Viral Hepatitis D among Hemodialysis Patients: A Worldwide Underestimated Problem

Hepatitis D virus (HDV) infection is a major concern among hemodialysis (HDi) subjects, particularly the hepatitis B surfaceantigen (HBsAg) positive patients; in HBsAg-positive subjects HDV can be transmitted at serum dilutions as high as10-11 (1) and HBsAg-positive HDi patients stand therefore a very high risk of becoming infected with HDV through bloodcontamination of the hemodialysis machinery or through transfusions. Despite the importance of the problem studiesof HDV in HDi are limited, the reported frequency of HDV infection among HDi patients is different throughout the worldand there is no definite standard protocol to manage disease in these patients. The following represent important issueswhen considering HDV infection among HDi subjects: 1) High risk of HDV/ hepatitis B virus (HBV) transmission due tochronic transfusion or blood exchanges during dialysis 2) High mortality and morbidity rates 3) difficulties in the diagnosisof HDV in HDi patients 4) Irreversible complications 5) Uncertain methods for treatments. Clearly the absence ofa definite standard protocol for effective management of HDV infection in HDi subjects stems from limited research onthis matter. As HDV infection in HD patients has been largely neglected globally, in order to gain knowledge on this issuewe carried out a world-wide investigation to determine the magnitude as well as the disease burden of HDV infectionamong HDi subjects with the ultimate goal to provide guidelines to manage HDV infection in this setting. We reviewed allthe related studies on “HDV and hemodialysis” “renal failure” by searching the MEDLINE. Forty-seven manuscripts wereretrieved in total. After a preliminary evaluation, we found only 18 articles that seemed relevant. These articles wereanalyzed in detail and the relevant data were gathered and summarized.