Dialysis facility screening and testing practices in the era of improved hepatitis C treatment

Introduction

Chronic hepatitis C virus (HCV) infection is a problem for patients receiving haemodialysis; the last estimate of HCV prevalence in this population was 8.9%, more than 5 times the rate in the general population.1-3 Because of the need for prolonged vascular access, exposure to body fluids, and reusable equipment shared between patients, there is elevated risk of HCV transmission and outbreaks in dialysis facilities, and the risk of infection increases with successive years on dialysis.3 HCV infection also decreases survival among haemodialysis patients.2 Previous HCV treatment options for patients with end-stage renal disease (ESRD) were limited and often unsuccessful; fortunately, in 2016 and 2017, two new medications were approved to treat HCV of all genotypes in dialysis patients with high cure rates.4 Given the high prevalence of HCV and risk of transmission, it is recommended that dialysis facilities screen all patients for HCV antibody (anti-HCV) on intake and bi-annually for those who are anti-HCV negative.1 Once an individual tests anti-HCV positive, additional anti-HCV testing is unnecessary. Additionally, with highly effective treatments now available, it is more important than ever that anti-HCV positive dialysis patients be tested for HCV RNA to determine current infection status and assessed for treatment. The NYC Department of Health and Mental Hygiene (DOHMH) examined anti-HCV and RNA testing performed by dialysis centres in NYC between 1 January 2014 and 31 December 2017 to assess HCV testing practices.

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