology. 2003;50:157-160.
Meyers CM, Seeff LB, Stehman-Breen CO, et al. Hepatitis C and renal disease: an update. Am J Kidney Dis. 2003;42: 631–657.
Sette LH, Almeida Lopes EP. Liver enzymes serum levels in patients with chronic kidney disease on hemodialysis: A comprehensive review. Clinics (Sao Paulo). 2014;69:271-278.