Hepatitis C Virus Infection and Hepatic Function in Chronic Hemodialysis Patients

There is little information about the serologic survey for control of hepatitis C by using third-generation assays among chronic haemodialysis (HD) patients, and no analysis of costs has been made to this end. A serologic survey for control of hepatitis C was performed in 190 HD patients attending a single dialysis unit, using second- and third-generation assays. Costs of both serologic surveys were calculated. Anti-HCV prevalence tested by third-generation assays increased from 25% (48/190) to 28% (53/190) compared to second-generation testing; 56% (9/16) of patients showing uncertain findings by second-generation tests gave unequivocal results by third-generation assays; median duration of HD treatment and raised aminotransferase levels were positively associated (P = 0.004 and P = 0.012, respectively) with anti-HCV detected by third-generation assays. The serologic survey for control of hepatitis C in HD patients at our centre was slightly more expensive by third-generation assays compared to second-generation testing (US$18866 vs US$17200 per year). In summary, the use of third-generation tests largely clarified the uncertain results of second-generation tests; new additional positive patients were detected by third-generation assays compared to second-generation testing. Third-generation assays showed the association of duration of HD treatment and raised aminotransferase levels with anti-HCV antibody, as previously found by first- and second-generation assays. To date, third-generation screening and confirmatory assays seem extremely useful in the serologic survey for control of hepatitis C in HD centres without a considerable outlay.

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“…HCV infection by first-and second-generation assays in our HD patients were previously studied [6,10].…”

Section: Methodsmentioning

confidence: 99%

Serologic survey for control of hepatitis C in haemodialysis patients: third-generation assays and analysis of costs

Fabrizi¹,

Lunghi²,

Raffaele³

et al. 1997

Nephrology Dialysis Transplantation

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“…First-generation (ELISA-1) detect antibody to the recombinant antigen c100-3, a recombinant polypeptide expressed from the portion (NS4) of the viral genome encoding non-structural proteins. A prevalence of anti-HCV antibody between 1.32% and 36% in chronic dialysis patients has been seen by numerous investigators with the use of first-generation tests (12)(13)(14)(15)(16)(17)(18)(19)(20)(21)(22)(23).…”

Section: Serological Diagnosis: Screening Testsmentioning

confidence: 99%

Diagnostic Workup of Hepatitis C and the Patient on Maintenance Dialysis

2001

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“…Once first-generation enzyme-linked immunosorbent assays (ELISA) to detect specific antibody to hepatitis C virus (HCV) became available, the high prevalence of HCV infection among chronic hemodialysis (HD) patients became apparent [1][2][3][4]. With the introduction of second-generation [5][6][7][8][9][10][11] and third-generation [12,13] ELISA testing, the number of anti-HCV-seropositive patients in this population increased.…”

Section: Introductionmentioning

confidence: 99%

Detection of de novo Hepatitis C Virus Infection by Polymerase Chain Reaction in Hemodialysis Patients

Fabrizi

Martin²,

Dixit³

et al. 1999

Am J Nephrol

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Patients on chronic hemodialysis (HD) treatment have been identified by serological testing, including second- and third-generation enzyme-linked immunosorbent assay (ELISA), as a high-risk group for hepatitis C virus (HCV) infection. Previous studies have shown that de novo cases of HCV may occur in HD units in the absence of other parenteral exposures, which suggests the spread of HCV between patients. In addition, the reverse-transcription polymerase chain reaction (RT-PCR), which directly detects HCV virus, has identified HCV infection in chronic HD patients who are seronegative. The aim of this study was to determine the incidence of HCV infection detected by RT-PCR technology in a large cohort of chronic HD patients. One hundred and twenty chronic HD patients, HCV-negative by serological assays (second-generation ELISA) and molecular techniques (branched DNA and RT-PCR), were observed for a mean period of 9.5 months. They were tested monthly for serum alanine aminotransferase levels (ALT) and by second-generation ELISA. At the end of the follow-up period, they were again evaluated by branched DNA and RT-PCR testing. HCV RNA was detected in patients’ sera by RT followed by PCR using two separate primer sets from the 5′-untranslated region of the HCV genome. Southern blot was performed using a digoxigenin-labeled probe. Two patients who had HCV RNA detectable by RT-PCR at the end of the follow-up period remained branched-DNA-negative. Thus, the incidence of de novo acquisition of HCV infection in the current investigation was 2.1% per year. In 1 patient RT-PCR positivity and anti-HCV ELISA seroconversion occurred. The 2nd patient remained anti-HCV ELISA-negative, although viremic. In both patients, the onset of positivity by RT-PCR was associated with a rise of ALT levels into the ‘abnormal range’ in our laboratory. In these 2 patients, de novo acquisition of HCV infection was observed in the absence of obvious parenteral risk factors other than their presence in the HD environment. In conclusion, de novo acquisition of HCV infection may be undetected by ELISA and branched-DNA assays. The need to monitor chronic HD patients by serial ALT testing is emphasized. RT-PCR shoud be incorporated into diagnostic testing for HCV infection in chronic HD patients. RT-PCR technology can identify HCV in HD individuals with raised ALT activity.

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Hepatitis C Virus Infection and Hepatic Function in Chronic Hemodialysis Patients

Cited by 7 publications

References 3 publications

Serologic survey for control of hepatitis C in haemodialysis patients: third-generation assays and analysis of costs

Serologic survey for control of hepatitis C in haemodialysis patients: third-generation assays and analysis of costs

Diagnostic Workup of Hepatitis C and the Patient on Maintenance Dialysis

Detection of de novo Hepatitis C Virus Infection by Polymerase Chain Reaction in Hemodialysis Patients

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