Improved detection of hepatitis C virus infection by transcription-mediated amplification technology in dialysis population

Abstract

Background: Hepatitis C virus (HCV) infection remains common among patients undergoing maintenance dialysis and plays an adverse effect on survival in this population. Accurate detection of HCV viremia (HCV RNA) in dialysis patients requires a sensitive and specific diagnostic test. Methods: The Versant™ HCV RNA Qualitative Assay, based on transcription-mediated amplification (TMA) technique, was prospectively evaluated in 112 dialysis patients. Performance characteristics of the Versant HCV TMA Assay were evaluated in comparison to the Amplicor ® 2.0 HCV test based on polymerase chain reaction (PCR) technique. In addition, anti-HCV serologic tests including third-generation enzyme immunoassay and Recombinant Immunoblot Assay were performed. Results: Of the 112 specimens tested, 29 were reactive by Versant HCV TMA Assay, yielding an overall prevalence of HCV viremia of 25.9%. The concordance between TMA and PCR techniques was excellent [91% (101/112)]. Eleven specimens (10%) were invalid or equivocal by PCR due to interference phenomena; all 11 specimens had valid TMA results (2 patients being TMA reactive and 9 nonreactive). Four specimens [3.6% (4/112)] that tested PCR-negative and HCV TMA nonreactive were anti-HCV seropositive, consistent with resolved HCV infection. In the group of seronegative samples, one was reactive by TMA Assay [1.25% (1/80)]. Conclusions: The HCV TMA technology seems a highly sensitive tool for detecting HCV RNA in the dialysis population, with no evidence of specimen interference. One EIA-negative but HCV-RNA-positive patient by Versant HCV TMA Assay was identified. Prospective clinical trials are under way to assess the clinical impact related to the use of HCV TMA technology in dialysis population.

Transcription‐mediated amplification (TMA) for the assessment of viremia in hemodialysis patients with hepatitis C

“…In view of its high sensitivity and the lack of interference from agents present in the reaction, especially heparin, the TMA is a promising tool for application to patients on hemodialysis. However, only few studies have so far evaluated the use of this technique in the hemodialysis population [Froio et al, 2003; Khan et al, 2004; Kalantar‐Zadeh et al, 2005; Rigopoulou et al, 2005; Rao et al, 2010]. Two studies evaluated the use of anti‐HCV ELISA and HCV RNA testing by TMA for the detection of HCV infection in hemodialysis patients.…”

“…TMA was able to identify the presence of active HCV infection in a higher percentage of samples than PCR. More recently, Rao et al [Rao et al, 2010], comparing HCV RNA testing by PCR and TMA in hemodialysis patients, concluded that cases in which the PCR result is indeterminate due to the presence of interfering agents, TMA was able to define safely the presence or absence of viremia.…”

“…In nonuremic patients, the TMA has been used for different purposes, such as the diagnosis of viremia and for monitoring treatment of hepatitis C [Comanor et al, 2001; Kolk et al, 2002; Martinot‐Peignoux et al, 2010]. However, the use of TMA in hemodialysis patients has been less studied [Froio et al, 2003; Khan et al, 2004; Kalantar‐Zadeh et al, 2005; Rigopoulou et al, 2005; Rao et al, 2010].…”

Detection of Pathogens in Water Using Micro and Nano-Technology

“…Transcription Mediated Amplification (TMA) is a very similar (and commercially available) amplification procedure that exploits essentially the same mechanism but making use of a different type of reverse-transcriptase and thus avoids the use of RNaseH (Hill, 2001;Chelliserrykattil et al 2009;Bachmann et al 2010;Rao et al 2010).…”

The Relationship between Tumor Necrosis Factor-α Polymorphisms and Hepatitis C Virus Infection: A Systematic Review and Meta-Analysis

“…The production of inappropriate levels of tumor necrosis factor (TNF)-α, TNF-β, interleukin-10, interleukin-12, and some other kinds of cytokines are reported to contribute to viral persistence, to influence the function of liver, and to affect response to antiviral therapy. [11][12][13][14][15][16] Among these cytokines, TNF-α is a multifunctional immune modulator encoded by the major histocompatibility complex class III. It can recruit and activate macrophages, NK cells, and T cells for their effectors' functions including the production of immune regulatory and antiviral cytokines, which promote the inflammatory response of liver cells and mediate liver cell injury, or lead to the persistence of chronic inflammatory liver.…”