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Liver disease patterns in hemodialysis patients with antibodies to hepatitis C virus
C Caramelo1, A Ortiz, B Aguilera
1Servicio de Nefrología, Fundación Jiménez Díaz, Universidad Autónoma, Madrid, Spain.
Insights
In hemodialysis patients, liver damage from Hepatitis C Virus (HCV) correlated with time since initial aminotransferase elevation, but not with diagnostic test intensity or PCR results.
Area of Science:
- Hepatology
- Virology
- Clinical Diagnostics
Background:
- Hepatitis C virus (HCV) infection is a significant concern in hemodialysis patients.
- Understanding the correlation between diagnostic markers and liver histopathology is crucial for patient management.
- Previous studies have explored serologic markers but comprehensive correlation with histopathology in this population is needed.
Purpose of the Study:
- To correlate histopathology findings with various diagnostic tests in hemodialysis patients infected with HCV.
- To assess the predictive value of serologic markers and polymerase chain reaction (PCR) for liver disease severity.
Main Methods:
- Serologic testing for HCV (ELISA 1, ELISA 2, RIBA 2) and Hepatitis B virus markers.
- Liver biopsy analysis for histopathologic patterns in HCV-positive patients.
- Polymerase chain reaction (PCR) to detect HCV RNA in plasma.
Main Results:
- HCV infection was detected in 65 of 163 hemodialysis patients.
- Histopathologic findings included cirrhosis, chronic active hepatitis, and reactive hepatitis.
- A positive correlation was observed between the time from the first aminotransferase peak and histologic damage (P=0.015).
- Liver disease severity did not correlate with RIBA 2 intensity, aminotransferase levels, or past Hepatitis B virus infection.
- Aminotransferases were normal in some patients with severe liver disease and elevated in those with mild changes.
- HCV RNA was detected by PCR in 15 of 19 biopsied patients, but PCR positivity did not reliably predict histologic severity.
Conclusions:
- Time since initial aminotransferase elevation is a significant correlate of liver histologic damage in hemodialysis patients with HCV.
- Standard serologic markers and PCR are insufficient to predict the severity of liver disease in this cohort.
- Clinical and biochemical markers alone may not accurately reflect the extent of liver damage in hemodialysis patients with HCV.
Abstract:
The present study correlated histopathology and diagnostic tests in hemodialysis patients with serologic markers for hepatitis C virus (HCV). Hepatitis C virus infection was found in 65 of 163 patients, as assessed by anti-c100-3 (ELISA 1), anti-c22-3, c33C (ELISA 2), and RIBA 2. Several histopathologic patterns were found in 33 liver samples from HCV-positive individuals: cirrhosis (n = 3), chronic active hepatitis (n = 14), chronic persistent hepatitis (n = 2), isolated hemosiderosis (n = 5), reactive hepatitis (n = 6), and others (n = 3). There was a positive correlation between time from the first aminotransferase peak and histologic damage (P = 0.015). However, the severity of liver disease did not correlate with the intensity of RIBA 2 positivity, mean levels or pattern of aminotransferases elevation, or markers of past hepatitis B virus infection. Moreover, aminotransferases were persistently normal in three patients with severe liver disease and were elevated in 10 patients with only mild changes. In 19 biopsied patients, the presence of plasma HCV RNA was examined by the polymerase chain reaction (PCR), which was positive in 15 of the 19 biopsy specimens. The ability of PCR positivity to predict the histologic severity of the disease was insufficient: four patients with minor liver damage had positive PCR and two patients with significant liver damage had negative PCR. No further correlations of PCR positivity were found with the other biochemical or immunologic markers of HCV infection.(ABSTRACT TRUNCATED AT 250 WORDS)