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Re-infection following sustained virological response with a different hepatitis C virus genotype: implications for infection control policy.

O'Shaughnessy MM, O'Regan JA, Murray FE, Connell JA, Duffy MP, Francis VM, Dwyer S, Thornton LM, Conlon PJ - Clin Kidney J (2012)

Bottom Line: He was subsequently cohorted with other HCV-infected dialysis patients and became re-infected with HCV genotype 3a.Epidemiological and molecular investigations identified a highly viraemic HCV genotype 3a-infected dialysis patient as the likely source of this infection.This critical incident informed a revision to local and national infection control policy regarding the dialysis management of patients who achieve an SVR following anti-viral treatment.

View Article: PubMed Central - PubMed

Affiliation: Department of Nephrology, Beaumont Hospital, Dublin, Ireland.

ABSTRACT
We report the case of a 45-year-old haemodialysis patient who achieved a sustained virological response (SVR) following pegylated interferon therapy for hepatitis C virus (HCV) genotype 2 infection. He was subsequently cohorted with other HCV-infected dialysis patients and became re-infected with HCV genotype 3a. Epidemiological and molecular investigations identified a highly viraemic HCV genotype 3a-infected dialysis patient as the likely source of this infection. This critical incident informed a revision to local and national infection control policy regarding the dialysis management of patients who achieve an SVR following anti-viral treatment.

No MeSH data available.


Related in: MedlinePlus

Trends in HCV viral load and ALT titres from 2008–2011. Shaded area indicates pegylated interferon therapy. ALT, alanine aminotransferase.
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fig1: Trends in HCV viral load and ALT titres from 2008–2011. Shaded area indicates pegylated interferon therapy. ALT, alanine aminotransferase.

Mentions: A 17-year-old male (index patient) commenced maintenance haemodialysis in 1983. He received an estimated 20 U of packed red blood cells for treatment of renal anaemia. He underwent deceased donor renal transplantation in 1984. His transplant failed in 2002 due to chronic allograft nephropathy and he was tested for HCV infection as he returned to dialysis. HCV genotype 2 with a viral load of 7 312 217 copies/mL (∼2 708 228 IU/mL) was discovered. Alanine aminotransferase was 105 IU/L and liver histology supported mild hepatitis. He declined interferon treatment and received a second deceased donor renal transplant in 2003. This transplant failed due to recurrence of his original glomerulonephritis and he developed end-stage kidney disease within 4 years. According to local policy, he was cohorted with HCV-infected patients when he resumed haemodialysis in 2007. In September 2009, he commenced a 24-week course of pegylated interferon therapy. Serum HCV RNA was undetectable by Week 12 (see Figure 1). This remained negative 6 months after completion of therapy, by definition a sustained virological response (SVR). He continued to dialyse alongside patients with detectable HCV RNA.


Re-infection following sustained virological response with a different hepatitis C virus genotype: implications for infection control policy.

O'Shaughnessy MM, O'Regan JA, Murray FE, Connell JA, Duffy MP, Francis VM, Dwyer S, Thornton LM, Conlon PJ - Clin Kidney J (2012)

Trends in HCV viral load and ALT titres from 2008–2011. Shaded area indicates pegylated interferon therapy. ALT, alanine aminotransferase.
© Copyright Policy - creative-commons
Related In: Results  -  Collection

License
Show All Figures
getmorefigures.php?uid=PMC4400513&req=5

fig1: Trends in HCV viral load and ALT titres from 2008–2011. Shaded area indicates pegylated interferon therapy. ALT, alanine aminotransferase.
Mentions: A 17-year-old male (index patient) commenced maintenance haemodialysis in 1983. He received an estimated 20 U of packed red blood cells for treatment of renal anaemia. He underwent deceased donor renal transplantation in 1984. His transplant failed in 2002 due to chronic allograft nephropathy and he was tested for HCV infection as he returned to dialysis. HCV genotype 2 with a viral load of 7 312 217 copies/mL (∼2 708 228 IU/mL) was discovered. Alanine aminotransferase was 105 IU/L and liver histology supported mild hepatitis. He declined interferon treatment and received a second deceased donor renal transplant in 2003. This transplant failed due to recurrence of his original glomerulonephritis and he developed end-stage kidney disease within 4 years. According to local policy, he was cohorted with HCV-infected patients when he resumed haemodialysis in 2007. In September 2009, he commenced a 24-week course of pegylated interferon therapy. Serum HCV RNA was undetectable by Week 12 (see Figure 1). This remained negative 6 months after completion of therapy, by definition a sustained virological response (SVR). He continued to dialyse alongside patients with detectable HCV RNA.

Bottom Line: He was subsequently cohorted with other HCV-infected dialysis patients and became re-infected with HCV genotype 3a.Epidemiological and molecular investigations identified a highly viraemic HCV genotype 3a-infected dialysis patient as the likely source of this infection.This critical incident informed a revision to local and national infection control policy regarding the dialysis management of patients who achieve an SVR following anti-viral treatment.

View Article: PubMed Central - PubMed

Affiliation: Department of Nephrology, Beaumont Hospital, Dublin, Ireland.

ABSTRACT
We report the case of a 45-year-old haemodialysis patient who achieved a sustained virological response (SVR) following pegylated interferon therapy for hepatitis C virus (HCV) genotype 2 infection. He was subsequently cohorted with other HCV-infected dialysis patients and became re-infected with HCV genotype 3a. Epidemiological and molecular investigations identified a highly viraemic HCV genotype 3a-infected dialysis patient as the likely source of this infection. This critical incident informed a revision to local and national infection control policy regarding the dialysis management of patients who achieve an SVR following anti-viral treatment.

No MeSH data available.


Related in: MedlinePlus