There are three: hepatitis B virus (HBV), hepatitis C virus (HCV) and human immunodeficiency virus (HIV). The main risks relate to HBV outbreaks due to the greater chance of infection from needle-stick injury, its chronic carrier state and the virus’ ability to survive for up to 7 days on environmental surfaces. HCV and HIV are less infectious in dialysis units, though outbreaks have been reported emphasising the need for infection control measures.

HBV is the most likely of the BBV to be transmitted by needle-stick injury, with a risk that may be as high as 1 in 3 if the infected patient is eAntigen positive or has a high viral load. HBV can also be transmitted sexually, from mother to child (“vertical transmission”) and rarely via blood transfusions. Figure 35.1 shows worldwide prevalence. The ability of this virus to survive outside the human body causes concern in renal units because of “horizontal transmission” – patient to patient. Presentation is usually with jaundice and raised transaminases. Diagnosis is confirmed if patient is HBsAg positive and becomes antiHBs/anti-HBc positive. Viral load and is quantified by HBV-DNA. HBV can be prevented by vaccination and treated but not cured with suppressive therapy.

The majority of HCV infection is related to IV drug abuse or blood transfusion. However, blood transfusion accounts for far fewer cases than in the past since the introduction of viral screening in 1991. Sexual transmission is low. The risk of acquiring HCV from a needlestick injury is around 1 in 30. Infected patients are less likely to present with jaundice than HBV and are more commonly detected by screening or during investigation of abnormal LFTs. The diagnosis is confirmed if the patient is HCV-PCR positive and anti-HCV positive. Viral load is then quantified by the HCV-QPCR test. There is no vaccine for HCV but cure rates of up to 95 % can now be expected with the latest treatments.

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