Abstract

Hepatitis D virus (HDV) infection is a major concern among hemodialysis (HD) subjects, particularly the hepatitis B surface antigen (HBsAg) positive patients; in HBsAg-positive subjects HDV can be transmitted at serum dilutions as high as 10(-11) ((1)) and HBsAg-positive HDi patients stand therefore a very high risk of becoming infected with HDV through blood contamination of the hemodialysis machinery or through transfusions. Despite the importance of the problem studies of HDV in HDi are limited, the reported frequency of HDV infection among HDi patients is different throughout the world and there is no definite standard protocol to manage disease in these patients. The following represent important issues when considering HDV infection among HDi subjects: 1) High risk of HDV/ hepatitis B virus (HBV) transmission due to chronic transfusion or blood exchanges during dialysis 2) High mortality and morbidity rates 3) difficulties in the diagnosis of HDV in HDi patients 4) Irreversible complications 5) Uncertain methods for treatments. Clearly the absence of a definite standard protocol for effective management of HDV infection in HDi subjects stems from limited research on this matter. As HDV infection in HD patients has been largely neglected globally, in order to gain knowledge on this issue we carried out a world-wide investigation to determine the magnitude as well as the disease burden of HDV infection among HDi subjects with the ultimate goal to provide guidelines to manage HDV infection in this setting. We reviewed all the related studies on "HDV and hemodialysis" "renal failure" by searching the MEDLINE. Forty-seven manuscripts were retrieved in total. After a preliminary evaluation, we found only 18 articles that seemed relevant. These articles were analyzed in detail and the relevant data were gathered and summarized.