Hepatitis C Virus Core Antigen Test in Monitoring of Dialysis Patients

Abstract

Hepatitis C virus infection is a persistent worldwide public health concern. The prevalence of HCV infection is much higher in patients on chronic haemodialysis (HD) than in the general population. HCV infection can detrimentally affect patients throughout the spectrum of chronic kidney disease. Despite the control of blood products, hepatitis C virus transmission is still being observed among patients undergoing dialysis. Detection systems for serum HCV antibodies are insensitive in the acute phase because of the long serological window. Direct detection of HCV depends on PCR test but this test is not suitable for routine screening. Recent studies have highlighted the importance of HCV core antigen detection as an alternative to PCR. Few studies exist about the efficacy of HCV core antigen test in dialysis population. We studied the utility of HCV core antigen test in routine monitoring of virological status of dialysis patients. We screened 92 patients on long-term dialysis both by PCR HCV-RNA and HCV core antigen test. The sensitivity of HCVcAg test was 90%, the specificity 100%, the positive predictive power 100%, the negative predictive power 97%, and the accuracy 97%. We think serological detection of HCV core antigen may be an alternative to NAT techniques for routine monitoring of patients on chronic dialysis.

The Correlation between Hepatitis C Core Antigen and Hepatitis C Virus RNA Levels with Respect to Human Immunodeficiency Virus Status, Hepatitis C Virus Genotype and Interferon-Lambda-4 Polymorphism

“…It should be mentioned that the correlation between HCVcAg and HCV RNA levels was also typically high among other groups of patients with impaired immune response, including liver and kidney transplant recipients [27] and patients with end-stage kidney disease [28]. In contrast, such correlation was less consistent among immunocompetent individuals.…”

Management of hepatitis C virus infection in hemodialysis patients

“…Prevalence of HCV infection is markedly higher in patients on maintenance hemodialysis (MHD) [3][4][5][6][7] . Chronic HCV infection detrimentally affects the life quality, decreases life expectancy, leads to renal transplant rejection, and increases the mortality of MHD patients suffering from chronic kidney failure [1,5,6] .…”

“…Prevalence of HCV infection is markedly higher in patients on maintenance hemodialysis (MHD) [3][4][5][6][7] . Chronic HCV infection detrimentally affects the life quality, decreases life expectancy, leads to renal transplant rejection, and increases the mortality of MHD patients suffering from chronic kidney failure [1,5,6] . Moreover, HCV infection has been shown to increase the prevalence of renal insufficiency, defined by serum creatinine ≥ 1.5 mg/dL; the mechanisms may include the direct HCV-related renal injury and HCV-related cirrhosis with subsequent renal impairment [7] , and this will be harmful for patients who receive renal transplantation.…”

“…Thus, it was highly possible that some of the hemodialysis patients got HCV infection through this way, especially in regions with poor socioeconomic conditions, where the qualified medical staff and equipments available to treat MHD patients were very limited. In the past two decades, the sensitivity and specificity of laboratory tests for detection of HCV have improved greatly, leading to the more stringent screening of blood donors and the marked decline of new HCV infections [6,45,46] . On the other hand, the availability of erythropoietin has reduced the need of blood transfusion in hemodialysis patients.…”

“…Of note is that the anti-HCV tests may fail to detect HCV infection in 1.66% [45] to 7.2% [46] of MHD patients, because the immunocompromised status of these patients prevents them from having detectable anti-HCV antibodies [1] . So it is necessary to detect HCV core antigen by chemiluminescent assay or HCV RNA by polymerase chain reaction (PCR) in anti-HCV negative patients who are at high risk of HCV transmission [6,46] . If HCV RNA is positive, it is necessary to quantitate and genotype the HCV RNA further to provide important information for phylogenetic analysis of HCV isolates and selection of treatment strategy in MHD patients [45,50] .…”