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Hepatitis C virus infection in chronic haemodialysis patients, a clinicopathologic study
1Department of Medicine, King Faisal Specialist Hospital and Research Centre, Riyadh, Saudi Arabia.
Insights
Hepatitis C virus (HCV) infection is common in chronic hemodialysis patients, affecting 40.4% in this study. Early HCV infection may be missed by relying solely on antibody detection.
Area of Science:
- Nephrology
- Hepatology
- Infectious Diseases
Background:
- Chronic hemodialysis patients are at risk for infections.
- Hepatitis C virus (HCV) poses a significant health concern in this population.
Purpose of the Study:
- To evaluate the prevalence of HCV infection among chronic hemodialysis patients.
- To assess the relationship between HCV infection and clinical/laboratory markers.
- To investigate the diagnostic limitations of anti-HCV antibody testing.
Main Methods:
- Prospective evaluation of 52 hemodialysis patients.
- Monthly screening for anti-HCV antibodies, liver enzymes (ALT, AST), iron, and ferritin.
- Quarterly screening for HBV, CMV, EBV, and HIV markers.
- Liver biopsy analysis for hepatitis classification.
Main Results:
- HCV antibodies detected in 40.4% of patients.
- Significant association between anti-HCV positivity and blood transfusion history (P<0.05).
- Elevated liver enzymes were more frequent in anti-HCV positive patients (P=0.01).
- Liver biopsies revealed chronic hepatitis in all evaluated patients.
Conclusions:
- Hepatitis C is prevalent in chronic hemodialysis patients.
- Anti-HCV antibody testing alone may miss early or past infections.
- Comprehensive viral marker screening and clinical evaluation are crucial for accurate diagnosis.
Abstract:
Fifty-two patients on regular haemodialysis at our institution were evaluated for the presence of HCV infection. Evaluation included detailed history, clinical examination, and monthly screening for anti-HCV antibody, liver enzymes (ALT, AST), serum iron and ferritin. Also, three-monthly screening for other viral markers, HBV (HBsAg, HBsAb, HBcAb), CMV (IgG and IgM), EBV, and HIV. Anti-HCV antibody was found in 21 patients (40.4%). There was a significant (P less than 0.05) relationship between presence of anti-HCV antibody and proportion of patients who received blood transfusion. During a 12-month follow-up, four (11.4%) patients seroconverted to be Anti-HCV positive while one case (4.8%) seroconverted to be anti-HCV negative. The frequency of elevation of liver enzymes was significantly higher in Anti-HCV positive cases (14/18) than in negative cases (11/28, P = 0.01). Evaluation of liver biopsies of 13 patients showed chronic persistent hepatitis in six and chronic active hepatitis in seven cases. We concluded that hepatitis C is a common problem among chronic haemodialysis patients at our institution; HCV infection is documented in 70% of all clinically diagnosed NANB hepatitis. Presence of anti-HCV antibodies cannot differentiate between active and past infection and cases with early HCV infection can be missed when relying on the mere detection of anti-HCV antibodies.