Lack of de novo hepatitis C virus infections and absence of nosocomial transmissions of GB virus C in a large cohort of German haemodialysis patients

Abstract

To determine the prevalence and incidence of hepatitis C virus (HCV) infections among haemodialysis patients, a large prospective multicentre trial was conducted in the German Federal State of North Rhine-Westphalia. Sera obtained from the recruited patients in two separate sampling rounds run 1 year apart were analysed for both anti-HCV antibodies and HCV RNA. HCV RNA positive samples were also genotyped by direct sequencing of an HCV core fragment. In the first and second rounds, 150 (5.2%) of 2909 and 114 (5.4%) of 2100 patients were anti-HCV positive, respectively, and 4% of individuals were viraemic. Evaluation of potential risk factors in a case-control study indicated that the factors 'foreign country of birth', 'blood transfusions given before 1991' and 'duration of treatment on haemodialysis' were associated with the risk of HCV infection. Among the 2100 patients of whom 'paired' serum samples from both rounds were available for testing, not a single 'de novo' HCV infection could be recorded. The fact that in a subset of about 20% of these patients no nosocomial GB virus C (GBV-C) transmission occurred during the observational period suggests that the lack of HCV seroconversions was not only attributable to the isolation of HCV-infected patients but also to the strict adherence to so-called universal hygienic precautions for infection control maintained in the participating dialysis centres.

Analytical Performance Characteristics and Clinical Utility of a Novel Assay for Total Hepatitis C Virus Core Antigen Quantification

“…While the trak-C assay could not detect core antigen in 10 of 90 HCV RNApositive samples obtained from German hemodialysis centers (38), its Architect counterpart correctly recognized all of these specimens with very low levels of HCV viremia. Therefore, use of the Abbott test might provide at least an interim solution for the yet unresolved issue and the still ongoing discussion in the dialysis community of the need for and advantage of supplemental HCV RNA testing of anti-HCV-negative patients on maintenance hemodialysis (3,7,9,16,40). Similar considerations could apply to other settings, including transplantation medicine, in which the availability of a sensitive immunoassay for HCV core antigen determination should also represent a valuable diagnostic benefit for the immediate resolution of peculiar serological constellations which are particularly problematic in the course of decision making (20).…”

“…These materials were available from a former study performed by our group (40) and allowed comparison of the HCV core antigen determinations by the Architect assay with those previously determined by the trak-C test (Johnson & Johnson, Ortho Clinical Diagnostics, Rochester, NY).…”

Association of HCV Core Antigen Seropositivity with Long-Term Mortality in Patients on Regular Hemodialysis

“…The estimated prevalence of HCV infection (i.e., anti-HCV antibody positive) in dialysis patients was approximately 8% in the USA [1], 5% in Germany [2] and 10% in Japan [3]. Standardized prevalence rates for anti-HCV antibody were 13-fold higher in men and 9-fold higher in women when compared with the population-based controls [4].…”

Hemodialysis of Patients with HCV Infection: Isolation Has a Definite Role

“…In the last decade, there are many studies available in the literature showing that isolation of HCV-positive patients decreases HCV seroconversion [11,12,13,14,15,16,17,18,19,20]. Brief findings of these studies are shown in table 1.…”