Hepatitis B virus reactivation in a large haemodialysis unit: virological and infection control issues.

A 60-year-old Asian man, originally from Pakistan but presently UK resident had been on long-term haemodialysis for end stage enal disease secondary to diabetic nephropathy.Hewasbeingdialsed three times a week at the various dialysis units at the Heart of ngland NHS Trust and was not on any immunosuppressive treatent. He had no history of recent travel. He was “negative” for BV, HCV and HIV by routine screening. In late September 2007 BsAgwasweaklypositive (signal/cut-off ratio3.337)by theMonoisa Ultra assay (Bio-Rad Laboratories) and strongly positive (s/co 37.77) by the Vidas Ultra assay (BioMerieux). The results of the idas assay were confirmed by a specific HBsAg neutralisation test Vidas Ultra assay). He was also found to be weakly reactive for epatitis B e antigen (HBeAg), antibody to HBeAg (anti-HBe) postive, anti-HBc positive, and anti-HBc IgM negative. His HBV viral oad reached a peak of 1,667,360 IU/ml (Roche Cobas Taqman HBV ssay). The patient had mild transaminitis (peak aspartate aminoransferase 124 IU/ml). Retrospective testing of stored sera showed hat 4 months previously he was anti-HBc positive and HBV DNA ositive but HBsAg negative (HBV viral load 848 IU/ml) (Fig. 1).