Kinetics of hepatitis C viral RNA and HCV‐antigen during dialysis sessions: Evidence for differential viral load reduction on dialysis

Abstract

Hepatitis C infection is a common problem in dialysis units. The prevalence ranges from 3% to more than 50%. Several reports have described a variable reduction of HCV-RNA during hemodialysis treatment sessions. But so far nothing is known about the HCV antigenemia or the kinetics of the reduction of HCV-RNA and HCV antigenemia during these sessions. HCV-RNA was monitored using the VERSANT HCV bDNA assay 3.0 (Bayer Healthcare Diagnostics, Leverkusen, Germany) or the HCV-Monitor TaqMan (Roche Diagnostics). HCV antigenemia was tested by using Ortho-trac-C assay (Ortho Clinical Diagnostics, Neckargemünd, Germany). Kinetics of HCV-RNA were available in 15 dialysis sessions measured by bDNA assay and in 5 dialysis sessions measured by rt-PCR. Quantitative HCV-antigenemia was available in fourteen dialysis sessions. Not only HCV-RNA but as expected also the HCV-antigenemia fell during the dialysis session. However, while the average reduction of HCV-antigen appears steady and linear, the level of HCV-RNA seems to be stable during the first 3 hr of dialysis, and decreases rapidly during the last 2 hr. The results seem to be independent of the HCV-RNA detection method. The different kinetics of HCV RNA and HCV antigen load suggest that there are different mechanisms responsible for the reduction of the HCV antigen and HCV-RNA, respectively. Reduction of viral load during dialysis session indicates a potential benefit of dialysis in case of HCV associated antiviral therapy.

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

“…Our results are in keeping with information coming from other sources concerning HBV [18,19,20] or HCV [35]. The mechanisms underlying the intradialytic drop in HBV viraemia remain to be clarified.…”

Hepatitis C infection in hemodialysis patients: A review

“…There are two main reasons why blood for HCV RNA testing should be drawn prior to a dialysis procedure: (1) presence of heparin in the blood sample can lead to false-positive PCR result for HCV; and (2) a patient's HCV RNA level can decrease during the HD session (though it will return to baseline within 48 h). Adsorption of HCV to dialysis membrane, destruction of HCV particles during the HD session, and, rarely, escape of HCV into the dialysate are other reasons why a patient's HCV RNA could be falsely low [29] . In addition to detecting HCV RNA, HCV genotyping is also required to predict response to treatment and to specify the duration and dosage of treatment.…”

Is Hepatitis C Virus Core Antigen an Adequate Marker for Community Screening?

“…Unlike anti-HCV antibodies, serum HCV RNA is a reliable marker for the diagnosis of an ongoing HCV infection and is usually used for monitoring anti-HCV treatment. But its high cost, and the requirement for considerable technical skill and related equipment, limit its routine use in community screening (16).The HCV core antigen (HCV Ag) possibly exists in both complete HCV virions and RNA-free core protein structures and has been detected in the serum of infected individuals (8,13,20). Several HCV Ag assays developed in the last decade have been shown to have good correlation with HCV RNA assays (3,21,25,28).…”