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Dialysis Patient
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Dialysis Patient

I have a 78 year-old uncle, whom has been on dialysis three times a week for the past few years. He had stomach cancer and successful surgery to remove the cancer over 10 years ago, but his kidneys have since failed and he has problems with anemia. He was recently hospitalized to have a port cleaned and the hospital detected hepatitis C in his blood and contacted our county's public health department in Michigan, so he could have this confirmed. I have several questions, and would really appreciate the insight of your medical experience on this matter.

I have a few major concerns. Obviously, I want my uncle to get the best care possible in this situation and I also wouldn't want anyone else in the community exposed to hepatitis. It's my understanding that the illness is carried and spread through the blood and bodily fluids. I'm certain that the transmission in this case was not through sexual contact. In fact, from my very limited understanding (this is all new to me) I can't see any possible transmission other than through the medical treatment he has been undergoing. Is it possible that the hepatitis was contracted in the dialysis unit, and could this pose a threat to other people in the unit? If that's a possibility, I assume (hope) the county will pursue this, but is there anything we can do to make sure this happens and noone else is possibly exposed?

Secondly, I understand that the course of the illness is variable for each individual. However, given his poor general health and age, is it likely that the illness may have a quicker and harsher impact on my uncle?

Finally, given his age and health condition as it is outlined above, could you give me any idea on how future treatment/management might proceed? I understand some of the drug treatment is quite harsh, especially for the elderly, and a transplant would be out of the question here so what are some options that might be left for this tricky situation?

I am grateful for your time on this and for sharing your medical expertise; thank you very kindly.
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To answer your questions:
1) The hepatitis C virus is spread by contact with blood.  As you have mentioned transmission through bodily fluids is unlikely in your uncle's scenario.  Transmission via a blood transfusion is possible.  There is also the possibility that your uncle has always harbored hepatitis C and this was the first time it was diagnosed.

2) It is true the course of the illness is variable for each individual.  The presence or history of alcohol use is a poor prognostic factor.  Any medication that affects the liver adversely will also portend a poor prognosis.  

3) The first step would be to quantify the amount of virus present, and test to determine the specific type of virus.  A liver biopsy would then likely be done to determine if there is any inflammation.  After this evaluation, a decision can be made about whether treatment is appropriate.  

Followup with your personal physician is essential.

This answer is not intended as and does not substitute for medical advice - the information presented is for patient education only. Please see your personal physician for further evaluation of your individual case.

Thanks,
Kevin, M.D.
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