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Human Immunodeficiency Virus Infection in Hemodialysis Patients
Baltimore-Boston Collaborative Study Group;
B. Frank Polk, MD;
Alan Watson, MD;
Paul Whelton, MD;
W. Gordon Walker, MD;
Luis Gimenez, MD;
Ellen Taylor, MD;
Judith A. Britz, PhD;
John Sadler, MD;
James Zachary, MD;
Gary Briefel, MD;
Cedric Bryan, MD;
James Carey, MD;
Pierre Forgacs, MD;
Wendell W. Hoffman, MD;
Patricia Murphy, MD;
Richard Platt, MD;
Michael Lazarus, MD;
Edgar Milford, MD;
Raymond Hakim, MD;
David R. Snydman, MD;
Andrew Levey, MD;
Ira B. Tager, MD;
J. E. Groopman, MD
Arch Intern Med. 1988;148(3):617-619.
Abstract
• Patients undergoing chronic hemodialysis receive multiple blood transfusions and, thus, are susceptible to infections transmitted through blood and blood products, including infection with human immunodeficiency virus (HIV). To determine the prevalence of antibody to HIV among patients undergoing chronic hemodialysis in Baltimore and Boston in 1985, we conducted a cross-sectional seroprevalence study. Repeatedly enzyme-linked immunosorbent assay (ELISA)—positive serum samples were tested by Western blot analysis. Among 435 patients in Baltimore, 12 (2.8%) were seropositive by both ELISA and Western blot techniques. Among 90 patients In Boston, three (3.3%) were seropositive. Among 100 frozen serum samples obtained from another Boston hemodialysis population In 1980, only one was seropositive. Many repeatedly ELISA-positive specimens were observed in each of the three groups studied, especially the serum samples that had been stored at -30°C to -70°C for four years. Most were nonspecifically reactive as demonstrated by reactivity with an H9-control ELISA plate. Patients undergoing hemodialysis, many of whom have received frequent transfusions in the past, are at increased risk for prior infection with HIV. Serologic testing for either screening or case-finding purposes must be conducted with great attention to specificity; serum samples frozen for prolonged periods are especially likely to be nonspecifically ELISA positive. These findings have implications concerning case-finding purposes, dialysis procedures, renal transplantation, and seroepidemiologic research.
(Arch Intern Med 1988;148:617-619)
Author Affiliations
Johns Hopkins Medical Institutions, Baltimore; Electro-Nucleonics Inc, Columbia, Md; University of Maryland, Baltimore; Francis Scott Key Medical Center, Baltimore; Louis J. Kolodner Dialysis Unit, Baltimore; Howard County (Maryland) Dialysis Facility; Lahey Clinic Medical Center, Boston; Brigham and Women's Hospital, Boston; Tufts—New England Medical Center, Boston; Beth Israel Hospital, Boston; New England Deaconess Hospital, Boston
Footnotes
Accepted for publication Oct 6, 1987.
Present in part at the Second International Acquired Immunodeficiency Conference and at the Tenth International Congress of Nephrology, London, July 30, 1987.
Reprint requests to Department of Epidemiology, Johns Hopkins School of Hygiene and Public Health, 615 N Wolfe St, Baltimore, MD 21205 (Dr Polk).
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