Hepatitis C virus infection and hepatic function in chronic hemodialysis patients

Hepatitis C virus infection among chronic dialysis patients in the south of France: a collaborative study

During the last quarter of 1992, 984 patients from 13 dialysis centers in the Provence-Alpes-Côte-d'Azur region in France participated in a multicenter cross-sectional study to determine the prevalence, the risk factors, and the clinical consequences of infection by the hepatitis C virus (HCV). Serum samples were tested for anti-HCV antibodies using second-generation enzyme-linked immunosorbent assay (ELISA). In the case of a positive result, a combination test was performed using second-generation recombinant immunoblot (RIBA) or direct detection of HCV-RNA by nested polymerase chain reaction (PCR). Collected data included the patient's age, gender, cause of the kidney disease, type of dialysis treatment, number of years on dialysis, weekly dialysis time, drug addiction, co-infection with hepatitis B virus and human immunodeficiency virus (HIV), number of kidney transplants, number of blood transfusions, and history of acute or chronic hepatitis. Chronic HCV infection was detected in 232 (23.6%) patients, whereas only 71 (7.2%) were infected by HBV. Logistic-regression analysis showed that HCV infection was associated with dialysis over a long period, numerous blood transfusions, female gender, kidney grafts, HBV infection, hemodialysis, and acute as well as chronic hepatitis. Multiple-correspondence analysis confirmed that the contamination was both transfusional and nosocomial. These results underscore the need for a strict compliance with "universal precautions" (Centers for Disease Control [CDC], Atlanta) in dialysis units and raise the question as to whether anti-HCV-positive patients should be isolated.

Detection of hepatitis C infection by polymerase chain reaction among hemodialysis patients

One hundred forty-five patients on regular hemodialysis (HD) at our institution were evaluated for the presence of hepatitis C virus (HCV) infection. Forty-three patients (29%) were found to have detectable antibodies to HCV using second-generation enzyme-linked immunosorbent and recombinant immunoblot assays. Forty positive patients (anti-HCV+) and 10 negative patients (anti-HCV-) were tested for direct detection of the HCV genome by the polymerase chain reaction (PCR). Twenty-one anti-HCV+ patients (52%) had detectable RNA HCV in plasma (PCR+). No anti-HCV- patient had viremia. In addition, we compared the 43 anti-HCV+ patients with the 102 anti-HCV- patients for duration of HD, history of blood transfusion, serologic markers of hepatitis B virus, and acute and chronic liver disease. On retrospective univariate analysis, statistically significant associations with anti-HCV+ were duration of HD (P = 0.0001), blood transfusions (P = 0.0005), co-infection with hepatitis B virus (P = 0.01), and acute and chronic liver disease (P = 0.06 and 0.01, respectively). Three significant variables (duration of HD, chronic hepatitis, and blood transfusions) of the multivariate analysis permit the classification of 65% of anti-HCV+ patients and 81% of anti-HCV- patients. In the anti-HCV+ group, when the same parameters were compared in PCR+ or PCR- patients, no statistical difference appeared. These results reveal that 52% of anti-HCV+ HD patients have HCV infection. The clinical consequences of HCV infection in that population are not characterized since no difference has been documented between PCR+ and PCR- results.

Hepatitis C infection in children and adolescents on haemodialysis and after renal transplant

Serum antibodies to hepatitis C virus (HCV) were measured in children and adolescents on haemodialysis (HD, n = 20) and after renal transplant (RT, n = 33). Seropositivity was observed in 3 HD patients (15%) and in 7 RT patients (21.2%) with an enzyme-linked immunosorbent assay (2nd generation) and a recombinant immunoblotting assay (2nd generation). HCV RNA was detected by the polymerase chain reaction in the 10 patients with anti-HCV antibodies. Anti-HCV positivity was significantly correlated (P < 0.05) with the number of blood transfusions and the time on HD. Transaminase levels were not useful for screening. This study confirms that there is a high risk of HCV infection in children and adolescents on HD or after RT. Moreover, HCV infection is closely related to the number of blood transfusions as well as the time on HD.