Hepatitis B virus infection: implications in chronic kidney disease, dialysis and transplantation

Abstract

Hepatitis B virus (HBV) infection occurs worldwide but is most prevalent in Southeast Asia and sub-Saharan Africa with reported prevalence rates varying from 3 - 26 %. The higher prevalence of infection has been reported in patients with HBV and human immunodeficiency virus (HIV) co-infection. Hepatitis B virus not only affects the liver but has also been implicated in the pathogenesis of membranous. membranoprolifcrative and mesangial proliferative glomerulonephritides. Though controlling the spread of H B V infection in renal dialysis units h as been one of the major triumphs in the management of end-stage renal disease. transmission of H B V can still occur through contamination of equipments and environmental surfaces and the use of multiple dose vials of drugs. Some reports have indicated that prior H B V infections have negative impact 011 graft and host survival following transplantation. In terferon can be used in the treatment of HBV-associatcd glomcrulonephritide s (HBV- G N) but is contraindicated in transplantation because of its immuno-modulatory effects. Despite the fact that patients with chronic kidney disease (CKD ) have suboptima l response to H B V immunization,immunization is still beneficial to these patients. However, reports indicate that most patients with C K D were either not immunized or were given suboptimal doses. Control of H B V in the population by immunization can lead to a reduction in t he prevalence of HBV- G N. In addition, immunization of patients with C K D will help in controlling H BV infection in dialysis settings and can lead to improved graft and host survival following transplantation.