Human Immunodeficiency Virus Infection in Hemodialysis Patients

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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)

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