Prospective study of hepatitis C virus infection in hemodialysis patients by monthly analysis of HCV RNA and antibodies

Abstract

The aims of this study were to (i) evaluate the prevalence and the incidence of hepatitis C virus (HCV) infection in hemodialysis patients in two different centers in São Paulo (Brazil), (ii) determine the time required to detect HCV infection among these patients by serology or PCR, (iii) establish the importance of alanine aminotransferase determination as a marker of HCV infection, and (iv) identify the HCV genotypes in this population. Serum samples were collected monthly for 1 year from 281 patients admitted to hospital for hemodialysis. Out of 281 patients, 41 patients (14.6%) were HCV positive; six patients seroconverted during this study (incidence = 3.1/1000 person-month). In 1.8% (5/281) of cases, RNA was detected before the appearance of antibodies (up to 5 months), and in 1.1% (3/281) of cases, RNA was the unique marker of HCV infection. The genotypes found were 1a, 1b, 3a, and 4a. The presence of genotype 4a is noteworthy, since it is a rare genotype in Brazil. These data pointed out the high prevalence and incidence of HCV infection at hemodialysis centers in Brazil and showed that routine PCR is fundamental for improving the detection of HCV carriers among patients undergoing hemodialysis.

Hepatitis C virus genotypes in hemodialysis patients in the Federal District, Brazil

“…However, the predominance of genotype 1, subtype 1a was also found in other Brazilian studies carried out among hemodialysis patients 1,8,10,15,16,19,23 . These data suggest that the high frequency of subtype 1a is probably a consequence of HCV nosocomial transmission in hemodialysis units.…”

“…Studies carried out in São Paulo 15,16,19 , Rio de Janeiro 3 , Belo Horizonte 7 , Recife 1 , Tocantins 23 , Goiás 8 and Campo Grande 10 have shown that genotype 1, subtype 1a, was prevalent in those patients. However, the genotyping methods employed in the majority of those studies (except in Goiás State), which were based on 5' NC region analyses, did not permit the correct identification of the HCV subtypes.…”

Hepatitis C and hemodialysis: a review

“…Moreira [39], in a prospective study, observed a 14.6% prevalence of HCV infection and an incidence of 3.1/1000 affected individuals/month, in an analysis of chronic renal patients from two dialysis centers in the metropolitan region of São Paulo, Brazil. Simmonds [40], using ELISA and 2 nd generation IB tests, performed antibody detection on 217 patients undergoing hemodialysis.…”

“…Moreira [39] observed that the monthly determination of ALT does not aid in the early detection of HCV infection. The values that were observed were within the normal upper limit for ALT in both carrier patients and non-carrier patients.…”

“…Since PCR detects RNA and indicates the presence of circulating antigen in the affected individual, it could be the technique of choice as a complementary test to serology, allowing the detection of viremia in a period prior to serologic conversion, as has been demonstrated by several studies [39].…”