Diagnostic Dilemmas in Hepatitis C Virus Infection for Hemodialysis Patients

Abstract

Background: Hepatitis C virus (HCV) is a leading cause of chronic hepatitis in dialysis patients. The diagnosis of HCV infection in these patients is predominantly based on laboratory tests because of the specificity of the clinical course of the disease. Aim: The present prospective study aimed at determining very accurately the prevalence rate of HCV infection in patients on dialysis by simultaneously testing them for anti-HCV and for HCV RNA levels. Materials and methods: For the present cross-sectional longitudinal study we recruited and followed up 93 patients from St George University Hospital Hemodialysis Unit between July 2013 and December 2014. All patients were tested for anti-HCV and HCV RNA. The anti-HCV negative patients were tested for anti-HCV and HCV RNA at least twice at intervals of 6 months or more (up to 12 months). Anti-HCV antibodies were identified using a third generation ELISA assay. Commercial kits for real-time polymerase chain reaction (RT-PCR) were used to detect HCV RNA in the plasma and mononuclear cells. Aminotransferase and gammaglutamyl transpeptidase levels were studied to find if liver inflammation was present. Results: The total seroprevalence in 68 patients was 20.6% (14). Of these, 10 patients were viremic (HCV RNA+/anti-HCV+), and 4 patients (5.9%) had discordant results (anti-HCV+/HCV RNA-). Acute hepatitis was detected in one patient. Duration of dialysis in HCV viremic patients was longer than that in aviremic patients (p=0.005). Conclusions: The present study suggests that HCV infection in dialysis patients can be diagnosed more accurately if these patients are tested using two diagnostic methods - a serological test and a biomolecular assay. Further studies with larger sample size may prove the feasibility of such approach for all dialysis patients in this country.

The Micro-Elimination Approach to Eliminating Hepatitis C: Strategic and Operational Considerations

“…Nonetheless, HCV prevalence remains far higher in people receiving hemodialysis than in the general population. [48][49][50] In low-income countries, both transfusion of contaminated blood products and hand-borne nosocomial transmission continue to be major infection pathways, 13 but for high-income countries, the latter is currently the key pathway. 51 Interferon-based therapies are not well tolerated by hemodialysis patients, as reflected in treatment rates of 1 to 4% in high-income countries.…”

Heterologous Immunity between Adenoviruses and Hepatitis C Virus (HCV): Recombinant Adenovirus Vaccine Vectors Containing Antigens from Unrelated Pathogens Induce Cross-Reactive Immunity Against HCV Antigens

“…These extensive studies have also led to many surprises, which are often sidelined in the quest to finding a definitive answer to the specific questions being asked. Besides the different courses disease can take after clinical HCV exposure, there are two confirmed yet unexplained observations worth noting: (1) there is a very high false positive diagnosis of HCV when using anti-HCV antibody in patient sera as a detection method, a technique that’s used in first-line diagnostic tests around the world, and (2) there are a number of reports describing that peptides derived from HCV antigens can specifically stimulate T cells enriched from PBMCs of unexposed and uninfected individuals [9,10,11,12,13,14,15,16,17,18].…”