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Hepatitis C virus infection in French hemodialysis units: a multicenter study
G Salama1, L Rostaing, K Sandres
1Laboratoire de Virologie, CHU Purpan, Toulouse, France.
Insights
Hepatitis C virus (HCV) RNA testing is crucial for hemodialysis patients, especially those with uncertain antibody results. Early detection of HCV RNA can inform patient isolation policies and improve clinical management.
Area of Science:
- Nephrology
- Virology
- Epidemiology
Background:
- Hepatitis C virus (HCV) infection is a significant concern in hemodialysis patients.
- Accurate and sensitive detection of HCV is essential for patient management and infection control.
Purpose of the Study:
- To determine the prevalence of HCV antibodies and RNA in a large hemodialysis cohort.
- To correlate HCV markers with patient bioclinical features and alanine aminotransferase (ALT) levels.
Main Methods:
- 1,323 hemodialysis patients were tested for HCV antibodies using third-generation assays.
- HCV RNA was detected using a standardized ultrasensitive RT-PCR assay, with pooled and individual sample analysis.
- Statistical analysis, including multivariate analysis, was employed to identify correlations.
Main Results:
- 16.3% of patients tested positive for HCV antibodies (anti-HCV).
- 70% of anti-HCV positive and 3% of anti-HCV equivocal patients were RNA positive.
- A small percentage (0.5%) of anti-HCV negative patients were found to be RNA positive, later developing anti-HCV antibodies and elevated ALT.
Conclusions:
- HCV RNA testing is clinically relevant for hemodialysis patients, particularly those with equivocal antibody results, to guide isolation protocols.
- The ultrasensitive RT-PCR assay with pooling is a valuable tool for HCV screening in epidemiological studies of hemodialysis populations.
Abstract:
The aims of the study were: (i) to evaluate the prevalence of hepatitis C virus (HCV) antibodies (third generation tests) and RNA (standardized ultrasensitive RT-PCR assay) in a large cohort of hemodialysis patients, and (ii) to correlate HCV markers with bioclinical features and alanine-aminotransferase (ALT) activity. Antibodies were assayed by two methods in 1,323 patients (60% men, median age 65 years, median hemodialysis duration 3 years) attending 25 French hemodialysis centers including 9 self-care units. RNA was assayed using the Cobas Amplicor 2.0 method in pooled samples from 10 anti-HCV(-/-) patients and on individual samples from the other patients. Of the 16.3% patients (range 0-44%) tested (+/+) for HCV antibodies (anti-HCV), 2.3% tested (+/-) and 81.4% tested (-/-). 70% of the anti-HCV(+/+) patients and 3% of the HCV(+/-) patients were RNA(+). Pooled analysis revealed that 5/1077 anti-HCV(-/-) patients (0.5%) were RNA(+); all 5 displayed subsequently an increase in ALT and became anti-HCV(+/+). Mean ALT was higher (multiple of normal) in anti-HCV(+/+) RNA(+) patients than in anti-HCV(+/+) RNA(-) patients (0.46 +/- 0.08 vs. 0.22 +/- 0.07, P < 0.0001) and similar in all the RNA(-) patients, whatever their HCV antibody status. Multivariate analysis demonstrated that HCV status was linked to hemodialysis duration, previous kidney transplantation and positive anti-HBc. To summarize, the determination of the RNA status of anti-HCV(+/-) patients may have clinical relevance if a policy of isolation is contemplated. Standardized ultrasensitive RT-PCR assay combined with a pooling strategy is a promising method for use in epidemiological studies.