Dialysis-Membrane-Dependent Reduction and Adsorption of Circulating Hepatitis C Virus during Hemodialysis

Abstract

Background/Aims: Patients on chronic hemodialysis (HD) are often infected with hepatitis C virus (HCV), a common cause of chronic liver disease. In some cases, however, decreases in the serum HCV load after HD have been documented. To better understand this phenomenon, we investigated the effects of various types of dialysis membrane on virus load in the circulation in vivo and in vitro. Methods: HCV RNA levels in patients’ serum, filtrate and dialyzer membranes were analyzed semiquantitatively by reverse transcription-polymerase chain reaction (RT-PCR) before and after HD treatment with two to four different types of dialysis membrane. HCV RNA was also determined from each fraction in in vitro dialysis and ultrafiltration. Results: In HD patients treated with a polysulfone (PS) membrane and a hemophan membrane, the HCV RNA titer reproducibly decreased by a factor of 10^–1–10^–2. In contrast, a cuprophan (CU) membrane had no detectable effect on HCV viremia, and HD with the AN69 membrane reduced HCV RNA levels in only a subset of the patients. In addition, a PS membrane, but not a CU membrane, reduced the level of circulating HCV in an in vitro assay. In both in vivo and in vitro experiments, HCV RNA was recovered from the PS membrane itself, but not from the ultrafiltrate. Conclusions: Membrane-dependent adsorption of HCV occurs during HD, causing a transient reduction in HCV in the circulation of patients.

Hepatitis C Is Less Aggressive in Hemodialysis Patients than in Nonuremic Patients

“…Contrarily, the viral load was significantly higher in patients with normal renal function (P ϭ 0.016). Although dialysis patients have immune compromise resulting from uremia, the HCV viral load of HD patients is usually low, and this may be the result of the clearance of HCV RNA during HD, the adherence of viral particles to the dialysis membrane, or the release of cytokines (28,29). Badalamenti et al (30) found a reduction in viral load during HD associated with the simultaneous elevation of interferon-alpha levels, and concluded that this might contribute to the fact that the disease is less aggressive in dialysis patients.…”

Prevalence of hepatitis C virus (HCV) infection and HCV genotypes of hemodialysis patients in Salvador, Northeastern Brazil

“…In fact, the biological dynamics of HCV viremia is well known and the possibility that some of these HD patients have viral replication below the detection limit of PCR in serum should not be excluded (31). In HD patients, membranedependent adsorption of HCV can occur during hemodialysis, causing a transient decrease in HCV load in the circulation of patients (32). To increase the sensitivity of PCR, some investigators have suggested the application of PCR to detect HCV viremia in whole blood instead of serum (33,34).…”

Kinetics of Hepatitis B Virus Load During Haemodialysis Sessions and α-Interferon: A Prospective Study

“…Adsorption of the virus onto the haemodialysis membrane and pressure-dependent destruction could be major potential mechanisms of virus clearance during the haemodialysis procedure, as in HCV [38,39]. The synthesis of various cytokines [40,41,42] or the removal of factors required for viral production have been also cited to explain the intermittent reduction of HBV viraemia in patients on long-term HD.…”