Hepatitis C virus infection in dialysis and chronic liver patients: Viraemia dependent anti‐E2‐antibody response

Abstract

Cryptic hepatitis C virus (HCV) infection relates to patients infected chronically with HCV that are seronegative but have HCV-RNA. These patients are not identified by the standard serological tests for HCV, which are based on detection of antibodies to core, NS3 and NS5 antigens. They will, therefore, be wrongly diagnosed as non-infected, and are considered as a potential risk for others. Cryptic HCV infection in dialysis units occurs frequently and, due to medical procedures, is a major factor for contracting the virus when unrecognised. This study was conducted in order to assess the humoral immune responses to E2-antigen in sera of patients infected chronically with HCV. Recombinant E2 protein in enzyme linked immunosorbent assay (ELISA) and Western blot (WB) were used to test the occurrence of anti-E2 antibodies in the sera of patients from the liver clinic and of dialysis patients. The presence of E2 antibodies was found to be correlated with the presence of HCV-RNA and with viral load. Antibodies to the E2 protein could be detected in as many as 30% of the sera from dialysis patients with cryptic HCV infection (HCV-RNA only). The results suggest that detection of anti-E2 antibodies may enhance significantly HCV serological standard testing; especially among patients on dialysis, and that antibodies to envelope E2 protein appear to depend on and correlate with the presence of HCV particles.

De novo HCV infection among dialysis patients: a prospective study by HCV core antigen ELISA assay

“…The occurrence of HCV RNA positive but seronegative patients is not infrequent in the dialysis population; 48 in fact, the immune compromise conferred from chronic uraemia may impair the production of anti‐HCV antibodies. Clinical studies are in progress in order to ascertain the role of HCVcAg ELISA Assay in chronic HCV‐infected patients on maintenance dialysis who fail to exhibit detectable anti‐HCV responses.…”

Utility of routine real time quantitative PCR monitoring of HCV infection in haemodialysis patients

“…This leads to undetected chronic carrier state in many individuals marked by the presence of HCV RNA and seronegative status. [18] Thus, the high HCV prevalence in HD patients in a developing nation emphasizes the need for aggressive monitoring of HD patients by PCR at regular intervals irrespective of the serological status. [19] There were 5 patients (4.06%) with equivocal serology of which 3 were positive by PCR [ Table 1].…”

Hepatitis C inflection in dialysis patients: a link to poor clinical outcome?

“…However, EIA may have inherent shortcomings in the ESRD population [80,81,84,85]. Dialysis patients with HCV infection may display undetectable HCV antibodies [62]; the false negative status could occur at the late stages of HCV infection because of the compromised immune system or effect of MICS in these patients, resulting in deficient or absent antibody response [70,86,87]. Indeed, in other immuno-compromised states such as advanced AIDS, the EIA may fail to detect HCV infection [88].…”