What You Should Know About Infectious Diseases:

As a hemodialysis patient, you want to learn all you can about your treatment and what you can do to maintain your health at its best. One important area you should know about involves infectious diseases. These are diseases that happen when harmful germs get into your body and make you ill. Kidney failure interferes with your body's natural immunity, making it easier for you to get some types of diseases like hepatitis or AIDS through your dialysis treatments. This booklet will give you general information about some important infectious diseases, including hepatitis B and C and HIV/AIDS, and tell you what you can do to prevent them.

Some Facts About Hepatitis B

What is hepatitis B?

Hepatitis B is a virus infection that causes liver disease. Most people fight off this infection themselves, but up to 10 percent progress to chronic liver disease and possibly liver cancer. Hepatitis B is spread by contact with the blood of an infected person.

You may have an increased chance of getting hepatitis B if you:

• have sex with an infected person

• inject illegal drugs

• live with an infected person and share items such as razors and toothbrushes with the person

• have been exposed to sharp instruments contaminated with infected blood, such as needles used for tattooing, body piercing and acupuncture (these needles should be carefully cleaned and disinfected before use, or disposable needles should be used)

• have hemophilia

• are a patient or work in a home for the developmentally disabled

• your parents were born in Southeast Asia, Africa, the Amazon Basin in South America, the Pacific Islands or the Middle East.

• In addition, a baby can get hepatitis B from an infected mother during childbirth.

Could I get hepatitis B through my dialysis treatment?

In the early years of dialysis, there was a danger of getting hepatitis B through exposure to the blood of an infected person at the dialysis unit. However, today the chance of getting hepatitis B through your treatment is very small because of two important advances. One of these advances is the use of strict infection control measures in dialysis units. (See Preventing Infections in Dialysis Units for more information about the infection control measures your dialysis care team should use.) The second improvement is the availability of a vaccination for hepatitis B.

Can I get hepatitis B from a transfusion?

The chances are very small. All donated blood is screened carefully for hepatitis B as well as other blood borne infections, such as hepatitis C and HIV.

How do you know if you have hepatitis B?

The only way to tell for sure is to have a blood test. Most people who get hepatitis B have no symptoms at all.

However, some people may have flu-like symptoms including:

• loss of appetite

• nausea or vomiting

• fever

• extreme tiredness

• stomach or joint pain

• In addition, you may have yellowing of the skin or eyes.

Some people may become carriers of hepatitis B, which means they have no symptoms but can still infect others with the disease. The carrier state may last for years or even for life. Some carriers may eventually develop scarring of the liver, liver failure or liver cancer.

Are there treatments for hepatitis B?

Yes. Two drugs have been approved for the treatment of chronic hepatitis B. These are interferon alpha‑2b and lamivudine. These drugs should not be given together. Overall, about 35 percent of patients treated with injections of interferon for four to six months will have a long-term response. The response to oral lamivudine, given for at least one year, may be somewhat lower. Lamivudine is very well tolerated, but viral resistance to treatment may occur. Interferon therapy often results in loss of appetite, depression and hair thinning.

How can hepatitis B be prevented?

One of the best ways to prevent hepatitis B is to be vaccinated. Hepatitis B vaccination is recommended for all children (including adolescents and teens) and hemodialysis patients and staff. The vaccine works by causing your body to make special proteins called antibodies that protect you against hepatitis B. Your response to the vaccine depends on your age, other medical conditions you may have and your general state of health, but most people will make enough antibodies to protect them against the disease. If you are vaccinated, your dialysis care team will check your blood periodically to make sure enough antibodies are present. If you have not yet been vaccinated, ask your dialysis staff about the vaccination.

You can also help to prevent hepatitis B by following safe sex guidelines and by avoiding high-risk behaviors such as injecting drugs.

Some safe sex guidelines are:

• Use latex condoms to prevent the exchange of body fluids.

• Have only one sexual partner.

Does Medicare cover the cost of the vaccination?

Yes. Medicare covers 80 percent of the cost of the vaccination. Check with your private insurance company about whether they will pay the balance.

Is the vaccination safe?

Yes. The vaccines are made from baker's yeast and contain noninfectious particles called antigens. You cannot get hepatitis from the vaccination. These vaccines have undergone extensive clinical testing and have been used on millions of people worldwide with few side effects. However, people with acute illness or a known allergy to yeast should not be vaccinated.

Some Facts About Hepatitis C

What is hepatitis C?

Hepatitis C is a viral infection that can cause liver disease. Hepatitis C is spread by contact with the blood of an infected person.

You may have an increased chance of getting hepatitis C if you:

• inject illegal drugs

• received blood transfusions or solid organ transplants before 1992 when better testing of blood donors became available.

Less commonly, hepatitis C may be spread by:

• passing from an infected mother to her baby during childbirth

• having sex with an infected person

• living with an infected person and sharing items such as razors and toothbrushes

• exposure to sharp instruments contaminated with infected blood, such as needles used for tattooing, body piercing and acupuncture (these needles should be carefully cleaned and disinfected before use, or disposable needles should be used).

Can I get hepatitis C through my dialysis treatment?

The chance of getting hepatitis C through your treatment is small because of the strict infection control measures used in dialysis units today. (See Preventing Infections in Dialysis Units for more information about these infection control measures.) However, there have been some reports that hepatitis C has been spread between patients in hemodialysis units where supplies or equipment may have been shared between patients. If you are a long term hemodialysis patient, you should be tested for hepatitis C.

Can I get hepatitis C from a blood transfusion?

The chances are small because of better testing of blood donors, which became available in 1992.

How do you know if you have hepatitis C?

Blood tests are available to check for hepatitis C. People who are at increased risk should be tested (see list in What is hepatitis C?). The doctor may do a combination of tests to make the diagnosis. Many people who have hepatitis C have no symptoms and feel well. For some, the most common symptom is extreme tiredness.

Is hepatitis C a serious illness?

Hepatitis C is serious for some persons but not for others. Most of the people who get hepatitis C carry the virus for the rest of their lives. Most of these persons have some liver damage, but many do not feel sick from the disease. Some of those with liver damage due to hepatitis C may develop scarring of the liver and liver failure, which may take many years to develop. Others have no long‑term effects.

Are treatments available for hepatitis C?

Yes. Drugs are available to treat hepatitis C. A combination of interferon alpha-2b and another drug called ribavirin has shown a better success rate than treatment with interferon alpha alone.

How can you prevent hepatitis C?

At present, no vaccine is available for hepatitis C. However, researchers are working to develop a vaccine, and it may be available in the future. In the meantime, the following steps can help to prevent hepatitis C:

• do not inject illegal drugs

• do not share toothbrushes, razors or other personal care articles that might have infected blood on them

• follow safe sex guidelines

• if you are considering getting tattoos or body piercing, make sure the tattoo artist or piercer follows good health practices such as washing hands and using disposable gloves

• get vaccinated against hepatitis B.

Some Facts About HIV

What is HIV?

HIV is the human immunodeficiency virus. It can lead to a disease that causes progressive damage to your body's immune system, called acquired immunodeficiency syndrome (AIDS). This disease increases your chances of getting serious infections that people normally can resist. The most common one is caused by a parasite called Pneumocystis carinii, which causes a kind of pneumonia that is hard to treat. People with AIDS are also more likely to develop certain cancers, such as Kaposi's sarcoma. This cancer is usually limited to the skin, but may become widespread in AIDS patients, affecting the skin, lymph